House of Commons Hansard Debates for 25 Jun 1993

Mrs. Audrey Wise (Preston) : I had intended to congratulate the House on dealing with this subject in a wide context, but, having heard the speech by the hon. Member for Basildon (Mr. Amess), I feel that things have gone too far. Indeed, I begrudge every moment not devoted to the subject of the health and welfare of children. Nothing contributes more to damaging the health, welfare and happiness of children than bad housing. I will not labour the point, because others have already made it, but I associate myself with what they said.

Every week, many of my hon. Friends and I are faced with the tragedies that are acted out in homes and, in the case of those not fortunate enough to have homes, bed-and-breakfast accommodation. Many children live in the kind of homes which can only give them the message that they are well and truly animals of the lowest order, deserving of no humane consideration. The root cause is the financial pressure on councils and housing associations.

Long ago, when my grandfather stood as a Labour candidate in a local authority election, he referred to the importance of housing. It is a pity that we have to discuss the subject today in the same terms as he used.

I believe that play is for children the equivalent of work. It is certainly of the utmost importance. My hon. Friend the Member for Islington, North (Mr. Corbyn) was mocked when he suggested that it is no use telling children to play football if they have no football ground to play on, but he had a valid point. Not only do we lack sports facilities : we lack the most elementary play facilities, even for the tiniest children. Our children are often made to play in areas where they are a nuisance to older citizens.

For some time, I have looked into the problem of the general neglect of play safety, especially of bouncing castles. The slashing cuts in the Health and Safety Executive budget perpetrated by the Government notwithstanding, it should be pointed out that, had a new machine been introduced to a factory, more care would have been devoted to ensuring the safety of its users than has been devoted to the safety of those who use bouncing castles. I was involved in an intermnable correspondence which was passed from Department to Department--none

Column 609

of them knowing whose responsibility these castles were. Finally, the Health and Safety Executive emerged as the responsible body. Accidents are supposed to be reported, but nothing is done to collect the statistics without which we cannot compile our knowledge of the subject. We are talking here about serious accidents--not bruises, but broken necks and a toe in an eye. Our neglect of such matters shows how profoundly unfriendly and neglectful society is to children.

I should like to touch briefly on the experience of mothers at birth. Although there has been a gratifying reduction in perinatal and infant mortality, there is no room for complacency. Social inequality is as great as ever ; 4,000 babies' lives would be saved every year if the figures for social classes 4 and 5 were brought up to those of social classes 1 and 2. The figures come from a Public Accounts Committee report of about two years ago.

There is unnecessary trauma. An inquiry by the Select Committee on Health revealed that many mothers, when giving birth, experience unnecessary trauma and distress, and their dignity and their wishes are often disregarded in a cavalier fashion, to the great detriment of the beginning of their lives as mothers and the founding of their families. We outlined many splendid recommendations that have been taken up with alacrity by the midwifery profession in particular and by voluntary organisations, such as the Maternity Alliance, the National Childbirth Trust and AIMS--the Association for Improvements in Maternity Services. I hope that the Government will respond positively.

We uncovered an almost total lack of research into the post-natal health of mothers. If the health of new mothers is

neglected--everything from depression to backache--the life of the infants in their care will be detrimentally affected. I therefore await energetic action by the Government.

A fairly narrow issue, it may seem, although it affects many people, is the Government's proposal that there should be a limited or selected prescription list. Last Saturday, a mother came to see me and brought with her a petition. She did not know that one has to pray to this honourable House in specific, archaic language. She just wrote down her experiences and fears and collected the signatures of other people.

Although it is not an official petition, I want to share with the House what this mother wrote. She and her husband, who had never done anything like this before, collected 900 signatures. She said : "Alexandra is what would appear to be a normal, healthy, happy, six-month old baby, but unfortunately she suffers from a skin condition called atopic eczema. This form of eczema affects her in the most distressing ways, as she is unable to sleep more than two hours at one time and also requires up to eight forms of medication a day and 24-hour care. The Government is considering the removal of all types of skin medication from the NHS medical list. This would mean going without medication due to costs which cannot be met by the ordinary working family, resulting in permanent disability or full-time hospitalisation. Alexandra is one of many who will suffer if the Government is allowed to go ahead with yet another policy aimed at helpless and defenceless children. Please show your support for the future of Alexandra and many like her."

If hon. Members know anything at all about skin conditions, they should use their imaginations for about 10 seconds and consider the life of that family. My

Column 610

constituent is wrong when she says that all forms of skin medication would be removed from the prescribed list. Those that would still be available on prescription, even under the Government's proposals, would be the fiercest and most potent forms, which have to be used with the greatest discretion and whose use, especially their long-term use, should be minimised.

Those potent forms of medication must be backed up by the constant use of emollients of all kinds. It is important that they should be of all kinds. Skin sensitivities are so precise and so varied that one cannot talk about generic prescribing and thereby meet the needs of these people, many of whom are children. The lives of their families will be rendered utterly miserable, as will the lives of those children.

Miss Lestor : When I was lobbied recently by dermatologists in Salford, I discussed this very point with them. In addition to my hon. Friend's point, they referred to the fact that, in the case of children, they have to experiment with a treatment because, as my hon. Friend said, there is no one overall treatment. The Government's proposals will cause havoc and misery to families, and will be very expensive for the parents.

Mrs. Wise : My hon. Friend is absolutely right. Furthermore, new sensitivities can appear. The medication often has to be changed. There is scope for further exploration of this condition and the use of alternative therapies. More research should be done into allergies. However, none of that is a substitute for topical preparations to be applied to the skin.

The proposal is concerning professionals as well as parents. I have a letter from a health visitor in Preston, who says that she comes "across many families who have children with Eczema or similar skin complaints. These children often need many months or even in severe cases, years of treatment with Dermatological creams. The area in which I work has a very high unemployment rate and a large number of single parents, as well as people on lower wages. I feel that, if people have to pay for these essential medications, they will not seek treatment if they have not got the money to buy these creams and may try to use other substances which they can buy more cheaply over the counter, but which will not be as effective. If Eczema is left untreated it can cause a lot of ill-health by introduced infection due to scratching, misery for the child keeping it awake at night, and for parents as well as the child".

The problem is not confined to my constituency or only to poor families. I received a letter from a mother in Hampshire, who says : "My four year old daughter has severe atopic eczema and has to use a large range of emollients together with topical steroids to keep her condition under control. She has to be moisturised regularly at hourly intervals to stop her skin cracking and peeling and I am at present using 500 grams of moisturiser on her a day. He skin is very sensitive and through trial and error we have at last found the creams that suit her. Should these now cease to be available, I know her condition will deteriorate badly. She has already had a spell in hospital and it is only the constant use of these emollients that keep her out of hospital. Surely it is more cost-effective to continue to provide these valuable creams on the NHS than to take up much needed hospital beds, not to mention the extreme suffering which will be caused to the eczema sufferers and their families." I am glad that that mother chose to write to a Labour Member. I do not know what conclusion to draw from that, but I am glad that she chose to share her information with me.

Someone from London says :

Column 611

"Our four-year-old son Peter has suffered from eczema since he was six weeks old. For the first two years of his life he itched so intensely that he woke scratching several times a night and his physical and mental development was held back. In 1991 he started to see Dr. John Harper, the consultant at Queen Elizabeth Hospital for Children, Hackney"--

about which I will have more to say later--

"and also at Great Ormond Street. Thanks to the sophisticated management provided by QEH, the eczema is now well controlled, and Peter is a happy and lively little boy ... Peter regularly uses a combination of seven back oils, emollients and creams. Of these only one is proposed to remain on the Selected List. If the others are removed, we shall have to purchase them via private prescriptions at an average cost of just over £24 per week or over £1,250 per year excluding any dispensing fees charged.

Both of us hold reasonably well paid professional jobs. We would manage to find this amount, simply because we could not do otherwise--although there would be sacrifices by the rest of the family. The impact on a low-income family would be horrific. (We point out that £24 a week is three times the amount of Child Benefit Peter receives)."

I chose to read those letters because sometimes we have to let people speak directly to the House, in their own words and from their own experiences, which often are more immediately relevant than ours.

I think that the Government hope that the general public will think that skin complaints are trivial. Of course they are not life-threatening ; they are just profoundly life-damaging. A member of my family once experienced such intensive itching that she wanted to throw herself under a bus, so I can imagine what it must be like if the person affected is a baby.

I urge the Government to think again about the selected list in general, and in relation to skin preparations for allergic conditions in particular. I know that the Government have been fully briefed by the National Eczema Society. Eczema is a chronic problem, but there are other problems relating to children's intensive care needs. Hon. Members may have seen the television programme about the shortage of intensive care beds for children ; I do not intend to labour the points that it made, except to say that it reduced my mother to tears. As a great-grandmother, she imagined her great- grandchildren suffering the deprivation depicted in the programme. I hope that the programme reduced Conservative Members to tears--and, more important, spurred them to action.

One particular case that received publicity involved my own local hospital, the Royal Preston. An 11-year-old girl died of asthma, and my local hospital was one of three which could not give her the intensive care she needed. She died two miles from the Alderhey hospital in Liverpool. She lived in Cumbria ; one does not need much knowledge of geography to understand the significance of that. She was first treated at a hospital in Lancaster, but, through lack of intensive care beds, it could not give her all she needed ; nor could Preston or Manchester. If she could have been treated at the Royal Preston, she would have been in intensive care considerably before the final crisis that was reached in the ambulance. Asthma kills 2,000 people a year. It is a serious and increasing problem, and many of its victims are children. Some suffer relatively mildly, but many suffer a great deal of misery and handicap at school, for example. However, as 2,000 people a year die from asthma, it is imperative that there are sufficient beds for children, and that they are specialist paediatric intensive care beds. I have been

Column 612

appalled by the regrettable complacency in some--although not all--of the speeches made by Conservative Members today.

However, hospital beds for children represent only a relatively small part of the way in which we deal with children's health. We do not want to fall into the trap of providing a national sickness service rather than a national health service--a national health service should be a much wider concept--but, if we cannot even manage to provide a national sickness service, we are falling at the first hurdle. That failure is affecting many children.

I refer briefly to the situation in London. I do not represent a London constituency, which possibly makes it all the more appropriate for me to draw attention to the problems facing highly deprived areas not very far from the House itself. The recent specialty review gave some valuable information and made some interesting, possibly dangerous, and certainly expensive, recommendations. I shall share with the House some of the information.

The report stated :

"As might be expected there is a correlation between deprivation and high admission rates to hospital for children under 15"-- but, in the case of the very highest deprivation, there is a dip in admission rates which suggests that such populations

"might experience difficulty in gaining access to health care." The figures for London show that the two areas with the greatest levels of deprivation- -Tower Hamlets and Hackney--have lower hospital admission rates for children up to the age of 14 than less deprived areas. That is not because the reasons for hospital admissions suddenly end. Deprivation and admissiochildren do not need to go to hospital. The figures show that there is something wrong with hospital provision. Will the specialty review remedy that? The review recommends the closure of the Queen Elizabeth hospital in Hackney, and its transfer to the Royal London hospital site. The review says, however, that the Queen Elizabeth

"has a paediatric, accident and emergency service, which provides a major contribution to primary care in this locality. We heard good reports of the service provided at the Queen Elizabeth from local GPs."

I cannot understand how the report could then say :

"We recommend as a matter of priority that the services currently provided at the Queen Elizableth are transferred in their entirety to the Royal London Hospital."

The review also says :

"Since the proportion of children in the population is so high and their needs are so great, it will probably be necessary to reprovide out patient and day care facilities on or close to the Queen Elizabeth site The site development plans for the Royal London will have to be worked through carefully if children are to receive the maximum benefit from our recommendations. The impressive new unit at the Royal London hospital will not be large enough to meet all requirements."

I may be cynical, but I think that we shall get the closures and the transfers. I do not think that we shall get the re-provisions, the extensions and the maintenance of numbers of doctors and nurses which the report also recommends. I may be cynical ; there is one way to prove me wrong.

The provision is patently too low at the moment. It is fashionable to say that London is over-provided, but, in

Column 613

Hackney and Tower Hamlets, it is not over- provided but under-provided. Cynics like me should be proved wrong by lifting the provision first, by providing the extra first, and by stopping trying to use hon. Members such as myself, who are from provincial seats, as a stick with which to beat our colleagues in the deprived inner areas of London. Some of us saw through that ploy long ago.

Mr. Corbyn : I appreciate very much, as do many London Members, what my hon. Friend is saying about the health service in London. In Professor Tomlinson's proposals, consideration was given endlessly to the financial consequences to this hospital, that hospital or the other hospital. Consideration was given to the market potential of this or that hospital, and to the private sector.

No consideration was given to the problems of poverty, bad housing and homelessness throughout London, and the Government are clearly approaching the health problems of London from the wrong angle.

Mrs. Wise : I agree with my hon. Friend. The studies of London health care are inadequate and are endangering London's health service, which could certainly stand a lot of improvement. I think that we shall get the closures, but not the improved primary care. We shall get the closures to the children's sector, but not the extension of provision and the re- provision.

As a mother and grandmother, I would rather keep what I have, even if it is not first-class and de luxe, than have facilities closed and fail to have adequate re-provision.

In the atmosphere of cuts, there will not be adequate re-provision. It is a pity that, in discussing the health and welfare of children, we must focus on those children who may die for want of hospital care, or those who may suffer endless miserly for lack of something as simple as a cream with which to soothe the skin. I would rather have spoken, as some of my hon. Friends did, of the wider issues in society. There are so many respects in which our society--and in particular, the Government--let down our children.

I will conclude by referring to my constituency, and by making a point about adolescents. A few weeks ago, I received a letter from members of staff at the Royal Preston hospital about the adolescent unit of that hospital. The letter said :

"We have recently been informed that this service is to be transferred to an acute paediatric ward specialising in burns, plastic surgery and orthopaedics which will offer only four adolescent beds instead of current eight beds."

The letter says that the adolescent ward

"offers adolescent patients the facilities of their own lounge, kitchen, shower and laundry room, together with full-time supervision by trained nurses with dedicated responsibility for adolescent patients."

The staff thought that the number of beds was to be cut from eight to four. I have found out today that there is now no specialist adolescent provision at the Royal Preston hospital. Adolescents will either go to the paediatric wards or to the adult wards.

There is now no specialist adolescent accommodation as described in the letter from the hospital staff. That is deplorable. I have no doubt that the decision has been forced on the hospital by the general stringency in the health service. I am making a criticism not of the Royal Preston hospital, but of the situation faced by our

Column 614

hospitals. It is important that children are in children's wards, and that the special requirements of adolescents are met fully. I hope that, in time, we will be able to say that our society properly looks after the welfare of our children, in sickness and in health and whether they are poor or from a more fortunate background. I deeply regret that that is not the case today. We cannot make that claim, and the situation is getting worse for many children and their parents.

1.22 pm

Mr. Peter Bottomley (Eltham) : I made my maiden speech in the House in July 1975. In it I referred to how the trade unions represented the interests of those at work and in work, while the rest of us have responsibility mainly for family and domestic interests. Many in the union movement have rightly given attention to matters other than work-related interests.

It is worth noting that in 1975, the then Labour Government proposed a two- year freeze on family allowance, yet wanted to have a pay increase every six months for those in work. The problem was that inflation was running at a rate of 10 per cent. in the first six months of 1975. People were that much worse off in a short time. The control of inflation makes a great difference to those who care for dependants. That is where the issue of health and welfare of children comes in.

I would define health and welfare as trying to improve the chances of well- being and to reduce the incidence of avoidable disadvantage, distress and handicap. There is no point in thinking that either we or our children can go through life in a totally risk-free environment. We know that, even at the time of birth, a significant proportion of children suffer from congenital malformations or disabilities.

It is worth starting where Arthur and Peggy Wynn did in their analysis of pre-conceptual care. People should be aware that for a child born to a non- smoking father the chance of a severe congenital malformation is 0.8 per cent. If the father is a smoker and consumes tubes 20 times a day at 10p a time, the chances of a child suffering a severe congenital malformation rise two and a half times to 2 per cent. That is an increase in avoidable risk which people should know about.

I do not argue that everyone can give up smoking straight away. I call smoking tubing to avoid the glamorous word. I prefer to say more accurately that people buy a tube which is three or four inches long, bring it near their faces and light it up. That practice can increase the chances of severe congenital malformation by two and a half times. It should also be known that if a mother has consumed significant amounts of alcohol in the 48 hours before conception, that also has a statistically significant effect on the chances of a child being born with a handicap.

I do not want to pretend that handicap has to be life changing. People can come to terms with handicap and many handicaps are not terribly relevant to people's lives, although some are. However, the smoking and drinking to which I have just referred are, in terms of avoidable disadvantage, distress and handicap, things that people should know about.

I believe that people should be practising what I call "conception control" if they are sexually active at a young age. There would then be a greater span between the

Column 615

generations and people would move from puberty and grow up before taking on the responsibility for children at too early an age. One of the developments that I have welcomed over the past 10 years since the House began to debate family policy issues is demonstrated by the fact that The Daily Telegraph now has a weekly family supplement. As well as the more jolly things, that supplement refers to some of the more serious things in life.

I have a plea for our radio and television broadcasters. Most of us who watch television or listen to the radio are aware that, every week, there are startlingly obvious programmes about gardening which tell people, for example, "Now is the time to prune your wisteria" or "Now is the time to scratch the thatch from your grass."

When will we have programmes to help the 600,000 or 700,000 people each year who are forming a family or the 200,000 or 300,000 people who are going through family separation, divorce or break-up? What about the 1.4 million people who contribute to a pregnancy which leads to birth or the 1.4 million parents whose children reach primary school age each year? What about the 1.4 million parents whose children reach the troubled teenage period?

In addition to the soap operas, there should be opportunities, in five- minute or 10-minute bursts once a week or half an hour a month, to raise the kind of issues that parents face for the first time because those issues have been faced by generations of people before. Such coverage might help people to develop confidence and competence in the experiences that they face.

Parents are primarily involved in raising children. They determine most of the health and welfare. They improve well-being and help reduce the avoidable risks that children face. Parents are even more important than the medical and social services and teachers. Clearly, when parents can work in partnership with the professions, life becomes much better for the children. That is clearly shown by the remarkable figures produced by the national health service in relation to child immunisations.

There is a difference between the apparent Labour party position and the Government's position in respect of child immunisations. About five years ago, some 40 years after the establishment of the national health service, we woke up to the fact that we had a lower level of childhood protection against avoidable childhood diseases than there was in Zimbabwe or Beirut in the middle of civil war. We had taken our eye off the main aim of the NHS, which is to cut out avoidable or disabling disease.

Taking the figures generally, it was clear that the worst problems were in the inner-city areas. People asked whether it was difficult to set the same immunisation target for inner-city areas as for suburban or countryside areas. Although I do not want to stress this too much, at that time, some Opposition Members thought that we should set a lower target for immunisation in inner-city areas, because the problem there was more difficult.

I believe that the Government were right to say that, as the problem was more difficult in inner-city areas, there should be greater incentives to reward doctors and others. It was clear that the parents would be rewarded by the fact that their children would not fall ill. There was an incentive for doctors and practices to provide good support staff, to involve the parents and to create a culture in which parents were aware that protection was important, knew how to get it and received reminders if they forgot to come forward at the right time.

Column 616

I am not convinced that we were right to allow the school medical service or the school nursing service to die away. What we have managed to achieve in respect of the first six to 18 months of life should be extended throughout the school years. I ask the Government to consult people in the education service, the national health service and the royal colleges to see what can rightly be done at reasonable cost to try to extend the advances that we have re-established for the very young to children of primary and secondary school age as well.

There are some shocking facts in terms of the well-being of children. One is that eight is the peak age for a male child to be hit by a car in a traffic crash--not an accident, a crash. The peak age for a female is 11. That in part answers the question about the difference between boys and girls or men and women in terms of crime and so on. We give more protection to our daughters than to our sons. If we could extend protection of our sons for an extra three years, they might turn out still to have exciting, risk-taking lives but not to the ludicrous extent that so many of them get themselves killed by cars and not to the extent that they get into habits or activities out of school which lead to a life of crime for a period. It will come as a surprise to many people listening to this debate that, by the age of 30, 30 per cent. of men have been convicted of a serious criminal offence--one for which they could have been sent to gaol for six months or longer. Studies--sadly, they are not up-to-date studies ; they are not the result of a sudden crimewave--showed that 10 per cent. of 15- year-old males and 25 per cent. of males by the age of 21 have been convicted of a serious criminal offence. That is a lack of order on which we should focus.

It comes down to care and control. I have always put the emphasis on "order" rather than on "law". We bring in law to define as criminal behaviour that which is seriously anti-social or dangerous. It is the order or structure that matters.

I visited an impressive primary school--Middle Park--in my constituency, where ordinary teachers with ordinary children managed to have control and care in an assembly in which no voice was raised and in which teachers could speak to 200 or 300 people even more quietly than I am speaking now. Children from each class were rewarded for an improvement in their behaviour or for their work. They got recognition for the good things. They were treated by the teachers in a calm, quiet way. I should like that attitude to be extended to secondary schools as well. In my constituency, I recently learnt a good deal about the upbringing of three children, Georgina, Stuart and Stephen. I heard about how they have been taken along to Sunday school classes, how their parents encouraged them at primary school and at secondary school, about their weekend activities, and about Stephen and his father doing things together. I also heard from others such as a police inspector who used to go running with Stephen, who was involved in the London marathon--a very fine thing for someone approaching 18. I also heard how Stephen had worked at school and was going to qualify as an architect. I heard from ministers in the Methodist Church how the family of parents and children attended church together.

That is the kind of upbringing that many others in my constituency would benefit from. If more people had the upbringing that Georgina, Stuart and Stephen received, fewer children would get into serious trouble and we

Column 617

would certainly cut the number of those who wander aimlessly around the streets with knives--one of whom, sadly, murdered Stephen at a bus stop in my constituency about two months ago. That might be an extreme case, but one should look upon Stephen's family as a normal family--people who are capable of doing the things that hon. Members pontificate on.

I ask my hon. Friend the Minister to consider a decent response to this national year of the family. I make two suggestions. First, every three to five years--perhaps starting next year--there should be a publication across Departments on what the family policy targets are. By "family policy", I am not talking about what people should believe or what they should do with their bodies--we can get over-excited about such things ; in my 18 years in the House, no one has ever come to my surgery to ask for advice on either matter. They have come to ask for advice on the upbringing of their children and how to overcome some of the barriers which are in front of them. Those barriers are rather more in front of the poor, the underprivileged and those who have bad housing than others. The targets set in 1986 by the Department of Transport for reducing casualties have led to a reduction in serious injuries of 35 per cent. The number of deaths is down by 25 per cent., although traffic has increased by about 30 per cent. Such targets have worked in child immunisation and casualty reduction and can work in other areas such as education. Targets can be specified in health, the Home Office and housing.

I ask my hon. Friend the Minister to consider setting up across Europe a framework for cohort studies, perhaps with European Community help. The child cohort studies were the ones that gave us the first clue to the impact on child development of mothers smoking.

With a basic framework, all European countries in the Community--and perhaps some outside--could co-operate to set up a new cohort study every seven years and provide framework funding so that we can carry out further analysis as people go forward. That would be a positive approach--it would not require a directive, but could show co-operation.

As a final European point, the House knows that 20 children a year die unnecessarily on our roads because we refuse to move to common European time. Obviously, there is some risk to children going to school in the mornings, but there is a much greater risk to children coming back from school and during the hours when they are playing. There would be the same number of hours of daylight, whether we had common European time--as I call it--or double summer time and we moved to an hour earlier in winter, instead of Greenwich mean time. The number of deaths and the number of serious and slight injuries are predictable. The work has been done by the Transport Research Laboratory. The gain in Scotland is as great as, if not greater than, the rest of the United Kingdom.

If there is any other field of public policy where we knew that we were condemning 140 people to death because we could not bother to apply common sense as a result of some political failure, we would change smartly and the newspapers would be right to criticise if we did not. I ask the newspapers to start examining the issue of

Column 618

the 20 children and 120 adults who will die unnecessarily this winter because we cannot move to common European time. We should start to have that sort of rational approach which leads to great benefits to our children in terms of their health and welfare. 1.37 pm

Mr. Malcolm Wicks (Croydon, North-West) : It is a pleasure to follow the hon. Member for Eltham (Mr. Bottomley) because we worked together for a number of years when he chaired the Family Forum and I was at the Family Policy Studies Centre.

I shall outline some of the key trends and issues relating to the themes in this debate on health and welfare as they affect families with children in the United Kingdom. I shall outline some trends that are associated with insecurities and new needs. We always need to balance that with a recognition that some of the new trends and emerging family developments are associated with strengths. I can remember the hon. Member for Eltham talking about backing the sense of competence and confidence of families. We need to do that. When we discuss family life in Great Britain or read about it in our newspapers, it is as though the trends are pointing in a downward direction and we ignore some of the strengths. We always look back to the golden age of the family--I suspect that the historians among us would say that it never existed. The remarkable capacity of the British to be optimistic only about the past is something which we need to question. I am as interested in the strengths in family life as in its weaknesses.

We need to understand the major changes that now affect societies like our own--I include the European family, because the trends are not restricted to our own shores. Those of us who are interested in family policy and in relating matters about health and welfare to a wider policy agenda affecting employment, law and order, housing and many other matters must understand the force of some of those changes. Some of them are remarkable in terms of their scale and development over a relatively short period.

Let us recognise that more and more of our children are born to people who are not formally married. The increase in the proportion and number of children born outside marriage is demographically significant. It may have social significance, too. We need to understand it. Back in 1981, just 13 per cent. of our children were born outside marriage, most to single mothers. Today, almost one in three children--32 per cent. at the end of 1992--are born outside marriage. The change that has taken place is that, although many of those children are still born to single mothers, about half are born to cohabiting couples. The increase in cohabitation has taken place throughout Europe. The level of cohabitation is high in Scandinavian countries, but it is on the march throughout Europe. It is of social significance. As someone who is interested in analysing such issues and examining data, I worry that we know too little about that trend.

I am pleased that my former research institute, the Family Policy Studies Centre, will soon publish a report funded by the Rowntree Foundation on cohabitation and its significance for social policy. We do not know much about the trend and its significance. If the children born outside marriage --whether to cohabiting couples or to single mothers--were as secure and had the same needs as

Column 619

those born to the more conventional families, cohabitation would be a matter of interest only to theologians, churches and so on. It would have no social policy implications. At present, we do not know the answer to the question whether the life chances of children born to cohabiting couples are any different from those born to conventional married couples.

We rely to a great extent on the official collection of data on matters such as the number of marriages and the number of divorces for our social analysis. Therefore, let us recognise that our official statisticians are not capturing many emerging family patterns. If a couple cohabits and the relationship breaks down, with consequences for the children, by definition that is not captured in statistics on divorce because if the two people were not married in the first place, they do not divorce. We all get excited about the number of divorces every year and whether it has risen a little or fallen a little. Let us remember that that statistic captures a smaller proportion of the picture of family breakdown than it did a generation or even 10 years ago. That is significant.

The importance of cohabitation has increased. More couples choose to have a child before marriage. Most of the couples go on to get married. In older generations, of all the things that one did, one got married first. Certainly in Scandinavia, and to some extent in Britain, marriage is the thing that people do at the end of the process. The Swedish demographers tell me that a couple may have one child and then get married when the second child is on the way or the first child goes to primary school.

Although many pundits deplore the decline in the popularity of marriage, the remarkable thing sociologically is that marriage is still so popular. Most of the material and legal advantages of marriage have disappeared-- although not all of them. Yet by the year 2000, seven out of 10 people will probably still get married. That is the interesting factor which has policy implications.

As we all know, marriage is an increasingly risky institution and occupation. Of new marriages taking place in the late 1980s and early 1990s, 37 per cent. will end in divorce. The proportion seems to be increasing. The significance of that to today's debate is clear, because most of the marriages that break down will involve children under the age of 16. That is a worrying factor. Every year, approximately 160,000 children in Britain see their mum and dad divorce. The risk of a child under the age of 16 having divorced parents is about one in four.

I urge the House to examine those trends carefully. In 1969, for England and Wales, and a few years later for Scotland, the House decided to legislate for easier divorce. Personally, I have no quarrel with that decision, but I doubt whether the House was able to think through the social, psychological and economic implications of its decision for so many of our children.

The evidence that is emerging increasingly proves that divorce can be an economic and emotional disaster for adults and children. I am not pleading that the clock should be put back and the law changed--far from it--but we should recognise that the social revolution in family life has not been bloodless. It has had calamitous consequences for women and children in particular, although I know that men, too, have been adversely affected. Although many one-parent families have been created by divorce, many result from the rise in single parenthood.

Column 620

The economic consequences of that are obvious. Surely it is worrying that as many as seven out of 10 such families are dependent on income support. Of all one-parent families, 85 per cent. will spend some of their lives on income support.

If I were Chief Secretary to the Treasury--I doubt whether that will happen for a while--and I were undertaking a review of public spending, I would not have started at the end of the process. There is no point in asking why we are spending so much now and what we can get away, politically, with cutting. I would start at the beginning of the story and I would try to understand why more and more of our people and families with children are becoming socially insecure. I would ask questions not about social security benefit but about employment, training and child care. I would ask how we can create socially secure families. If I were serious about cutting spending on social security, that is where I would start. Perhaps the Government will prove me wrong in showing that they have had the wisdom to start at the beginning of the story. That is always a useful place to start.

Divorce and the rise in the number of one-parent families have produced more socially insecure children. There was a time when some people wanted to hope that the great social revolution of family change was having no calamitous consequence. However, research from my former institute, the Family Policy Studies Centre, shows that on a range of indicators, based on longitudinal survey data, children in one-parent families do less well than those in intact ones. That is clear whether one is studying data on the numbers who acquire educational qualifications, on those who leave school early at 16, on those who form a cohabiting relationship or on those who have a child while still a teenager.

It would be good to debate the balance of reasons for that disparity, which range from material and economic disadvantages, which I would stress, to the psychological and emotional difficulties of bringing up a child single- handedly. I would certainly lay stress on the sheer difficulty of doing that. I sometimes think that debates between ideologues about one or two- parent family life should give way to a new movement for three or four- parent families ; the costs and strains are now so immense that the more parents a child has, the better!

Today, between one in five and one in six of our children are brought up in one-parent families. Life is tough, emotionally and psychologically, for many of them. Those children are more likely to leave home early because of family break-up. Life is also very tough materially and financially. Those difficulties should be one of the major issues on our future social policy agenda.

The political right use the term "dependency culture". As a relatively new Member of the House, however, I am struck by the number of people in one- parent families who come to see me at my advice surgery who, for want of other opportunities, or for want of realising that they exist, are totally dependent on the state. Life is not good in such circumstances. If all that people can look for is more money from the income support system--goodness, they need it--or a slightly better flat in a local authority tower block, life is tough. If we are to offer hope to so many children we need a new agenda on training and employment.

Another significant change that we need to consider is in the pattern of work and family life. We now have almost contradictory trends--the rise of mass unemployment

Next Section

Home Page