The principle of early intervention encourages a holistic approach to meeting the needs of children and families, including though play, learning, social relationships, and emotional, psychological and physical wellbeing, along with health, nutrition, growth development and

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safety. Evidence has highlighted that this early part of the child’s life between conception and the age of two is a formative period in all spheres of their development. Although there is little narrative memory of this period, a child’s experiences from this time impacts upon their cognitive, social and emotional functioning and in turn their relationships, behaviour, educational attainment and opportunities throughout the course of their life.

In this regard, “The 1001 Critical Days” manifesto highlights evidence from international studies that demonstrate that when a baby’s development lags behind the norm during the first years of their life, this gap tends to increase over subsequent years rather than to improve. Prior to being elected, I was employed in the NHS as a clinical psychologist and, in the various areas where I worked, I have seen at first hand the long-term impact of adverse childhood experiences on development and on later life chances.

A lack of parenting skills can be a product of intentional or non-intentional conduct by carers, and it is recognised that the period between pregnancy and the first years of a child’s life is a time of great vulnerability. Secure attachment and nurture are crucial to children’s emotional wellbeing and development, and it is important that parents who lack confidence in their abilities or who are struggling should have access to the support, mentoring and skills building opportunities that they need. Parenting skills classes have therefore been rolled out across Scotland.

Babies are disproportionately represented in the child protection system and statistically more likely to die prematurely than older children. In addition, any neglect or abuse occurring during this period can have life-changing effects, owing to infants’ bodies being fragile and their brains being at a crucial stage of their development. Because of the additional pressures of parenthood, parents are also at risk of perinatal mental health problems and of coping difficulties during this period. Individual, social and environmental factors can have an impact in this regard.

However, as well as being a time of vulnerability, this period of a child’s life is also a time of great opportunity when it comes to providing support and changing patterns. In this regard, I note it has been reported that during pregnancy and the first year of a child’s life is an ideal time to work with families, as it is a time when parents are particularly open to support and motivated to change, and when firm foundations for family life can be established. There is a growing body of evidence that intervention in early life can transform the lives of babies and of their parents.

“The 1001 Critical Days” manifesto states that it aims for every baby to receive sensitive, appropriate and responsive care from their main care givers in the first years of life, with more proactive assistance from the NHS, health visitors, children’s centres and other public bodies that are engaged in a coherent preventative strategy. My own experience tells me that additional monitoring and early assessment does not happen often enough in cases where there could be developmental disorders such as autistic spectrum disorder. That can have a negative effect on children, as well as on their parents, who might find it difficult to cope and therefore require additional support at an early stage. Early assessment of developmental disorders can ensure that the right resources are swiftly put in place, which will improve a child’s chances and their adaptation.

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Our party agrees that the early years are a crucial time for development and intervention because, when it comes to breaking the cycle of inequality, we recognise that prevention, resources and support are key. Throughout our time in government in Scotland, we have promoted an early years framework and been committed to strategies aimed at promoting and facilitating a stable and nurturing environment for children. In recent years, the Scottish Government have developed and introduced legislation in the form of the Children and Young People (Scotland) Act 2014, which gives Scottish Ministers and public bodies a legal requirement to issue reports on how they take the United Nations convention on the rights of the child into account. It also extends free pre-school provision from 475 to 600 hours a year of early learning and childcare for all three and four-year-olds and for just over a quarter of all two-year-olds—those from low income households. It also gives children and young people access to a named person service. In the early years, that is the health visitor. The named person is a single point of contact who can help to co-ordinate support and advise families, and those working with them, when required. This can involve the monitoring of emerging perinatal mental health difficulties.

In 2010, through collaboration with a wide range of experts, the Scottish Government also launched their pre-birth to three strategy, based on four main areas: the rights of the child; relationships; responsive care; and respect. Those strategies are not all-encompassing, and there is room for continued improvement. However, the Scottish Government understand the importance of the early years of children’s lives and the benefit to society as a whole of trying to prevent future issues through early intervention. A child’s sense of interaction with the world develops at this time, alongside its learning of emotional regulation and well-being, and the development of its neurological functioning. As such, we are committed to continuing to make early years the key priority it deserves to be, focusing funding accordingly and trying to ensure that all children have the best start in life possible.

My party will work collaboratively across this House to ensure that in Scotland and across the UK children have the very best start, which they deserve. I am impressed and pleased that we have guidelines from the all-party group on foetal alcohol spectrum disorder and I am happy to share those with the Scottish Government and to look at key recommendations.

In finishing today, I would like to thank sincerely all of the House staff for their extraordinary efforts this year. I wish all Members of the House, the House staff and of course, you, Madam Deputy Speaker, a very merry Christmas and a happy new year from my party.

4.31 pm

Justin Madders (Ellesmere Port and Neston) (Lab): First, I commend and congratulate the hon. Members for East Worthing and Shoreham (Tim Loughton) and for Dwyfor Meirionnydd (Liz Saville Roberts) on securing this debate. I also pay tribute to the members of the all-party group for conception to age two—the first 1001 days for developing the manifesto and raising the profile of these important issues. All the Members who have spoken today have done so with great eloquence on these issues.

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Let me go through some of today’s contributions. The hon. Member for East Worthing and Shoreham, in his opening remarks, correctly said that this is about challenging the mindset and going beyond the troubled families programme, which has proved to be a success around the country. He rightly highlighted the shocking statistics on suicide among new mothers and rightly said that much of it is preventable. He gave us a volley of statistics and they all point towards this manifesto as being something on which there should be widespread agreement, and I think that agreement has been apparent from today’s contributions.

It was also a pleasure to hear from my hon. Friend the Member for Nottingham North (Mr Allen), whose work in this area I was a keen reader of before entering this place. I was glad to hear his contributions today. He rightly said that this is about investment in individuals, that a consistent approach has to be taken across changes of Government and that this is about a philosophy in the way we do things. He made an interesting point when he said that, if we proposed spending £17 billion on an early intervention programme, we may have a little difficulty in getting that past the Treasury, but that is actually the potential saving that might be realised if this is done correctly. Of course, this is about so much more than simply making savings. He said that early intervention should mean that late intervention is consigned to the dustbin of history, and we would all welcome that.

Mr Graham Allen: Like the hon. Member for East Worthing and Shoreham, and many others who spoke, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), I did not have a chance to speak about a broad policy area in this field—social investment. There is now a way of monetising and finding out how much we can save ourselves, and the many social instruments and social investments out there are growing by the day. I hope my hon. Friend will consider that in his remarks, because massive savings can be made in this area—indeed, money can be made in order to reinvest in new services.

Justin Madders: I am grateful for that intervention, and my hon. Friend is right to say that this can be monetised. I recall that when my local authority carried out an examination of the early intervention scheme a figure of about £100 million was mooted. There are challenges in getting different Departments to buy into that, because they are all quite protective about their own sources of money, but if we take a holistic approach, we can see that there will be savings right across Departments. I hope that we can begin to develop that approach.

The hon. Member for Congleton (Fiona Bruce) rightly highlighted the staggering and shocking statistics about alcohol intake during and indeed before pregnancy, and rightly said that a clear message needs to be sent out about the risks. She rightly paid tribute to the work of my hon. Friend the Member for Sefton Central (Bill Esterson) with his all-party group on foetal alcohol spectrum disorder. The group took a great deal of evidence in preparation for its report, which has been released today. It is unambiguous in its recommendations about the need for clear and consistent advice to be

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given on the dangers of alcohol during pregnancy and the need to improve training and education across the board. He has laid down a clear challenge for the Minister in this area and I look forward to hearing what his response will be.

The hon. Member for Foyle (Mark Durkan) spoke with his usual passion and sincerity on the subject. He gave us the memorable phrase, “What happens in our early years stays with us throughout our years.” I am not sure what he meant about the goings on in Las Vegas. Perhaps he will enlighten me outside the Chamber. He rightly pointed out the academic research that is set out in the manifesto. Clearly, an evidence-based approach is welcome, because the evidence is there and it is clear.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) spoke with great personal experience on this area. She rightly pointed out that early experiences can affect a child’s relationships throughout their lives. We have heard from a number of Members about how difficulties in relationships can perpetuate the cycle of despair that we currently see and have been discussing today. She made a valid point about early assessment of development disorders, especially autism. At the moment, that assessment does not happen quickly enough. She also talked about this idea of a named person being the point of contact for the families, and saw it as a positive development. I am certainly aware of a number of similar initiatives that have shown the benefit of such an approach.

We have had a great many informed, respectful and consensual contributions today. I will try my best in this season of goodwill to maintain that. I am speaking here as a member of the shadow Health team. The NHS is really where my focus is. It was first conceived to be a responsive treatment-based service that supports everyone in society from the cradle to the grave. It is only in recent years that we have begun to understand how that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a newborn baby’s life will be.

I will keep my remarks quite brief as we have been squeezed out by other business today. Let me just touch on a few areas that highlight why this period is so vital and a few areas where we should be doing a little better.

As we know, the manifesto takes its title from the period from conception to age 2 when a baby’s brain is developing at its fastest. We know that the earliest experiences have a lifelong impact on mental and emotional health. We also know that, when a baby’s development falls behind the norm during the first years of life, rather than catch up with those who have had a better start, they are actually more likely to fall even further behind in subsequent years. More than a quarter of all babies in the UK are living in complex family situations that present heightened risks to their well-being. The sad reality is that babies are far more likely to suffer from abuse and neglect and up to seven times more likely to die in distressing circumstances than older children. We have a duty to give every child an equal opportunity to lead a healthy and fulfilling life.

“The 1001 Critical Days” manifesto is the best chance for us to make that happen. Not only is it the right thing to do for our children, but it is the right thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early years intervention can yield a

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return on investment as high as 6% to 10%. My hon. Friend the Member for Nottingham North eloquently showed how that could be translated into significant savings across Government.

Mr Allen: I sense that my hon. Friend may be coming to the end of his remarks, so I am going to squeeze in one more intervention, if I may, and it is in respect of the next Government. There may be a change of Government in 2020. My hon. Friend has an opportunity to spend some time developing an early intervention philosophy across, as I mentioned, not only health and children’s services, but the economy and even international affairs. That preventive view, rather than attempting to cure, could be fundamental to the next Government, as it should be and increasingly is to the current Government. Will he give us an assurance that this will be in his thoughts as he develops policy in his area?

Justin Madders: I thank my hon. Friend for his intervention. I am certain that I will be able to take those comments on board. As I said, it is a subject in which I took an interest before I entered this place. I believe that is the right approach and I am confident that in four and a half years’ time we will have the opportunity to put it into practice. [Interruption.] Some may disagree about that. In the season of good will, a little latitude is surely permissible.

If it is done in the right way, early intervention can save money, save lives and improve the well-being of parents and children. The former Scottish Health and Finance Minister Tom McCabe summed it up perfectly when he said,

“We have heard evidence, stacked from the floor to the sky, that this is the right thing to do.”

Focusing on the first 1001 days is not just about ensuring the healthy development of future generations of children, but about making our NHS and many other public services sustainable.

I want to say a few words about perinatal mental health, as I know this is an issue that many Members feel passionately about, not least the shadow Minister for mental health. Perinatal mental health problems affect up to 20% of women at some point during pregnancy or in the year after childbirth. We heard from the right hon. Member for North Norfolk (Norman Lamb), who pointed out the impact not only on the mother, but on the child and the wider family. About half of all cases of perinatal depression and anxiety go undetected and even those that are detected fail to receive evidence-based forms of intervention. This is important because severe perinatal mental health problems are bad not only for the women affected, but for the development of the children involved, as the right hon. Gentleman highlighted.

In particular we need to ensure that all women affected have access to appropriate treatment, and that variation in access is addressed. The right hon. Gentleman referred to a map which starkly highlighted that. It is worrying that 41% of maternity units have no access to a trained mental health worker, 30% are unable to offer psychological support, and on a wider but connected issue, about a third have no overnight accommodation. It is also regrettably the case that under this Government there has been a reduction in the number of specialist in-patient mother and baby units. The Government’s pledge to spend £15 million on perinatal mental health was extremely

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welcome, but we need to see that pledge put into action. I would be grateful if the Minister could update the House on what he has been doing in that respect.

We will tackle the problems that parents and children might have in this period, and spot the problems early enough, only if we have joined-up multi-agency working between health services and local family support services. Children’s centres have a critical role to play in this mix in many areas. As a former member of the advisory board of the Stanlaw Abbey children’s centre in my constituency, I have seen at first hand what a welcoming and safe place it is for families to visit, as indeed are all children’s centres. In addition they have a wealth of experience and knowledge, and trained staff who have the skills to identify problems at an early stage, whether in bonding, the mother’s mental health or child development, so that that disadvantage can be tackled.

I have heard from Stanlaw Abbey the great strides made by children coming into the centre and how much progress they make, as well the support given to the parents, many of whom have re-entered education and the world of work, thanks to the help of the centre. The one challenge that continually remains, though, is how to engage with those families who do not come through the door. We know that they are out there. They will not all need support, but some will, and despite extensive efforts to reach out to these families, they simply stay outside the system for too long, missing out on the crucial support that this debate is trying to highlight.

For me children’s centres have to be the cornerstone of a successful early years policy. That is why it is so concerning that under this Government we do not appear to have any strategy for children’s centres. The Prime Minister famously promised to protect such centres, but there are 700 fewer designated children’s centres than there were in 2010.

Alongside that, many of the local government services that families used to rely on are taking a massive hit. The transfer to local authorities in October this year of the healthy child programme for children up to five years of age presents an important opportunity for local authorities to integrate health, education, social care and wider council-led services and to focus on improving outcomes for children from birth. But I find it difficult to square the circle of this announcement alongside the £200 million in-year cut to public health that this Government have introduced.

There is a real risk that the decision could cost more money than it saves and that the good intentions behind passing responsibility to local authorities could be stymied from the off as a result of the short-term approach to funding that the cuts represent. I would therefore be grateful if the Minister updated the House on what support he is giving to local authorities to ensure that commissioning is properly resourced when they assume this new responsibility. What steps is he taking to ensure that the cuts do not affect front-line services?

As we know, many local authorities have been forced to pare back to the statutory minimum, which is totally against the grain of what we are trying to achieve. Taken together, the failure to invest in early help services and the lack of priority the Government give to this type of provision mean that Ministers will fail to support adequately all children and families in those critical 1001 days. The cross-party agreement we have heard about today needs to be matched by cross-departmental harmony across Government.

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In conclusion, the evidence is overwhelming. It is so obvious that it should have underpinned Government policy decades ago. Anyone who is a parent will recognise the intensity of feeling when observing how their child is developing. That innate desire for one’s offspring to grow up to be happy, healthy and wise should be all the encouragement we need to support this incredibly important document, not just for our children but for everyone’s children. On that note, I would like to wish everyone in the House a very merry Christmas.

4.45 pm

The Minister for Community and Social Care (Alistair Burt): I thank all colleagues who have taken part in what is a most important debate, despite being the last of this parliamentary term. It was handled in an exemplary way by a number of colleagues who know a great deal about the subject. I commend them for the breadth of interest and knowledge they demonstrated. I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) and the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for securing the debate through the Backbench Business Committee.

I also pay tribute, as others have done, to my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). The debate has been graced by a number of colleagues who have taken a huge interest in these matters over a lengthy period, often in quiet rooms, talking to people about the issues, and raising them on the Floor of the House. That often unsung work has been vital in giving us the information we need, and a number of hon. Friends deserve real credit for it, not least my hon. Friend the Member for South Northamptonshire.

I congratulate the all-party group for conception to age two—the first 1001 days on relaunching its manifesto, “The 1001 Critical Days”. I popped into the relaunch for a short time, but a few weeks earlier I was grilled by the group’s members on my interest in the subject. I am not the Minister responsible for children’s health, but one of the issues is that a number of different agencies are involved, and I understand very well that one of the requirements of the manifesto is to ensure that they work more closely together. I also have a particular interest in perinatal mental health, which I will spend a bit of time speaking about today. I certainly take the manifesto’s point about the range of different actors that need to be involved, and the fact that we need to work together more effectively. I will be glad to take that message back to colleagues. I thank the all-party group for its work.

I note that the manifesto includes a foreword by Dame Sally Davies, the chief medical officer. I must say that that is probably at least three quarters of the work done. I do not know how many Members have met Sally Davies, but they should know that anything she gets behind tends to happen. I therefore congratulate the all-party group on securing her support, which will be vital.

At the manifesto’s core is a clear and simple message: the first 1001 days of a child’s life are a critical window of opportunity. Prevention and early intervention at that stage can improve outcomes and transform life chances. There is no dispute about that across the

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House; there is perhaps sadness and regret that more was not done in the past, but we must all start from where we are and make progress. Much work has been done in recent years, and colleagues have been generous in their praise of it, but clearly there is more to do, and the manifesto sets out some of the challenges.

I will make a few general remarks about the speeches we have heard, and then I will refer to others as I go through my speech. The hon. Member for Nottingham North (Mr Allen), who has spent a great deal of time working on early intervention, spoke about the philosophy that was needed to understand this, and he is absolutely right—few could have done more than he has to bring that forward. Some of these issues are cultural; they are about taking people out of silos. He was generous in his praise of my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). My right hon. Friend, and I suspect a number of other Members, was much inspired by the work of a chap called Bob Holman—a family worker and an academic who chose to live in Easterhouse in the centre of Glasgow—on social justice. Bob is unfortunately quite ill at present. I would like to send good wishes to him for the remarkable work he has done. He is well known for his work in Scotland, and in the United Kingdom. We are sorry that he is ill and send our best wishes to him and to Annette.

The hon. Member for Foyle (Mark Durkan) and the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—thank you, John Ronald, who follows on me on Twitter, for helping me with the pronunciation—pointed out the importance of all of us in the British Isles looking to what work is done is by one another. I will certainly inform ministerial colleagues of the work being done by the unit at Queen’s University Belfast, and that being done in Scotland, and we can follow that up. I said to the hon. Member for East Kilbride, Strathaven and Lesmahagow after her intervention on mental health that I am keen to see what is being done in other places, and I will follow that up as well. We do have parenting skills classes in England. That provision has been much boosted by the health visitor programme, and it is as vital to us as it is in Scotland. I am sure that others will be interested in looking further at that.

The manifesto highlights the importance of high-quality universal services from conception to age two, which have rightly been described as a “lynchpin”. For the vast majority of women and babies in England, NHS maternity services provide a positive experience and good-quality care. We also have a good, strong, evidence-based universal public health programme—the healthy child programme from pregnancy to age five—which is delivered by health visitors. To strengthen the delivery of the programme, we have increased the number of health visitors by almost 50% in the past four years—one of the most rapid workforce expansions in NHS history. At the same time, the landscape for delivering services to under-fives is changing. On 1 October, responsibility for commissioning nought-to-five public health services transferred to local authorities. This change is of course a challenge for services, but it also presents an opportunity for local leaders to commission and provide more joined-up services for young children and families, across health, education and social care, based on their understanding of local need.

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The manifesto contains a number of recommendations, including one mentioned by my hon. Friend the Member for East Worthing and Shoreham about the attachment needs of families:

“Childminders, nurseries and childcare settings caring for under 2s must focus on the attachment needs of babies and infants, with OFSTED providing specific guidance on how this can be measured effectively.”

The Government absolutely agree. Personal, social and emotional development is one of the three prime areas of the early years foundation stage curriculum, and forming positive relationships, including with adults, is key to this. I will ensure that my colleagues in the Department look particularly closely at that recommendation, for attachment is absolutely crucial.

My hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Sefton Central (Bill Esterson) raised foetal alcohol issues. I commend them for the report that has, I think, come out today, following the inquiry by the all-party group on foetal alcohol spectrum disorder.

Bill Esterson: It is on its way to you.

Alistair Burt: Thank you very much.

It is too early to respond to the report, but I can say that it is really important. It is not like a Select Committee report, in that the Government do not have a duty to respond to it, but I would be extremely surprised if colleagues did not want to do so in due course, because it is so important. The official advice given is this:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol…If women choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk.”

We will shortly publish a consultation on the UK chief medical officer’s alcohol guidelines review. This will offer an opportunity to work with clinicians and other professionals to ensure that they are fully informed about the content of the guidelines and able to explain them to the women they care for and help them make informed choices on alcohol consumption. I would imagine that the substance of the inquiry ought to form part of that consultation and discussion. I think that the most important part of the advice is:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol”.

Bill Esterson: I am grateful to the Minister for those comments. The international examples given by his colleague the hon. Member for Congleton (Fiona Bruce) are very clear. The advice is not in two parts; it is a simple, single piece of advice: the best advice for mum and baby is to not drink at all. That is what happens around the world. The Minister has mentioned Dame Sally Davies. I hope she will agree with that and that that is what we will end up with, because it would make a massive difference.

Alistair Burt: I absolutely understand the hon. Gentleman’s point and hope that comes to pass. The Government will respond in due course.

I am the Minister with responsibility for mental health, which was raised by the right hon. Member for North Norfolk (Norman Lamb) in particular and the hon. Member for Ellesmere Port and Neston (Justin Madders).

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Mr Graham Allen: If the Minister is moving on from foetal alcohol syndrome, it is important to put it on the record again that, as of a couple of weeks ago, the attempt to have a prevalent study on foetal alcohol syndrome has not found funding. It is really important that we try to understand the issue in depth and get some evidence on how widespread it is. Will the Minister please consider looking at the matter in the light of the report he will receive today?

Alistair Burt: I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

Norman Lamb: Is the Minister satisfied that Health Education England recognises the importance of building the capacity of the workforce in order to ensure that there is a national service?

Alistair Burt: Yes, I am. HEE takes a real interest in the issue and I am sure there is more to be done. I take the right hon. Gentleman’s point about urgency as well. I am committed to doing more about that.

I am sure we will come back to this issue. This has been an excellent debate and I want to leave time for the mover of the motion to say a few words.

Madam Deputy Speaker, I wish you and all colleagues in the House a happy Christmas. If we conclude on a consensual note, with a debate as good as this one with very well informed people, the House is more than doing its job and is ready for a break.

4.58 pm

Tim Loughton: I am grateful to all hon. Members who have taken part in this debate. There have been some weighty contributions and I am grateful to those who have stayed for this last debate on the last parliamentary day of the year.

I am particularly grateful to the hon. Member for Nottingham North (Mr Allen) for his contribution. He spoke of the intergenerational problems we are inheriting, which he has done so much to address. He was also right in a later intervention to mention social finance and the possibility of social impact bonds, which we certainly want to develop.

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At times the debate risked being hijacked by the report of the all-party group on foetal alcohol spectrum disorder, of which I am a member. I am delighted that we had an opportunity to give the group a voice, because it is a very important subject.

I am grateful to the right hon. Member for North Norfolk (Norman Lamb), who did so much on perinatal mental health when he was a Minister. The map he produced puts starkly, in graphic terms, the service provider gaps around the country. I was also grateful to hear from the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks on behalf of the Scottish National party, who spoke of the Scottish experience and her time as a clinical psychologist in the NHS.

I pay tribute to the Opposition spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), not least for his optimism about the political fortunes of his party. I am grateful for the cross-party consensus, to which he contributed. He is absolutely right to say that it is a false economy not to be doing this. We need to impress on the Chancellor the fact that, just as we invest in roads and factories to aid the economy, we should invest in our youngest children as citizens who are going to contribute to society in the future.

This is an urgent matter for the whole Government and I urge the Minister to promote it as such. In doing so, I wish everybody a very happy and peaceful Christmas and an “attachment” new year.

Question put and agreed to.


That this House calls on the Government to consider the adoption of the recommendations in the cross-party manifesto entitled The 1001 Critical Days, the importance of the conception to age two period.

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Access to Health Services: West Cumbria

Motion made, and Question proposed, That this House do now adjourn.—(Guy Opperman.)

5 pm

Mr Jamie Reed (Copeland) (Lab): Thank you, Madam Deputy Speaker, for presiding over this Adjournment debate, the last parliamentary business of 2015.

The issue at hand is one that my constituents and people living across west Cumbria care a great deal about. I know that the Minister is well aware of the challenges. He has responded positively to my questions and requests in the past, for which I am exceptionally grateful to him, and I hope that he will do so again today.

I will first outline the issues facing my constituents with regard to their ability to access health services in west Cumbria, particularly hospital services at the West Cumberland hospital. The issues facing the North Cumbria University Hospitals NHS Trust, the pressures on ambulance services and the intense pressure on overworked and under-resourced staff are well documented, but despite that, little, if any, progress towards solving the problems would appear to have been made. I will then address the success regime and the opportunity it represents for health services in west Cumbria and therefore for our communities. The recent floods, the effects of which are keenly felt throughout the county, have magnified the issues at the heart of the debate on health services in west Cumbria, and I will also talk about that. I will conclude by outlining what I believe are the needs of the west Cumbrian community. After all, the key decision for decision makers, the Government, Ministers and NHS executives comes down to this: what do the people of west Cumbria want from their health and hospital services, and how can that be delivered? It must be said at the outset that that is a very different question from: what is the North Cumbria University Hospitals NHS Trust prepared to provide? The simple answer is that the people of west Cumbria need better access to health services, particularly in relation to hospital services provided by the West Cumberland hospital in Whitehaven.

In this context, the term “access” has myriad meanings. It means the actual services provided locally, and it means that those services must be staffed appropriately so that they can be provided to a high quality. It also means empowering communities so that when decisions are made about their services, they are listened to during the decision-making process. Access also means proper planning for the significant population expansion that is forecast for the area. In west Cumbria, each of those points are immensely challenging, and that is what we must address.

In July 2013, Sir Bruce Keogh, with whom I have a very good and effective working relationship, published his review of mortality rates at several hospital trusts around the country. North Cumbria University Hospitals NHS Trust, which serves my constituents, was one of the trusts and, along with 10 others, it was placed in special measures. The trust had higher than average mortality rates, and action to remedy that was justified and was welcomed.

At the time, Ministers were unable to provide basic information about what “special measures” meant for the trust. It was patently clear, however, that a major

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reason for the care failings at the trust was a chronic staff shortage. It is only right that I use this opportunity to thank, personally and on behalf of my constituents, the tremendous staff who are working tirelessly in trying conditions to provide high-quality healthcare. I know that many work unpaid overtime because they care about their patients, about the community and about the care they provide. It will be a tough winter and there will be huge pressures, but I want them all to know that I and my constituents understand that they are working in extraordinary circumstances.

The trust simply needs more staff, and the Government must intervene to ensure that it has more staff. Such a request has fallen on deaf ears for too long. The most recent report by the Care Quality Commission, published in September, showed the scale of the challenge:

“The recruitment of nursing staff also remained an on-going challenge. At the time of our inspection nurse staffing levels, although improved, were still of concern and there was a heavy reliance on staff working extra shifts and on bank and agency staff to maintain staffing levels. There were times when the wards were not appropriately staffed to meet the needs of patients.”

This simply is not acceptable.

In 2013-14, the trust spent £16 million on agency staff. That cannot be sustainable, and it is clearly a false economy. Agency staff are a short-term, expensive solution, but in my view the Government should be empowering trusts to achieve long-term, efficient solutions. Capping agency costs is a small, tentative step in the right direction, but it would be better all round if the Government provided funding to enable trusts to train and recruit for the long term. That would surely save money in the long run and enable predictable, stable, secure service design for the long term. Will the Minister therefore commit to making relief funding available to allow the trust to be more competitive in the recruitment market? If my local trust has to pay over the odds to secure services that are taken for granted in other parts of the country, it ought to be funded appropriately to do so.

In my constituency, I have been working with the trust and the University of Central Lancashire to bring a medical school to west Cumbria so that we can grow our own medics. That is a long-term sustainable solution to one of the key problems we are facing. I am delighted to say that the new West Cumberland medical education campus now exists at the Westlakes science park in my constituency, immediately adjacent to the new West Cumberland hospital. So far, it has succeeded without the support or involvement of the Government, but I hope that they will support the development not just in spirit, but through practical assistance, including money.

In addition to growing our own medics in west Cumbria for the benefit of the entire Cumbrian health economy, every part of which faces similar challenges, we are providing the basis for policy solutions by becoming a rural health policy laboratory. The campus can and should become the crucible of innovation that provides the solutions to the problems facing rural areas in respect of the provision of high-quality, accessible, universal health services. I hope that the Minister will express the support of the Government and the Department for that today.

I hope that the Government will look again at nursing bursaries, as I fear that their new policy will make it harder to train and recruit the medical staff that we all know we need. On 14 December, the chief executive of

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the Royal College of Nursing said that the decision to cut bursaries that was announced in the Chancellor’s autumn statement is having a negative impact on people who are considering a career in the profession. It is all well and good pledging to increase the number of training places, but the impact is wasted if the mechanism that we adopt turns people away.

The NHS staff survey shows the current strain on medical staff in north and west Cumbria. There has been a big increase in the proportion of staff who suffer work-related stress and, unforgivably, the prevalence of staff experiencing bullying from other staff is increasing. Staff are working extra hours unpaid. The people in west Cumbria rely on the services provided by those hard-working people. Much like the expensive agency bills, overworking staff simply is not sustainable. Will the Minister commit to seeing what action the Department can take to improve the situation? Sooner or later, our luck will run out. The good will of the medical professionals, who are exhausted and demoralised in so many ways, will run out too. It is patients who will pay the price.

At the beginning of the year, I wrote to the NHS’s chief executive, Simon Stevens. I asked him to visit Cumbria to see for himself the geographical challenges and to speak with patients and staff. I asked him to work with me and other stakeholders to develop a comprehensive recovery plan for the Cumbrian health economy. Nowhere in the country is quite like our county. The health inequalities, the demographic differences, the challenging geography and the contrast between the affluent and those who are less well-off all present unique challenges in designing and providing hospital services and health services in the round.

What is provided should be broadly the same in every community in the country. A national health service should ensure that there is equality of standards and accessibility in the health service, but how that is delivered must be flexible enough to accommodate unique local circumstances.

The success regime is the response to my request for a comprehensive recovery plan. The new regime is intended to develop a locally tailored solution to the problems we face. I support the success regime fully, but I have doubts about the support of the North Cumbria University Hospitals NHS Trust for the process.

Over recent years, actions by the trust’s executive team have led to the public being understandably worried about the prospect of key services being removed from West Cumberland hospital without a rationale. In September 2013, the trust moved some out-of-hours surgery services from the West Cumberland to the Cumberland infirmary in Carlisle, over 40 miles away. The public were not consulted on the change. Crucially, the modelling and assumptions underpinning the move were flawed. Much greater numbers of patients have had to travel than was either anticipated by the trust or told to the public. Either it was a lamentable failure properly to model the effects of service change or it was a lie. That raises serious questions about either the honesty or competence of the trust.

The trust’s attitude on a number of other issues since then has done little to reassure those who are concerned about its intentions with regard to the provision of services at the new West Cumberland hospital. I was present at a meeting—I think it was in October—with Simon Stevens on the success regime, in which the local

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hospital trust was told categorically that the “asset stripping” of services from West Cumberland hospital must not continue. It was an exceptionally uncomfortable meeting. Days later it was reported that senior managers at the trust had told staff that the accident and emergency department would be downgraded. That is unacceptable. The trust must abandon any preconceived plans to strip services. Those services must be provided at West Cumberland hospital, and the success regime must be allowed to complete its work.

I welcome the recent statement from the NHS in Cumbria, which set out in a public letter that the accident and emergency department, and other services, must remain at the West Cumberland hospital. That is the bare minimum that my community would expect, yet the trust had to be shamed into making such a basic commitment.

With regret, if the trust does not abandon its preconceived ideas about service reconfiguration and reduction, and if it tries to ride roughshod over the work of the success regime programme before it has a chance to develop its plan, I will be left with no option but to pursue the removal of the current trust management. I would be grateful if the Government would support what is clearly an effort of last resort. I take no pleasure in that, but unless the trust management can commit fully to the terms of reference of the success regime, it should have no part in the future of healthcare service design in north and west Cumbria.

The attitude displayed by the trust, whether deliberate or not, has meant that many in the local community simply do not believe a word it says. Its lack of willingness to engage with the public who use or rely on the services provided at our hospital means that many feel disconnected from a key service—the key service—in their community. The service reconfiguration of September 2013 was done without public engagement, and the development of the trust’s future clinical options did little to assuage legitimate concerns. The document showed the stripping of key services from West Cumberland hospital which, I repeat, is unacceptable.

Last year, in front of a crowd of almost 5,000 people at the recreation ground—the home of Whitehaven rugby league football club—trust representatives assured an anxious crowd that no decision on service reconfiguration would be made. However, the publication of the future clinical options appraisal in October 2014 showed that the plans had been in development for a year. It is easier to deal with Iran!

The duplicitous nature of the trust’s public statements, the covert actions that seek to pursue in private the opposite of what it states it wishes to do in public, and the public distrust that it has singularly managed to establish is staggering. It is truly breathtaking. Too often, the trust acts as a rogue trust, seemingly beyond any accountability to anyone and beyond the influence of the Cumbrian public. Will the Minister commit to examine the behaviour of the trust? Senior local medics, patients, local civic society, trade unions, and local representatives of all parties all doubt that any eventual consultation designed by the trust will be genuine or honest. Progress will not be possible within that climate of distrust.

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Hopefully, many of the trust’s preconceived ideas about service reconfiguration will be superseded by the work of the success regime. In the rest of the country the Government and NHS would be hard pushed to find a more committed, willing, well-informed and passionate community when it comes to health services than the community of west Cumbria. A campaign group set up to fight for services, “We Need West Cumberland Hospital”, has garnered much public support and I pay tribute to its work, as I do to the fantastic work of Siobhan Gearing, Carol Woodman, Lee Butterworth, Rachel Holliday, my hon. Friend the Member for Workington (Sue Hayman) and so many others.

Does the Minister agree that if the trust was committed to rebuilding trust within the community, it should involve the local public in open and transparent discussions about local services, instead of defying the NHS chief executive, deliberately undermining staff, raising doubts about services about which there should be no doubt, and acting like thieves in the night?

The recent local floods did not cause the underlying issues inherent in the north and west Cumbrian health economy. Nor did they cause lasting damage to the ability of the NHS in Cumbria to deliver services. What the recent floods did, among many other things, is prove beyond doubt the sheer folly of removing services from the West Cumberland hospital and putting them in the Cumberland infirmary in Carlisle, more than 40 miles away.

The floods meant that roads were impassable. Ambulances and other emergency services, which were already struggling more in Cumbria than anywhere else in the north-west, were under intense pressure. Power was cut to the Cumberland infirmary, which had to rely on back-up generators. I am told that there were no clean sheets or bedding. The laundry service failed and doctors and nurses could not get to work. The impact on patients was severe.

Getting from west Cumbria to Carlisle at the best of times is difficult. If the weather does not beat you, the tractors or the sadly routine road traffic accidents and diversions will. I am campaigning for serious improvements to the A595, but because of the floods over that weekend and the following days it was simply impossible to get from west Cumbria to Carlisle—not difficult, not unlikely, but impossible. The levels of the flooding could not be anticipated, but there are things that we can do to ensure access to, and the resilience of, our key services. Rain in the Lake district should never come as a surprise—it should never lead international news bulletins—but severe weather should not create a health emergency because access to services has been cut off.

I have been inundated with numerous examples of the situations people found themselves in, but the underpinning point is relatively simple: access to a full and comprehensive range of hospital service is, for the people of west Cumbria, essentially non-negotiable. The recent flooding showed that, if services are transferred from the West Cumberland hospital, in times of emergency, patients simply would not be able to access them because they would not be able to get to the Cumberland infirmary in Carlisle.

I repeat that that cannot be acceptable. In times of emergency, the people of west Cumbria need to be able to access their services. That can be assured only by retaining their services in their local hospital—the West Cumberland

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hospital—which is a fantastic new facility for which I have campaigned for more than 10 years. I make two specific requests of the Minister with regard to the hospital. Will he please move to unblock the funding for phase 2 of the hospital new build programme? The money has been allocated but is not yet accessible. I ask that that be done as soon as possible so as to provide confidence and help to build public trust. If, as is suggested by some, Monitor will shortly be able to allocate a fund £1.8 billion to the most challenged health economies in the country, will the Minister ensure that north Cumbria is at the top of that list?

The last point I should like to address is the short-sightedness of the trust’s desire to move services. West Cumbria is home to one of the most nationally strategic points in the shape of Sellafield. Over the coming years, with new nuclear reactors at Moorside, which is adjacent to Sellafield, thousands of jobs will be created, and my constituency will become one of the fastest-growing regional economies anywhere in the United Kingdom. As a result, the local population will grow significantly and quickly. The people who live in west Cumbria need better access to the health services on which they rely, but it is simply mind-boggling that, when the local population is growing, the trust thinks it is possible and perhaps even desirable to move services more than 40 miles up the road. The Minister has been unequivocal about that in the past and I thank him once again for that. The local NHS must take into account strategic infrastructure and the local population of host communities when planning services, so will he commit to write to North Cumbria University Hospitals NHS Trust to ensure that it publicly acknowledges that? Will he today, at the Dispatch Box, urge the trust to factor that population growth and strategic need into its future plans?

The fundamental principle in the debate is absolutely straightforward. Moving services more than 40 miles away from the West Cumberland hospital is the antithesis of the principles that underpin a truly national health service. I would go as far to say that, unless patients and taxpayers in my community can access the same level of healthcare routinely provided by the NHS in other communities, the national health service exists in name only. Forty miles is not a reasonable distance to ask people who are in need of medical care to travel, particularly when that 40 miles is served by such inadequate infrastructure. Mothers giving birth do not want to sit in an ambulance on the A595 hoping beyond hope that they do not get stuck behind a tractor.

A fully operational accident and emergency department supported by associated departments, consultant-led maternity services and paediatric services must remain at the West Cumberland hospital, for which I have much to be grateful for, both as an individual and as a recent parent. If we need to adopt a flexible approach in order to achieve that, that is what we must do. It must be accompanied by what will in many ways be nothing short of a new model of healthcare. The trust should know that the people of west Cumbria will stand for nothing less. The trust may be a provider of services but, after all, the NHS belongs to all of us.

I fully support the success regime, but I ask the Minister today to tell the trust in unequivocal terms that, unless it listens and responds to the west Cumbrian community, it will face a fight the likes of which it has never seen.

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5.18 pm

The Parliamentary Under-Secretary of State for Health (Ben Gummer): It seems appropriate that the final debate before Christmas is about maternity. It is appropriate in another way because it is about an area of the country that has too often been forgotten in the planning of services and where the people feel left out from the way in which the NHS has been formed in the past. The Government and I wish to address that. I am grateful to the hon. Member for Copeland (Mr Reed) for bringing his points to the House. He is a forthright campaigner for his constituents and cares passionately about his constituency, and he understands the needs and concerns of his patch. I listen with care, because I know he chooses his words with care. He would not have used the strong language he used in his speech were it not for the fact that he judged it necessary to do so.

I will begin where the hon. Gentleman ended—on the floods. I was glad that, despite the extraordinary amount of rainfall in Cumberland and Westmorland, the effect on NHS services was not as severe as it was in 2009 and 2005. That shows we are at least getting a bit better at resilience and planning. I would like to pay tribute to some of the people who stood out during the difficult period of the past few weeks. The NHS workers from across north Cumbria, many of them in his constituency, worked all hours to make sure people could access medication and receive treatment. It is a credit to them. The amount of work, commitment and vocational passion they bring to their jobs was reflected in the hon. Gentleman’s speech.

I will come on immediately to the problems in north Cumbria. They are well documented, although there is no agreement yet on how we address them. The fact is that north Cumbria is one of those rare things in England: a very remote area. We do not have them in our country in the way that others do. Our neighbouring country of Scotland has more remote areas and is able to understand the pressures that they put on health systems in a way that we do not. The Whip, my hon. Friend the Member for Hexham (Guy Opperman), also represents a remote and rural area. Rural areas pose particular challenges to a service that has grown out of an urban design for healthcare provision over many decades. We are seeing the pressures and difficulties posed by that structural conflict in north Cumbria.

To be blunt—the hon. Gentleman is cognisant of this—the care of patients in north Cumbria has fallen well short of where it should have been because of the structural failures in the way the NHS is set up in that area. That is why the hospitals were placed in special measures and why they have been there for so long. It is why they have not exited from special measures and why NHS England, together with Monitor and the trust development authority, has felt it necessary to place the whole of the health economy of north Cumbria into its so-called “success regime”. That is not a title I love very much, but I hope it points to the place we need to get to.

I will say from the outset that the success regime will be successful only if it comes up with a plan that is deliverable and has the support of local people and clinicians. The problem in the past has been that ideas have been proposed, normally from the centre, and placed on to local people. Completely understandably, they have said, “I am not having this. This doesn’t suit what we believe we need in terms of healthcare for our

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area and that’s not good enough.” Because the NHS is owned by local people, we will only win this if they feel any redesign will improve quality and services. We also have to be clear that it will pose difficult challenges to us as politicians, both as local representatives and Ministers. It is important we get behind the success regime when it concludes and are prepared to take difficult decisions. The one thing that will ensure that the poor state of patient care quality persists in north Cumbria for years and decades to come is if we do not take a decision. We have to take a decision. We have to make sure it is the right decision. We have to get behind it and make sure it happens.

Turning to some of the specific issues the hon. Gentleman raised, the issue of staffing really underlies all the problems in the various NHS bodies in north Cumbria. It is difficult to recruit to certain specialties in north Cumbria. That means the trusts and other NHS bodies depend on locums and agency staff. That is not the way to run the health economy either in north Cumbria or across the NHS. That is why we have taken wider action on staff agency costs and why we need specific help for north Cumbria. The success regime is looking specifically at this.

The hon. Gentleman mentioned the new medical school, led by the University of Central Lancashire, on the West Cumberland campus. I welcome its sense of innovation. It already provides very good non-medical healthcare courses, and I am glad it is reaching into new areas. I will be excited to see how it progresses and would like to see what it is doing for myself in the near future. I certainly endorse his plan for a rural health policy laboratory—it is the right way to go—which I hope will feed into the success regime and our understanding of how to learn from other areas of greater rurality and sparsity, such as Canada and Australia, and how they deal with, and provide exceptional care to, people in dispersed communities.

The hon. Gentleman mentioned nursing bursaries. I will not get into that debate now, but I hope he will be reassured by my announcement a few hours ago of a nursing apprenticeship route all the way to degree level to ensure that healthcare assistants can progress to registered nurses via an intermediate nursing associate position. In north Cumbria, it is much easier to recruit to healthcare assistant posts than to nursing posts. I hope he will understand where I am going with this. As in Hull and other parts of the country where it has been difficult to get nurses into post, it will allow us to give to our excellent, committed healthcare assistants, who have the values of the NHS right at the core of their being, a career progression route that they have not had so far. I hope he will take comfort from that initiative.

I understand that staff often work excessive hours just to keep things going in stressed areas such as north

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Cumbria. The NHS depends on their good will at such moments, but it is not something we should bank on, which is why we need to get it right for his constituents and the whole of north Cumbria.

The hon. Gentleman made two final points about the building programme at the West Cumberland and the transformation fund. I will certainly consider his request in respect of the West Cumberland, although it is probably best that Monitor comes to a final decision once the success regime diagnostic is at least concluded, which should be imminently, because it would be a mistake to embark on something that would be moderated by a joint decision within the success regime deliberations. I will ensure, however, that there is pace to that. It is important, if it is committed to, that it is delivered, but I assure him that I will look into the matter first thing in the new year.

The transformation fund is designed to stimulate the innovation we know there is in the NHS around clinical management and to bring efficiencies to bear across the hospital estate. It is not, I stress, a bail-out fund; it is designed to do what it says on the tine: to transform how we run our hospitals. Efficient care is good-quality care, as he understands better than most, which is why the hospitals delivering the best care in the country are also the best at looking after their finances. There is considerable talent within the management and clinical management core in the NHS, and we want to realise their ideas for making the NHS more efficient across the services it provides. That is the purpose of the fund. It is to help realise that innovation and to match their efforts. If we simply pour it into bailing out hospitals that are not doing their bit to transform and bring in efficiencies, it will be doing the wrong thing and we will be wasting money. However, I will certainly make his request clear to the leadership of NHS Improvement, which is concerned with this matter. He will be pleased to know that Jim Mackey, the exceptional new chief executive of NHS Improvement, is well acquainted with his part of the country and has its interests at heart.

It remains to me, as the last person to speak from the Floor this year, to thank the hon. Gentleman for bringing this important matter to the House. On this occasion, last is certainly not least, and I hope that Cumbria will be first in the new year in terms of the announcements we will make. I wish everyone still remaining in the Chamber—the Clerk, the Serjeant, the Whip, the Doorkeeper, the officials in the Box, the one or two determined visitors and you, Madam Deputy Speaker—a very happy Christmas.

Question put and agreed to.

5.30 pm

House adjourned.