11.New and expectant parents, including new adoptive parents, can usually expect to benefit from a range of formal and informal support services to help promote their wellbeing and their child’s health and development. These can include antenatal and postnatal classes run by the NHS and voluntary groups, specialist perinatal mental health support for those who need it, statutory health visiting checks, and parent and baby group classes. Our report last year found that the pandemic had affected access to these services, with potentially harmful long-term consequences for new parents and their children.
12.Through our evidence session and public engagement this summer, we heard that new parents’ access to these services remains reduced. One witness discussed the “continuous heartache of not having support” over the past 12 months, while another described it as “shocking” that so much of what we were told a year ago remains the same. An overarching theme was new parents’ ongoing need for support both with the usual challenges of becoming a new parent, but also to address the negative impact of having missed out on the support usually available over this period. Sally Hogg of the Parent-Infant Foundation suggested the extended period of restrictions meant that people who became parents during or shortly before the pandemic risked missing out on their window of opportunity for much of this support, potentially affecting their wellbeing and their children’s development:
There is a whole group of parents now who have never had experience of going to a children’s centre or seeing a health visitor face to face […] The way services are structured generally in the first two years of life, you get a lot of contact with services in the first few weeks and then it gradually declines. […] There is a huge need to mobilise public services, voluntary services and communities to ensure that we do not lose those invisible children, or only find out about them when there are serious incidents or later down the line. That requires investment.
13.Since last July, new and expectant parents have continued to face severe limits on the formal and informal support for their wellbeing and their child’s development that they would normally expect. Following a further 12 months of restrictions, the cohort of parents and children in need of catch-up support is now even larger, and the cumulative impact on parents’ health and children’s development has only increased.
14.Support for new families is concentrated in the early months of a child’s life, but for many families this crucial time fell wholly within the extended period of restrictions. Ensuring new parents can now urgently access comprehensive support—including catching up on support they have missed out on since the start of the pandemic—must be a priority for the Government.
15.Evidence has continued to emerge about the impact of the pandemic on mental health support for new parents, and mothers in particular. Research has suggested an increased likelihood of anxiety, depression and loneliness among new and expectant mothers, and access to mental health support among this group was around a third lower in 2020 than expected levels. New mother Bethany Power told us about her experience of waiting over a year for remote counselling and difficulties in accessing specialist perinatal mental health services rather than general adult services. Dr Sarah McMullen from the National Childbirth Trust (NCT) told us that, in a recent survey they had run, 25% of new mothers reported not being asked about their mental health at all in their six to eight week postnatal consultation with their GP.
16.The Government is working with NHS England to improve and invest in perinatal mental health services in England. The NHS Long Term Plan sets out an ambition to provide access to specialist perinatal mental healthcare for at least 66,000 women by 2023–24 and the establishment of 26 maternal mental health hubs across England is planned by April 2022. However, Dr McMullen told us “a lot of mental health issues will have been missed” among new mothers over the course of the pandemic. Our previous report called on the Government to fund and provide additional catch-up mental health support targeted at this cohort of parents, over and above these existing plans for service improvement, and witnesses remained supportive of further efforts to understand the mental health impact of this period on new parents and investment in extra targeted support.
17.In March 2021 the Government published its COVID-19 Mental Health and Wellbeing Recovery Action Plan, which committed to investing £500 million in mental health services in response to the pandemic. The Plan pledged to “continue to raise awareness of the resources and guidance developed in response to the pandemic for children and young people as well as parents and carers”. However, of the £170 million earmarked for action to tackle “critical backlogs” as a result of the pandemic, none was specifically aimed at perinatal services or support for new parents.
18.We welcome the Government and NHS England’s planned programme of capacity-building for perinatal mental health services over the next 2–3 years. However, new parents are already experiencing the mental health impact of covid-19. Plans for long-term capacity-building must be adapted to meet new needs and should sit alongside more immediate investment to address the mental health needs of new parents today—as we recommended last year.
19.We recommend that the Government provides additional funding and resources to bring forward the delivery of its perinatal mental health capacity-building programme. We also recommend that the Government fund primary healthcare services to invest in additional mental health catch-up services for new parents impacted by covid-19.
20.Since last autumn, Government guidance has allowed up to 30 people to meet as a “support group” (specifically including parent and baby groups), in an exemption from restrictions on gatherings. Witnesses suggested that while this exemption had been “really helpful” in giving some groups the confidence to restart, many others had not done so, depriving parents of what Dr McMullen described as “a vital safety net”. In our June 2021 public survey, 93% of respondents “disagreed” or “strongly disagreed” that they had been able to access baby and toddler groups over the past 12 months.
21.Witnesses cited factors such as staff having to self-isolate or look after children at home, as well as the complexity of “having to piece together different bits of guidance” on how to operate safely, as reasons why many groups had not restarted. Emily Tredget of Happity (an online platform designed to help parents find baby and toddler classes in their area) suggested parent and baby group organisers were wary of restarting classes following negative experiences last winter, even with such groups having been exempted from restrictions on gatherings and now the removal of legal restrictions:
We did a survey and it said that 24% [of providers] are still very confused as to whether they can go back. Some of them are quite traumatised from their experience back in November, where we were telling them that they were allowed, the DfE was telling them that they were allowed, but still their councils were coming in, forcibly in some cases, with police, shutting them down […] We definitely need to look at what we do going forward, in case there are any further issues.
22.Witnesses were also concerned the pandemic may have a long-term scarring effect on the provision of community-led support groups and parent and baby groups. Emily Tredget suggested parent and baby group providers had seen an average drop of 63% in their revenues over the last 12 months, while Dr McMullen cited figures from the National Council for Voluntary Organisations (NCVO) suggesting many charities organising such groups had also seen financial losses. We heard that families in more deprived areas may be particularly affected by the loss of such services.
23.Dr McMullen called for clearer guidance and communications to support more classes to restart, arguing that for organisers of support groups, “there is still a need for a really strong focus on risk mitigation. We have a duty of care to our volunteers, practitioners, staff and the parents we are supporting”. Despite the calls we heard for clear guidance for this sector, the Government’s guidance on the safe use of multi-purpose community facilities (which specifically covered support groups and parent and child groups) was withdrawn on 23 July, and while guidance on safe and effective volunteering and actions for early years and childcare providers remains updated, they do not specifically mention such groups.
24.Our inquiry last year heard compelling evidence on the crucial role of community support and parent and baby groups in supporting new parents’ wellbeing. The Government’s recognition of this in exempting such groups from some gathering restrictions last year was very welcome. However, the Government must now do more to clarify how organisers of these groups and classes can offer these services in a safe and responsible way following the lifting of most legal restrictions.
25.The Government should produce clear and dedicated guidance for organisers of community and charity-run support groups (including parent and baby groups) on how they can safely restart and continue classes in a covid-safe way. It should work with group organisers, local authorities and other relevant sector stakeholders to develop this guidance and ensure it is widely communicated.
26.We heard that new parents have continued to struggle to access support from health visitors since last summer. Many respondents to our June 2021 public engagement survey reported having had no contact at all with health visitors during the early months of their child’s life. Of those who had been able to access this support, a minority reported having received in-person visits, but far more said contact had been limited to video calls. Overall, 74% of respondents “disagreed” or “strongly disagreed” that they had been able to access health visiting support as much as they had wanted in the previous 12 months. Bethany Power told us that since March 2020, she had received little to no health visitor support, instead having to turn to paid-for support via charity-run classes, which parents on low incomes may not be able to access.
27.Concerningly, several respondents to our public engagement survey felt that their child’s emerging medical or developmental needs had been identified late due to the disruption to health visits. This echoes witnesses’ concerns that while delivering health visiting checks (and other activities, including breastfeeding support and support for adoptive parents) online had been a necessary and useful innovation during the pandemic, it was often less effective at offering high-quality support, allowing for rigorous assessments, or encouraging new parents to open up about the difficulties they are facing, and should not generally be seen as a desirable long-term replacement for face-to-face provision. Sally Hogg explained:
We know there are real risks in virtual service delivery. It can work well for some settings and some parents. If you do things like a health visitor check virtually […] you cannot really see that interaction between the parent and the baby, or pick up on some of those cues or physical development needs […] There is a real worry that mainstreaming some of those services, just because parents connected with them during a lockdown, will lead to substandard services going forward.
28.The health visiting workforce has expressed concerns that health visiting services during the pandemic were targeted at families already known to be vulnerable, which—together with a downward trend in health visitor numbers since 2015—has meant they are unlikely to have reached all families in need of their support. Dr McMullen described the decline in the health visitor workforce as a long-term issue that “needs really urgent attention” and argued the pandemic’s impact on health visiting had shown “the worst-case scenario of what happens when you have an underfunded and under-resourced service”.
29.Our report last year recommended that the Government should fund additional health visitor services to catch up on the provision of this support to vulnerable families. Responding to our recommendation, the Government stated that the allocation of health visitor resources is a matter for local authorities, as they are best placed to understand the needs of their local population and make decisions on funding priorities. More recently, in an August 2021 response to an e-petition, the Government again stated that it does not “advocate a specific health visitor staffing number or case load”, and that councils are responsible for making resourcing decisions to meet the public health needs of a local population (including health visiting), with funding provided via the local public health grant. It noted this grant would increase by 1% in cash terms in 2021–22, with future allocations determined at the 2021 Spending Review. It also stated that “the most recent data available on health visitor service delivery in England shows that a high proportion of infants received mandated health reviews in 2019–20”.
30.In our evidence session, we heard renewed calls for more in-person wellbeing check-ups for new parents and their children. Sally Hogg argued that time was of the essence in ensuring families receive an in-person health check from a health visitor or other qualified professional:
It does not necessarily have to be a health visitor […] [Local authorities] are perhaps asking family support workers or Home-Start workers to visit the children, so it is not an official health visiting check, but at least it is eyes on the family and an opportunity. We need to act quickly. We need to give local authorities, CCGs and the voluntary sector some flexibility to use the resources they have.
31.We remain concerned at the number of new parents reporting limited or no access to health visiting services over the period of the pandemic. Virtual checks were a necessary innovation during covid-19, but new parents and their children must now urgently receive in-person visits—ideally from a health visitor, but, if this is not possible and in view of the time-sensitive nature of this need, then from another qualified professional. We agree with the Government that local authorities are best placed to make decisions on local public health funding priorities, but the unique circumstances of covid-19 demand additional central government funding for local services to meet additional need.
32.In order to support parents who have missed health visiting checks, we recommend that the Government provide additional funding to local authorities to enable in-person visits to new parents by appropriate local authority, voluntary organisation, or health visiting staff, to be delivered by the end of the year.
33.Our previous report highlighted the increased risk of adoption breakdown as a result of covid-19, due to factors including depression among parents and disruption to children’s new routines. We heard that in a recent survey of adopters’ experiences, 65% reported stress, anxiety and symptoms of post-adoption depression, while some described feeling “abandoned and forgotten” once their child had been placed with their family due to the inability to arrange face-to-face support from social workers. Dr Sue Armstrong Brown from Adoption UK told us that the challenges facing adoptive families—both those shared with birth parents, including mental health, but also those unique to their circumstances such as post-placement support—remained “a serious concern” and “something that we need to pay close attention to”.
34.Adoptive families are able to access support through the Government’s Adoption Support Fund (ASF), which provides funds to local authorities and regional adoption agencies to pay for essential therapeutic services for eligible adoptive and special guardianship order families. Dr Armstrong Brown praised the impact of the Fund as “fantastic”, but also highlighted that demand for this funding has been outstripping supply during covid-19. She told us that in response to the pandemic, the Government had expanded the range of support services that could be accessed through the ASF and that this broader scope provided “a really strong set of things to build on”. She called for the ASF to receive “long-term, ring-fenced funding, potentially at a higher level”. In its recently published Adoption Strategy, the Government stated that 2021–22 funding for the ASF will be £46 million (an increase of £1 million compared to 2020–21) but did not confirm whether the wider range of support services that were accessible last year would continue to be in scope for the Fund in 2021–22.
35.We welcome the Government’s confirmation of the increased Adoption Support Fund budget for 2021–22. We agree with our witnesses that long-term funding for this initiative should be made available, as part of comprehensive and ongoing support for adoptive parents to overcome the challenges they have faced during covid-19.
36.We recommend that the Government conduct a review of the services funded under the Adoption Support Fund’s expanded scope in 2020–21, to consider which of the services temporarily offered in response to covid-19 should continue to be in scope for the Fund in future, or even scaled up and offered as standard across the whole of England. The review’s findings should be published in advance of the 2021 Spending Review, to ensure the long-term funding necessary to achieve this can be included in future departmental spending allocations.
16 [Sally Hogg],
17 Centre for Mental Health, 16 March 2021 (accessed 17 September 2021)
18 Royal College of Psychiatrists, 1 July 2021 (Accessed 17 September 2021)
21 NHS England, (Accessed 17 September 2021)
22 NHS England, 6 April 2021 (Accessed 17 September 2021)
24 See Annex: Recommendations from July 2020 report, Recommendation 13
25 Department of Health and Social Care, 27 March 2021 (Accessed 17 September 2021)
26 Department of Health and Social Care and Cabinet Office, p.16, 27 March 2021 (Accessed 17 September 2021)
27 [Dr Sarah McMullen]
28 [Dr Sarah McMullen]
31 [Dr Sarah McMullen]
34 Ministry of Housing, Communities and Local Government, (last updated 17 May 2021, withdrawn 23 July 2021) (Accessed 17 September 2021)
35 Department for Digital, Culture, Media & Sport, (last updated 1 September 2021) (Accessed 17 September 2021)
36 Department for Education, (last updated 17 August 2021) (Accessed 17 September 2021)
37 Petitions Committee - Summary of survey: The impact of Covid 19 on new parents - one year on - ()
39 [Dr Sarah McMullen]
40 [Sally Hogg]
41 Institute of Health Visiting, 21 December 2020 (accessed 17 September 2021)
43 See Annex: Recommendations from July 2020 report, Recommendation 9
44 Petitions Committee, Second Special Report of Session 2019–21, , p.12, HC 770
45 Department of Health and Social Care, , 20 August 2021
50 For example, the Government’s announcement of this expansion cited couples’ therapy and online counselling as examples of services which could be funded via the ASF in 2020–21. See Department for Education, 10 April 2020 (accessed 17 September 2021)
52 Department for Education, 26 July 2021 (Accessed 17 Septemebr 2021)