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Queen’s Speech

My Lords, I begin by drawing attention to my interests as set out in the Register. Child poverty remains one of the major concerns of the UK Government. The current Administration have failed to meet their targets, despite child poverty eradication being a key priority. The Child Poverty Bill in the gracious Speech will again attempt to address that issue, by imposing a new legal duty on the Government to eradicate child poverty by 2020. It is estimated that 4 million children, or 30 per cent of all UK children, live in poverty, and that is often associated with child abuse or neglect. Overall, it has recently been estimated that 16 per cent of children are physically abused and that 10 per cent are neglected or sexually or psychologically abused. That is because families with economic problems, such as unemployment, have a 16 times greater chance of abusing their child compared with other families with children aged under five. Furthermore, perpetrators of violence target single mothers and their children, such that there is a 12 times greater chance of a child being maltreated in a single-parent family. To tackle that problem, we have to look further than ensuring that children from low-income families do not lose out on opportunities at school, or in the local community, because of the cost of school trips, family outings or car-parking charges to visit parks and recreation grounds—not to mention hospitals. There has to be a systemic change in how we support families and children in need, with a much greater emphasis on home visitation programmes in order to identify families in difficulty and to target services at those most in need. The importance of primary healthcare teams in dealing with this issue cannot be underestimated, as parents with mental illness or drug or alcohol addiction are 10 times more likely to maltreat their children. Children who are in poverty or suffering from neglect or abuse are rarely, if ever, presented to health professionals working in medical centres and clinics. They just do not come. It has long been established and recognised by the World Health Organisation—in, for example, its World report on violence and health of 2002—that home visitation is the most effective way to reach these children and prevent harm and family separation. However, the health-visiting profession has been so drastically affected by recent Department of Health policies that families with newborns are lucky if they receive one visit from a health visitor. The chances of support in the home environment are, again, a geographical lottery, with those areas with Sure Start programmes having better facilities to support low-income families. Successful Sure Start programmes, such as the Essex home visitation care programme, should be identified and rolled out nationally. The Department of Health urgently needs to audit the number of visits that families with newborns receive under different primary care trusts around the country, as that varies dramatically from zero to 12. This information is currently unknown, according to the Community Practitioners and Health Visitors Association, as Unite the union reported on 16 October. Yet no progress can be made without this information. When are the Government making it available? I hope that the Child Poverty Bill will go some way to standardising the home visitation services offered to children and their families, such that minimum standards are established and implemented throughout the country. Yet I fear that without considerable changes and additions to the Child Poverty Bill, that will not be the case and vulnerable children will suffer preventable harm. For example, families with newborns must be visited in the family home by a qualified health visitor at least six times in the first two years of the child’s life for needs to be identified and preventive services offered. How will the Government meet that target? I am aware of the Department of Health’s 10 pilot programmes around the UK—at a cost of £7 million—under the nurse-family partnership scheme, which effectively reduces social exclusion for first-time mothers and promotes maternal and child health through weekly home visitations before and after birth. However, with one nurse per 25 families that scheme is so costly that it could never be rolled out nationally; it could only be applied to a fraction of those first-time mothers in poverty. Even then, by not offering home visitations to second or third-time mothers, the Government will miss 70 per cent of those children who will suffer maltreatment. How do the Government plan to incorporate those children in a new and effective programme? The National Health Service, as I have demonstrated, is surely significantly lacking in these critically needed preventive healthcare programmes, especially for mothers and vulnerable children at home. Yet there is an important World Health Organisation programme which is already in full and effective implementation in a number of countries outside the EU and which fills the immense gap that I have just identified of home visits by a professionally trained health education expert. I refer to the World Health Organisation’s women health volunteer programme. This may, with advantage, be complemented by health education in schools and the establishment of nurse-led health posts, which are best placed in the outreach of a primary health centre catchment area to support the mother from a geographical position closer to her than the primary healthcare centre to which the health posts belong. Community health education meetings of large groups are the final supplement to this preventive healthcare programme. I turn to the World Health Organisation’s women health volunteer programme as practised to the fullest extent in a country with which we are all familiar and by an NGO that I chair. The AMAR foundation trains and supports over 1,000 women health volunteers from the most underserved and marginalised communities in Iraq. These professionally trained women visit the homes of vulnerable families in their community. They bring vital professional healthcare advice and information, with formal teaching and informal materials on life-saving preventive health topics, such as malnutrition, vaccination, sanitation, breastfeeding and child nutrition. They refer back pregnant women, postnatal mothers and other members of the family who require health interventions to the primary health centre. The women health volunteer programme forms an integral part of the primary health centre’s mother-child healthcare work. The women health volunteers are continuously trained and supported and then report back to the primary healthcare managers and health professionals. The reach of such a programme is immense. In Iraq, every single one of the 1,000-plus volunteers is responsible for 50 families in the community. Across Iraq, this whole network of women health volunteers at this moment visits 28,000 families every month, reaching 250,000 vulnerable people, and identifying and supporting preventive and curative health needs. Perhaps even more importantly, the programme empowers the women volunteers themselves, providing them with sustained health education, alleviating the poverty that they too suffer and enabling them to shape the health of their families, their community and the nation. The results speak for themselves. Simple statistics show the impact of the women health volunteer programme. It is a statistically based programme and the information feeds back into each family file and personal medical record in the primary healthcare centre. That medical record—depersonalised, of course—builds up the health profile of the nation. There has, for example, been a huge upsurge in the immunisation of pregnant women and children through women health volunteer referrals to the primary health centres. There has been a similar upswing in the use of mother-child health units in the primary healthcare centre by mothers, both prenatally and postnatally. There has been a great upsurge in the use of child health services, including medical consultations, due to the referral system that the WHVs employ. The objective is to lift the health of the whole catchment area of the primary health centre. Since women are the primary users of health services, as we know, naturally it has impacted most beneficially on women and children. In this situation, in a rather vulnerable country, it is gladdening to see that there have been no cholera cases in the catchment areas where the women health volunteers are operating. This programme, when it is combined with the health education programme in schools, whereby 78,000 children in 147 schools in Baghdad are taught preventive healthcare in class twice-weekly, plus the placing of nurse-led health posts within the reach of mothers in the hearts of their communities, has an effect on the health of the whole catchment area that is dramatic, evidence-based and wholly positive. We need this programme here. The women health programme does not only function in Iraq, and the World Health Organisation would like to see it in all countries that have signed the Alma-Ata declaration of 1978. This places public health at the heart of the programme of health for the country in question. I have other first-hand experience of its success in countries as diverse as Lebanon, other countries in the eastern Mediterranean region of the World Health Organisation and elsewhere. To cut child poverty in a shorter space of time, I urge the Government to consider adopting a real focus on preventive healthcare through the programmes I have described so briefly, which supplement and bridge the gap between the fully professional health visitor programme and mothers outside that programme, who form the bulk of our UK population, whom current government health programmes can never reach. In addition, it is a great supplement to the services provided by the primary healthcare trusts. I stand ready to provide information to the various government departments that deal with these issues affecting children and women, especially the Department of Health. This Government have had many good ideas and have identified the need to tackle child poverty on many occasions. The gracious Speech has again mentioned our national and natural desire to cut child poverty as fast as possible. I hope very much that this time the Government will succeed. I ask them to think not just of regulation and of legislation but of the simple programmes that I have outlined which I believe could be just as effective here as in several other countries that I have mentioned.