To ask His Majesty’s Government whether, and if so when and how, the learning from the results of the Better Start longitudinal programmes will become pregnancy and early years policy and be implemented.

To ask His Majesty’s Government whether, and if so when and how, the learning from the results of the Better Start longitudinal programmes will become pregnancy and early years policy and be implemented.

My Lords, we welcome the valuable learning that is emerging from the five Better Start partnerships and we look forward to the national evaluation report in the spring. The programmes provide important insights into early-years support in highly disadvantaged areas. Best Start Family Hubs and Healthy Babies already deliver a place-based prevention focus model. We will consider Best Start evidence, alongside other evaluations, as we develop policy to deliver a new neighbourhood health service and raise the healthiest generation of children ever.

My Lords, we welcome the valuable learning that is emerging from the five Better Start partnerships and we look forward to the national evaluation report in the spring. The programmes provide important insights into early-years support in highly disadvantaged areas. Best Start Family Hubs and Healthy Babies already deliver a place-based prevention focus model. We will consider Best Start evidence, alongside other evaluations, as we develop policy to deliver a new neighbourhood health service and raise the healthiest generation of children ever.

The work in Bradford is to be commended. I can assure my noble friend that, through Best Start Family Hubs and Healthy Babies, local authorities will be expected to do exactly what the noble Baroness says is happening in Bradford: that is, to establish very inclusive and diverse routes for parent and carer participation. We want families to shape how services are set out and I absolutely agree that the first 1,001 days of a child’s life is a crucial and critical developmental window.

The work in Bradford is to be commended. I can assure my noble friend that, through Best Start Family Hubs and Healthy Babies, local authorities will be expected to do exactly what the noble Baroness says is happening in Bradford: that is, to establish very inclusive and diverse routes for parent and carer participation. We want families to shape how services are set out and I absolutely agree that the first 1,001 days of a child’s life is a crucial and critical developmental window.

It is an important point that the noble Lord raises. This is being dealt with by the Government’s proposal to have a three-month consultation, so that we get it right in terms of acknowledging the concerns and challenges of screen time for children. So, I take the point that the noble Lord has made. This is of course a matter for DSIT. I will ensure that it is aware of the noble Lord’s comments, as well as the relevant departments—my department and the Department for Education—in respect of the programme that we are talking about.

It is an important point that the noble Lord raises. This is being dealt with by the Government’s proposal to have a three-month consultation, so that we get it right in terms of acknowledging the concerns and challenges of screen time for children. So, I take the point that the noble Lord has made. This is of course a matter for DSIT. I will ensure that it is aware of the noble Lord’s comments, as well as the relevant departments—my department and the Department for Education—in respect of the programme that we are talking about.

I hope I can be helpful to the noble Baroness. In the Best Start for Life strategy, we committed that each Best Start Family Hub will have a children and family services practitioner to support children and families who have additional needs. I feel that this new offer will help parents to

understand their child’s development and identify emerging needs sooner. Importantly, it will also support vital join-up across the services, keeping children who have particular needs at the very centre.

I hope I can be helpful to the noble Baroness. In the Best Start for Life strategy, we committed that each Best Start Family Hub will have a children and family services practitioner to support children and families who have additional needs. I feel that this new offer will help parents to

understand their child’s development and identify emerging needs sooner. Importantly, it will also support vital join-up across the services, keeping children who have particular needs at the very centre.

As my noble friend knows, we are absolutely focused on improving quality and consistency of care for women throughout pregnancy, birth and the critical months that follow. That is why we have appointed the noble Baroness, Lady Amos, to lead an independent investigation and why the Secretary of State will chair a maternity and neonatal taskforce to address the recommendations of the investigation. It is very much part of our work to give babies the very best start in life.

As my noble friend knows, we are absolutely focused on improving quality and consistency of care for women throughout pregnancy, birth and the critical months that follow. That is why we have appointed the noble Baroness, Lady Amos, to lead an independent investigation and why the Secretary of State will chair a maternity and neonatal taskforce to address the recommendations of the investigation. It is very much part of our work to give babies the very best start in life.

My recollection from debating that point previously is that we are looking at the evidence and the best way to tackle the issue that the noble Baroness raises: in other words, what best supports children to have that healthy and best start in life? We are looking at this in the round and I am sure that we will return to it, but I will also be pleased to follow up in writing to the noble Baroness.

My recollection from debating that point previously is that we are looking at the evidence and the best way to tackle the issue that the noble Baroness raises: in other words, what best supports children to have that healthy and best start in life? We are looking at this in the round and I am sure that we will return to it, but I will also be pleased to follow up in writing to the noble Baroness.

This will not be a top-down approach. We are ensuring that Best Start Family Hubs and Healthy Babies are in every local authority area. That is a major development, because from April it will reach more than 500,000 more children. It will also help us transition to neighbourhood health services. However, all of this will, as ever, be more successful by working together with other groups, including third-sector organisations such as BRITE Box.

This will not be a top-down approach. We are ensuring that Best Start Family Hubs and Healthy Babies are in every local authority area. That is a major development, because from April it will reach more than 500,000 more children. It will also help us transition to neighbourhood health services. However, all of this will, as ever, be more successful by working together with other groups, including third-sector organisations such as BRITE Box.

I think I heard what my noble friend said: I got the gist. What matters is not just that we are in a position where children’s health and well-being is not where it should be but that we are pulling together all the best examples of practice, including Sure Start and family hubs, and investing in provision, services and information. This will take us forward to a situation where we genuinely have the healthiest generation ever. That is not something we have now, particularly in the more disadvantaged areas.

I think I heard what my noble friend said: I got the gist. What matters is not just that we are in a position where children’s health and well-being is not where it should be but that we are pulling together all the best examples of practice, including Sure Start and family hubs, and investing in provision, services and information. This will take us forward to a situation where we genuinely have the healthiest generation ever. That is not something we have now, particularly in the more disadvantaged areas.

They do: I completely agree. That is why they are very much part of our delivery plan. It is part of the move from hospital to community: part of the neighbourhood service model. We will be publishing the workforce plan in the spring; that will take account of it. This is a multidisciplinary approach. We are seeing more midwives. We are also seeing more consultants in obstetrics, for example, although I know that the noble Baroness was not referring particularly to that. We are also developing stronger health visitor teams. They all matter, because they bring the care closer to home in a way that will make the greatest impact.

They do: I completely agree. That is why they are very much part of our delivery plan. It is part of the move from hospital to community: part of the neighbourhood service model. We will be publishing the workforce plan in the spring; that will take account of it. This is a multidisciplinary approach. We are seeing more midwives. We are also seeing more consultants in obstetrics, for example, although I know that the noble Baroness was not referring particularly to that. We are also developing stronger health visitor teams. They all matter, because they bring the care closer to home in a way that will make the greatest impact.

Yes; that will be extremely helpful in this regard, and I thank my noble friend.

Yes; that will be extremely helpful in this regard, and I thank my noble friend.

The noble Baroness is right that consanguineous unions are decreasing. While it had the best data, the NIHR-funded study, Born in Bradford, to which the noble Baroness and I have referred, found that between 2000 and 2010, 39% of British Pakistani couples in Bradford were first cousins. However, that reduced by 27% by 2019, for the reasons suggested. Driving change across whole ranges of areas makes a difference, but it is important that we keep this in perspective and make any communications and support absolutely appropriate.

The noble Baroness is right that consanguineous unions are decreasing. While it had the best data, the NIHR-funded study, Born in Bradford, to which the noble Baroness and I have referred, found that between 2000 and 2010, 39% of British Pakistani couples in Bradford were first cousins. However, that reduced by 27% by 2019, for the reasons suggested. Driving change across whole ranges of areas makes a difference, but it is important that we keep this in perspective and make any communications and support absolutely appropriate.

I understand the point that the noble Lord is making, but this is a very complex topic in respect of which there is a great lack of reliable data. Any plans for any health information campaign anywhere clearly need to be considered carefully. Perhaps I can reassure the noble Lord that staff from the Genomic Medicine Service are already working with other national projects, such as Born in Bradford and Best Start for Life in Birmingham, to engage with the communities most affected by first-cousin marriage. Of course, any campaign plans for Shetland and Orkney will be a matter for the Scottish Government.

I understand the point that the noble Lord is making, but this is a very complex topic in respect of which there is a great lack of reliable data. Any plans for any health information campaign anywhere clearly need to be considered carefully. Perhaps I can reassure the noble Lord that staff from the Genomic Medicine Service are already working with other national projects, such as Born in Bradford and Best Start for Life in Birmingham, to engage with the communities most affected by first-cousin marriage. Of course, any campaign plans for Shetland and Orkney will be a matter for the Scottish Government.

The noble Lord is absolutely right that there is a whole range of factors in this area, and I am grateful to him for bringing that before your Lordships’ House. He will of course be aware of the main pillars in the 10-year plan: for example, moving from sickness to prevention, which is key. The noble Lord also mentioned tackling smoking, which we will continue to drive forward. But I wanted to use the Question to highlight that the NIHR is undertaking research projects into improving early recognition, diagnosis and treatment of specific genetic and congenital diseases, particularly in communities with high rates of marriage between close relations. So, to the specific point, I again hope that that will be helpful.

The noble Lord is absolutely right that there is a whole range of factors in this area, and I am grateful to him for bringing that before your Lordships’ House. He will of course be aware of the main pillars in the 10-year plan: for example, moving from sickness to prevention, which is key. The noble Lord also mentioned tackling smoking, which we will continue to drive forward. But I wanted to use the Question to highlight that the NIHR is undertaking research projects into improving early recognition, diagnosis and treatment of specific genetic and congenital diseases, particularly in communities with high rates of marriage between close relations. So, to the specific point, I again hope that that will be helpful.

To ask His Majesty’s Government what plans they have to address the health and social impacts of first-cousin marriage, including those relating to women’s rights.

To ask His Majesty’s Government what plans they have to address the health and social impacts of first-cousin marriage, including those relating to women’s rights.

My Lords, NHS England continues to drive improvements in care and access to genetic services for all communities,

including through research into the health risks of closely related couples—second cousins or closer—having children. In 2024-25, there was an investment of £1 million in the Genetic Risk Equity project, which supports equity of access to genetic services for the small proportion of closely related couples who have a higher risk of having children with certain genetic conditions.

My Lords, NHS England continues to drive improvements in care and access to genetic services for all communities,

including through research into the health risks of closely related couples—second cousins or closer—having children. In 2024-25, there was an investment of £1 million in the Genetic Risk Equity project, which supports equity of access to genetic services for the small proportion of closely related couples who have a higher risk of having children with certain genetic conditions.

I am grateful to my noble friend for those very informed observations, and I share the assessment that he has made.

I am grateful to my noble friend for those very informed observations, and I share the assessment that he has made.

I certainly have not, and I am not aware of discussions that have taken place between Ministers or officials in our department and those in other countries. However, I will be very glad to look into that and to write to the noble Baroness.

I certainly have not, and I am not aware of discussions that have taken place between Ministers or officials in our department and those in other countries. However, I will be very glad to look into that and to write to the noble Baroness.

I thank the noble Lord for his support in this area, which is indeed sensitive. The statistics he quotes are quite right. It is of course an interesting reflection that the risk of genetic abnormalities does not just double from 3% to 6% in those infants whose parents are first cousins, but also doubles in older white British mothers—I am a bit worried about saying “older” because it is actually over 34. However, the point is well made that it is not just this group. NHS England has recently published guidance to improve the recording of national data on closely related couples, so I hope that noble Lords will find this of interest as we go along. But of course, there has also been much investment in research as well as data development, and I absolutely agree that data is what has to drive us.

I thank the noble Lord for his support in this area, which is indeed sensitive. The statistics he quotes are quite right. It is of course an interesting reflection that the risk of genetic abnormalities does not just double from 3% to 6% in those infants whose parents are first cousins, but also doubles in older white British mothers—I am a bit worried about saying “older” because it is actually over 34. However, the point is well made that it is not just this group. NHS England has recently published guidance to improve the recording of national data on closely related couples, so I hope that noble Lords will find this of interest as we go along. But of course, there has also been much investment in research as well as data development, and I absolutely agree that data is what has to drive us.