14/11/17 – Talk by Jonathan Ashworth MP

Speaker: Jonathan Ashworth MP, Shadow Secretary of State for Health

14th November 2017 – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

Chair: Jim Fitzpatrick MP
Speakers: Kate Day; Jonathan Ashworth MP

The meeting was opened by the chair of the group, Jim Fitzpatrick MP, who welcomed the members and a group of visiting Early Years undergraduates from the University of Northampton.

Before hearing from the Shadow Health Secretary, a few minutes was given to Kate Day to address the group on the reality of mental health support in schools. Kate Day is a Consultant in Child and Adolescent Therapeutic Services in Devon.

Kate Day

Imagine if right now a child came into this room and told us they wanted to kill themselves. I know we would all want to protect and support them. I would like to tell you a true story.

A young boy aged 14 told us that he planned to jump off a bridge. We contacted our local CAMHS team. Their response was devastating. They could not respond immediately due to a shortage of resources. They could only provide support to those who had already made a suicide attempt. Shortly afterwards, the young boy did jump. He was severely injured but he did not die.

The physical injuries healed but the mental scars were left. He was only offered monthly visits by a CAMHS worker however this rarely happened as the only worker available was on sick leave. Is this the kind of support you would want for him?

Suicide is the most common cause of death for boys aged between 5 and 19 and the second most common for girls

  • 1 in 4 children show evidence of mental health issues
  • 75% of children do not get access to services they need
  • Currently just 0.7% of the NHS budget is spent on children’s mental health.

Evidence also shows that not enough of this inadequate funding reaches the frontline. Instead it is used to back fill cuts or to spend on other priorities. Whilst there appears to be a sea of change in attitudes, and pledges of funding from government, and even royalty speaking out, the rhetoric is still oceans apart from the reality.

A reality myself and others face every day is that many young people are deeply unhappy and their lives and that of their families are being shattered. I work with this distress every day, and am here to represent my colleagues and the children I work with to ask you to fight to ensure that the funding pledged to mental health goes directly through to the frontline where it is so desperately needed.

We need better funding for CAMHS for improving access to counselling in schools as in Scotland and Wales and for the training and supervision of GPs and school staff. We also need a PHSE curriculum designed to support mental health and well-being.

The National Counselling Society have pledged half the sponsorship needed to enable this Group to review the state of children’s mental health. We need to find matching funding. If you can help with this, or want to discuss these issues, please speak with me after the meeting.

Jonathan Ashworth MP, ShadowSecretary of State for Health

Jonathan Ashworth began by thanking Kate Day for her moving speech highlighting the neglect of child and adolescent mental health services, the raiding of budgets, and the underfunding that has taken place over many years.

Let me give a commitment to you as Shadow Health Secretary, that I am absolutely committed to increasing the funding for child and adolescent mental health services, ensuring that budgets are ring-fenced, and ensuring that the extra support that Kate highlighted in her remarks is there in the system as well.

I’ll come back to child and adolescent mental health services but can I start by saying that a big part of being Shadow Health Secretary is to criticise Government for the running of the National Health Service and demanding that the Government put more money into it, being on TV and standing up in the House of Commons, scrutinising decisions and pointing out when things have gone wrong, whether it be the winter crisis in A&Es, waiting lists, fair pay etc.  These are all the things that Shadow Health Secretaries do.  But when I first took on this role I wanted to do more than that, by going back to first principles of why the NHS was created 70 years ago. We did so to relieve the pain and suffering and anguish of those who couldn’t afford to pay for health care. That’s an important principle and one we will always be committed to, but we also created the NHS to provide medical care to every man, woman and child because we wanted an all-out assault on health inequalities in society. So, I see my job (aspiring to being a Health Secretary in a future Labour Government) as, yes, dealing with all the pressures of underfunding and lack of capacity, but also leading a big all-out assault on health inequalities, and if you want to do that, you start with children and child ill-health and child wellbeing.

Looking at the statistics, a child growing up in Britain today is likely to have a worse health outcome than one in economically-equivalent western European countries of similar size, and one born into poverty and deprivation is likely to have worse health outcomes than a child born in more affluent areas.

We’ve seen already that the progress in life expectancy that has been made in 100 years is beginning to tail off. The Marmot Review identified this. We know that poorer children are more likely to leave school obese, they are less likely to have the various immunisations they need, and they are more likely to have more tooth decay and dental problems (which is the biggest reason for child hospital admissions). When you look at the system you can see across the board that – and I don’t want to be party-political – we currently have a Government that has, through cuts to public health budgets, the decommissioning of health visitors, the watering down of the obesity strategy, the refusal to ring-fence CAMHS budgets, allowed our child health indicators to slip down various league tables.

I am committed to doing something about that.

So, for example, on obesity, one of the announcement in the general election campaign was to not only stick with the sugar tax, but also to ban the advertising of junk food and high sugar food during programmes, such as the X Factor, that are known to be family TV viewing. I also said that we would implement child health legislation, making it the responsibility of every single Government department to reduce health inequalities, with particular emphasis on improving the health of every child.

This means investing in the various public health initiatives, for example supporting breastfeeding, investing in anti-smoking and drinking services, investing in dental services, and quite significant sums in child and adolescent mental health services. As we’ve just heard, these services have been affected for too long. Indeed, 50% of CCGs (local health authorities) are raiding mental health budgets to fund other areas because the NHS is under so much pressure.

As a society we have for 70 years, quite rightly, targeted a lot of public investment at small children and babies, who are at the most vulnerable stage of their lives. But the second stage of vulnerability is during the adolescent years, and yet CAMHS has been neglected year after year. It has even been neglected by Labour Governments, although I would argue that we put more money in. We can’t say that the resources going into this stage of vulnerability have anything like matched the resources that have been put into services for younger children. Making CAMHS a real priority in future health policy is something I want to do if I become Health Secretary

One area I’ve spoken about is my own circumstances growing up with an alcoholic father. His alcoholism coloured every aspect of my life from the age of 7 or 8 years old. My parents were divorced and during the time I spent with him at weekends, I had to look after him. Drinking led to his death 6 or 7 years ago. When I became Shadow Health Secretary I decided that I wanted to start speaking out about these issues and I started talking to various charities. According to one estimate at least, there are two million children growing up with an alcoholic parent, and there are hundreds of thousands of children growing up with a parent who has a substance misuse problem. These children are more likely to develop alcoholism or addiction themselves, or mental and, in some cases, physical health problems. It’s a cohort of the population that has been ignored by the policies.

Children growing up in obviously chaotic families are normally identified by Social Services, and there are policy mechanisms in place, and although we can have a debate about whether they are satisfactory, we know that there can be a response from the State for them. Unfortunately there are many more children behind closed doors where the child is effectively the carer and yet the family looks stable on the outside and so they will never be identified as needing support.

So one area I want to do is to formulate a Government-wide strategy to support children of alcoholics and substance misusers. Child health and child wellbeing is a big priority for me. In the past Governments have made pledges and goals to defeat and abolish child poverty and as well as having that goal, I think that we should have a goal to have the healthiest children in the world. It’s a big ambition, but I don’t think it’s acceptable that a child growing up in England should have worse health outcomes that one growing up in other nations, and it’s absolutely disgraceful and offensive that a child born into poverty has worse health outcomes and life expectancy rates than a child born is wealthier parts of society.

Questions and Comments (taken in batches)

Sarah Clothier, Slimming World: You mentioned that the obesity strategy was watered down and I wondered if there is any hope that it will receive more attention in the future?

Estelle McKay: Related to that, Liverpool is trying to ban the Coca Cola bus from visiting 40 cities across the country during the festive season. At the time when we are talking about PHE trying to put an obesity strategy in place, we have right in the face of it this Coca Cola bus going round full of Christmas cheer and plenty of product while the company is saying that they don’t advertise to children. I’ve got a file of papers from Liverpool here that I’d like to pass to John Ashworth.

Mohsin Ali Chaudhary, British Society of Paediatric Dentistry: Government policy for dentistry is that it should be a consultant-led service and yet the shortage of consultants that we have in paediatric dentistry is huge.

Jonathan Ashworth: Workforce planning across the NHS has been woeful over the years, and this is partly to do with the complicated landscape that the NHS now finds itself in, partly due to being unclear as to who is responsible for workforce issues – is it NHS Improvement? is it Health Education England? is it the Secretary of State? A lot of the changes that were brought in by the 2012 Act created a very fragmented NHS which has exacerbated workforce issues. Jeremy Hunt says that he is now trying to deal with workforce issues: whether he will or not, we’ll see, but obviously with Brexit looming and training places having been cut, I don’t have much confidence that he’ll resolve the dentistry issue. I’ve said today that I think we should be putting an extra £6bn into the NHS, and we should be training more, and although we’ve said to the current overseas NHS employees that they can say, the NHS should also be able to continue to recruit from overseas.

On obesity, in fairness to David Cameron and probably Jeremy Hunt too, they were planning to be quite radical but Theresa May came along and ripped it all up. She has the old-fashioned attitude of “it’s up to you if you want to eat and drink too much.” I’ve got no confidence that we’ll hear any more about this.

On the Coca Cola bus, I don’t like it but I don’t know if I’d ban it, but I’d ban the advertising of it. I’ll look at the papers.

Dr Eunice Lumsden, University of Northampton: We have a real issue about the policies keeping pace with each other, e.g. the policies of the Department of Health not working hand in hand with the Department of Education, which is creating some real mental health issues for some of our youngest children. We might have investment in the early years but that investment is leading to children being separated from environments which would help their development and mental health. How are we going to address the disjointedness and the waste of money that is happening at the top level of politics?

Olivia Rutland: Are you planning on supporting a balanced diet? e.g. you would ban Iceland from TV advertising but Iceland sells affordable frozen vegetables. How are you going to go about supporting early intervention around a balanced diet?

Jonathan Ashworth: To address wellbeing and the health of every child doesn’t mean that the Dept. of Health and the Dept. of Education need to work closely together, particularly around investment in early years. I’m a believer in investing in Sure Start, and investing in Health Visitors so that we have a highly qualified health visitor workforce visiting mums and dads, is very, very important.

This links into the second question, because if you invest in the early years you can promote healthy eating because Health Visitors and Sure Start are very well placed to help families with issues like nutritional meals. So when I say “banning Iceland” what I mean is that I’m very happy for them to advertise their frozen peas, but it’s when they advertise their cakes and hot dogs and that sort of thing. I don’t mean a complete ban, just when it’s directed at children, for example during programmes like the X Factor which families watch together. Children see the adverts and make demands, and the advertisers know this. Unhealthy children grow into unhealthy adults as we know, and unhealthy adults cost more money and the NHS picks up the tab. There’s an economic case for making interventions because healthy adults mean a healthy workforce and that means it’s in the interests of the economy.

At this point (18.45) Jonathan Ashworth left the meeting and the group was given the opportunity to put questions and comments to Kate Day for the remaining time.

Ally Tansley   Association for Physical Education: Is there any credit to the idea of  training up a member of staff in every school to be a counsellor, so that you have someone qualified to deal with issues immediately without having to wait for counselling services?

Charlotte Davies, Fit2Learn: We are doing lots of work getting children to develop properly, particularly in motor skills. We have nobody really trained properly in child development: we need a curriculum that checks child development. A very important ability is connected with what’s known as your Moro Reflex. If you cannot work across your midline you are triggering constantly into anxiety. Because we do not make children suppress their Moro reflex, we’ve got about half our kids constantly in a state of anxiety – and that is something you can correct in 30 days. But we just do not do PE properly in this country – we need a proper PE curriculum.

Kate Day: I would like to see England follow suit with Wales and Scotland where they have counsellors in every school, and I am campaigning for that. I am in Devon and Cornwall, who are broadly supportive, but some schools have one part-time counsellor to 1600 students, while others have three full-time counsellors. We know that they are fielding a majority of these cases and holding quite serious mental health issues. So, yes, I absolutely agree that there should be a counsellor in each school. I think that there also should also be a wellbeing practitioner trained in medical issues, especially because nurses are being withdrawn and we need someone who can deal with e.g. children who are self-harming, taking overdoses, etc. where non-medically trained teachers are having to attend.

PE and Movement: trauma is sometimes linked to lack of movement and sometimes when a client is really distressed it can sometimes be about getting them to move.

Sharon Smith, University of Northampton: You mentioned early intervention. I think having a curriculum with mental health embedded in the early years is really important.

Dr Vicky Randall, University of Winchester: We have high funding in primary education regarding health generally, but can you see any potential in how can we make things more effective, for example working with stakeholders like yourself to address a more holistic health, rather than throwing it all down a sport route?

Kate Day: Have you heard of the ACT approach? An American psychologist says we can’t work with these things in isolation so I’m a great believer in looking systemically. We can’t work with a young person in distress without asking about sleeping, eating, social interaction, etc. Sometimes as well it’s about language and how it’s used: they might say that they’re depressed and we sometimes have to tell them that it’s ok and normal to be sad, and also that sometimes, anxiety can be a good thing.

At this point Jim Fitzpatrick left the meeting in response to the division bell.

Kate Day: I would like to see a more systemic approach to helping children, and that does include physical education as well.

Jillian Pitt, MyTime Active: I work in child weight management services in schools in three London boroughs, and of the four criteria that schools need to achieve to get their bronze award, one of them is PHSE policies on emotional literacy and wellbeing. From 2010 all funding was cut from the National Healthy Schools Programme. It was subsequently re-introduced as a pan-London initiative, but now that funding is drying up. Is it now time to make a case to revitalise the Healthy Schools Programme?  The framework is there, and it’s shown to be working in West London, where we work with partners like Mindup. Lots of schools are inviting those partners to work with them and e.g. introducing mindfulness into the daily life of students with amazing results. What do you think about that, and about more mindfulness being embedded into a school’s mental health policy?

Kate Day: I agree. The literacy around emotion needs to start very young, talking to children at a young age about what are normal emotions. It also needs to involve training teachers in the way they talk to young people about emotions. We might find that this mental health crisis may push this PHSE to happen. It does need a re-route.

Ally: I am a new mother and also a teacher. A lot of the conversations are around the topic of what the services and teachers should be doing and we don’t have many conversations about what parents should be doing. I feel like I am making it up as I go along each day. I’ve got a secure network, lots of support and a good income and I’m probably not the type of cohort that our group is writing reports on, but that’s not to say that we don’t matter. I think that there should be more information coming to me about healthy eating, wellbeing and health and all of that. I think there should be more drip-feeding of information to keep us informed.

Kathryn Peckham: I work with nurseries, schools and parents. You’re right, there are a lot of parents who don’t know what’s best, and it’s not that they can’t understand – they just don’t get the right information. It’s not hard to understand but it doesn’t get through.

Charlotte Davies, Fit2Learn: We’ve just written a book.

Kate Day: I agree about parenting and I’ve been trying to work with parents of teenagers, getting them together to discuss what’s going on around issues like sleep. It needs to come from a collaborative approach, though, and not dictating what to do. We have a lot of parents who are not actually parenting, not setting boundaries etc., for fear of getting it wrong.

Dr Eunice Lumsden, Northampton University: We have a catastrophe going on because of disjointed policy, with youngest children being separated from their primary caregivers for extended periods of time. We had an agenda coming down from schools earlier this summer saying very clearly that children aren’t ready for school. We’re not allowing them to be children, we’re not working alongside parents supporting them with our new knowledge about things like brain development. We have an early years policy, but it’s damaging children in so many ways. We have to lobby MPs. A year ago £75m was given out for development of school leaders, and part of the next strand of that is about mental health and another £45m will be given out in January to address the issues that we are creating because of the disjointedness of health education and social care. I don’t know what to do about it, other than keep shouting, but nobody is listening because it’s on nobody’s agenda.

Charlotte Davies Fit2Learn: We are going to the skills show on Thursday and I will be taking screen shots from graduates who cannot combine bilateral integration with sound processing and vision. This shows why we have a skills gap.

Dr Eunice Lumsden, Northampton University: The graduates this year will be the second lot who did national strategies from the age of five, so we see a really big difference when they come into university because their creativity is gone and they are unable to think for themselves because they are very much used to revision guides. So we see that because that’s part of the education system, but we also see at the other end a policy about women going back to work very early.

The meeting ended at 1900.