Wednesday 17 October 2018 / 2:30 PM Jonathan Ashworth

Jonathan Ashworth speech to Unite-CPHVA Conference


Jonathan Ashworth MP, Labour’s Shadow Health Secretary, speaking in Bournemouth at the Unite-CPHVA Conference at 11:45 today, said:

It is a pleasure to join you this morning at your Conference because I speak to you as Labour’s Shadow Health Secretary and a member of the Unite trade union. But I also speak to you today – for what is my third speech to this Conference – as a father who has seen for myself the extraordinary dedication, commitment, compassion and professionalism of community practitioners and health visitors.

I have two little girls both of course born in NHS hospitals, two healthy happy beautiful little girls. Gracie is 7 and Annie is 4.

But I recall when they were born, as tired anxious parents not sure if everything was ok, worrying about every little small thing so we turned to our health visitors to guide us.


And so the reason I was keen to come here today and speak to you, but more importantly listen to you, is because I wanted to thank community nurses, practitioners, health visitors, school nurses for everything you do day in, day out week after week.


Through your care and support, you touch the lives and relieve the suffering of so many. You share in the delight and rejoicing with a family with their newborn child and comfort others with their suffering.


From my own experience as a father and an MP in the city of Leicester, it’s clear to me you represent the very best of our National Health Service.

Caring for the current generation and ensuring the next generation has the best possible start in life. And as we look back upon the 70 years of our NHS, we remember that our NHS stands today as a beacon of hope for all because of its staff including all of you that have sustained it throughout its existence so I pay tribute to you today for everything you do.


When I first addressed this Conference two years ago I said I wanted to spend time on the frontline seeing the work Health Visitors do first-hand.


I hope I can soon spend some time shadowing school nurses as well because the experiences of shadowing Health Visitors were incredibly uplifting as I witnessed the extraordinary lengths you go to care for new parents with their babies.


But the experience also brought home to me the intense pressures you are under. So it is no surprise to me that Unite’s recent analysis shows health visitors struggling with dangerously high caseloads.


For example, health visitors in the London borough of Hounslow have average caseloads of 829 children under five- the highest in England.


Similarly, health visitors in Luton and Peterborough are each looking after 756 children, while in Croydon, south London, it is 591.


We know from an Institute of Health Visiting survey that more than 1 in 5 health visitors are working with caseloads of over 500 children. This is a stark deterioration compared with 1 in 8, reported in a similar survey conducted in 2015.


In all cases, substantially more than the recommended maximum caseload of 250 children if care is to be safe and of the highest quality.


It means intense pressures on health visitors on the ground with potentially serious consequences.

In August, the Care Quality Commission warned Birmingham Community Healthcare Trust that it was concerned about aspects of its performance, including that its health visitors were dealing with 500 families each on average


Unite has warned the health visiting service there is “in meltdown”, with Unite officer and my friend Su Lowe powerfully warning:


“We are into unsafe practice territory.”


As Labour’s Health Secretary I would never compromise my commitments to patient safety and its why I’m so concerned about increasing caseloads. We know that high caseloads are bad for babies and bad for parents- mental health problems not dealt with, domestic abuse not spotted. Sometimes with tragic consequences.


Rising caseloads constitute a longer-term cost for the NHS because of the damage which arises from a lack of early intervention and prevention.

We know the first 1001 days of a child’s life, from conception to age 2, are the most crucial for a baby’s development and can have a serious effect on a child’s health, education, brain development and behaviour as they grow up into adolescence and adulthood.

In others words, by giving every child the best possible start in life we create a strong foundation for almost every aspect of their future.


Research, led by the Wave Trust and others, into Adverse Childhood Experiences has found that failing to prioritise early years generates enormous problems for the future in terms of social disruption, inequality, mental and physical health problems, and cost. That’s why for example, I support the Wave Trust’s 70/30 campaign to bring about a 70 per cent reduction in child maltreatment by the year 2030.

So investing in and supporting our Health Visitors will be a priority of mine in Government. The value of Health Visitors was best summed up by a note that a local mum had written and was passed to me on the day that I shadowed Health Visitors.


This mother wrote she had always dreamed of a second baby. She loved being mum to Eve aged 2 and then a few days after Christmas her second baby Mary came along. She had two beautiful young children.


But this mum said “In my mind though I was sinking. I felt more miserable than I’d ever felt in my life. I was trapped. What had I done? I just wanted to run.”

This mum felt guilty about lacking motivation, felt detached and panicked about what would be normally be routine aspects of life.

This mother went to the doctors and the next day the health visitor got in touch. As she says “my health visitor literally came and rescued me.”

The health visitor worked with this mum over the following weeks. Something I know you all do and can relate to.

This mum said of her health visitor that “she turned things around and helplessness turned to hope”.

Helplessness turned to hope, what an extraordinary tribute to Health Visitors.


And yet, despite Tory promises, we are witnessing savage cuts to the Health Visitor workforce.


Today I am unveiling new research which finds that the number of NHS health visitors has been cut by 8% over the past year, whilst the number of school nurses has been slashed by nearly a quarter since May 2010, when the Tories came into office.


The numbers of NHS health visitors are now at their lowest level since October 2012 and have been cut by 8% in just one year.


These cuts to health visitors, school nurses and community nursery nurses expose the Tories’ hollow promises. The truth is that the Government’s cuts are dismantling the country’s public health system, failing some of the most vulnerable in our society and leaving children’s services at risk.


Unlike the Tories, I’m committed to giving every child the best possible start in life and central to our strategy will be delivering more health visitors in every community, ending the stark inequalities which continue to blight our children’s future.


So Labour is committed to expanding Health Visitor numbers not cutting them.


A well-resourced health visiting service also has the potential to reduce the later burden on GPs, Dentists, A&E, CAMHS, perinatal mental health services and, importantly when considering the evidence across the life course, many adult health and social care services too.

For example, when one in 5 new mothers develop a mental health problem around the time of the birth of their child and some 30,000 more women need specialist services, I know how crucial improving perinatal mental health support is, which is why I’ve pledged my support for the Hidden Half campaign.


And because we must do better in England where families generally receive the lowest level of universal health visiting support compared to other UK nations, as Health Secretary it’s my commitment to work with health visitors to implement an additional mandated health visit at 3-4 months backed up by an extra £25 million of investment from our Child Health Fund.


Because unlike the Tories who now try to claim they are ending austerity, a Labour government actually would end austerity in our NHS. This year on our plans the NHS would be getting an extra £7.7 billion, which includes a dedicated £250m Child Health Fund to resource our mission of improving the health of every child.


This would be funded by asking the wealthiest in society to pay more tax.


And because we know we need to recruit nurses, midwives of the future who can become Health Visitors we will bring back the training bursary too.


And instead of cutting public health prevention budgets by £800 million over six years as the Tories are doing we would expand and invest in public health budgets and prevention.


This year alone my research has found that public health will be cut by £96.3 million due to cuts to local authority budgets from central Government. As part of that, smoking cessation budgets are set to fall by £3.1 million, placing increased pressure on health visitors to discourage mothers from smoking in pregnancy.


And instead of imposing swingeing cuts on social care provision which we know is putting so much pressure in the wider NHS we would actually invest £8 billion extra in social care over a parliament.


Ending austerity also means ending privatisation in our NHS, so we would repeal the Tory Health and Social Care Act, and reinstate a universal public National Health Service.


So the challenge for the Government in their budget in the coming weeks is to reverse the cuts to public health budgets and reverse the cuts to social care.


The Healthiest Children


It was Nelson Mandela who told us: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”

I agree so radically improving the health and wellbeing of every child will be a personal mission of mine in a Labour government.


This week we learnt from the RCPCH of the potentially tragic consequences of failing to invest in children and the services they rely on.


The RCPCH predict that by 2030, without urgent action,

Mortality rates may be 140% higher for infants in England than in comparable wealthy nations,

Reported mental health problems are set to increase by 60%, based on current trends,

1 in 3 of the most deprived boys in England will be obese by 2030,

And A&E attendances for children may increase by 50% and outpatient attendances by 48%.

These are shocking predictions, which is why I believe we need a concerted, laser-like focus on improving the health and wellbeing of every child as an absolute priority. Our policy agenda should insist that no child is ever left behind, which is why I am determined that if I become the next Labour Secretary of State for Health, all children are given the very best start in life.


Our task is urgent because despite being the sixth largest economy in the world, health outcomes for babies and young children in the UK are stalling. We are lagging behind most other high-income countries on mortality, breastfeeding and obesity rates.

For example, more than one in three children in year six in our primary schools are either overweight or obese, with a nearly 3% rise on last year.

By failing to act we betray the life chances of so many children who are more likely to go on into adulthood and develop further health problems which in turn of course builds up further pressures on the NHS.


This is already in a context where we now face an obesity crisis of such magnitude, that we are spending around £6 billion a year on the medical costs of conditions related to being overweight or obese and a further £10 billion on diabetes.


And we know that health visitors play a crucial role in promoting the benefits of and support mums with breastfeeding.


But while the positive effects of breastfeeding are universal, there is variation across the country, with particularly low rates of breastfeeding among disadvantaged socio-economic groups.  So as part of our drive for the healthiest children in the world, for Labour in Government, it will be a priority to offer better support to mothers breastfeeding and to reinstate the Infant Feeding Survey.


Poverty and deprivation is a remorseless backdrop, however.


We know there is a direct correlation between children’s relative poorer health outcomes and the material circumstances in which they grow up in.


For example, obesity is twice as common among children living in the most deprived areas as compared to children in the most privileged areas. Two-thirds of boys aged 5-11 from the most deprived backgrounds are predicted to be overweight or obese by 2020 compared to about one in six boys from the most affluent groups.

Or take tooth decay which we know is the leading cause of hospital admissions for 5 to 9-year-olds. Here inequalities in tooth decay remain stark, with 5-year-olds in the most deprived areas of the country almost 7 times more likely to have decay than their peers in the most affluent areas.

In fact, earlier this year the Nuffield Trust has found that the most deprived children and young people were 58 per cent more likely to go to A&E than the least deprived. And they also found that babies born in the poorest areas in the UK weigh on average 200g less than those born in the richest areas, threatening their cognitive development.


So children flourish when freed from poverty and yet by 2022 one million more children are set to grow up in poverty. We must reverse that trend by investing to lift children out of poverty and provide our children with the very best early years support we can. It’s one reason why we want to have the rollout of Universal Credit halted.


We are also facing a crisis in child and adolescent mental health services. For all their talk of parity of esteem, the reality is that this Government is failing young people with mental health problems.

The Children’s Commissioner recently revealed that 800,000 children are living with mental health disorders. That’s the equivalent of a least three young people in every classroom.


However, 3 in 4 children with a diagnosable mental health condition do not get access to the support that they need. Its why investment in early years and school years children health services including school-based mental health counselling and schools nurses becomes even more important for the future too.


So improving the health outcomes of every child is vital for the sake of the next generation, and crucial for the future sustainability of our National Health Service.


Children and young people may be a quarter of our population but they are 100 per cent of our future so today I am challenging Ministers to ensure the NHS long-term plan puts our children first, reverses cuts to public health budgets, reverse cuts to health visitors and reverses cuts to school nurses.


And finally ends the stark inequalities which continue to blight our children’s futures. Anything less would signal the continued neglect of children’s services by this Government.


The Government’s failure on child health is a tragedy for every family affected.


The Tory attack on public health is a national scandal.


The neglect of children’s health and welling is a monumental social injustice.


For Labour, it will be a priority in Government to turn this around.


To work with you to build a new settlement for children’s health, with health visiting, school nursing and community nursing at its heart.


To give every child the best possible start in life as we focus on lifting the health and wellbeing of all our children.


It’s my commitment, together it will be our achievement.


Thank you.