Murdo Fraser speaking in the Scottish Parliament on the Early Intervntion in Health and Education debate - 10.02.2011

Speaking in this morning's Scottish Conservative debate on Early Intervention in Health and Education, Murdo Fraser MSP, Shadow Cabinet Secretary for Health & Wellbeing, said (check against delivery):

I am pleased to open the Conservative Party business this morning on Early Intervention in Health and Education.

The early years of a children's development provide the basis for all areas of the rest of their lives. This might seem like an obvious point to make, but it is one that is often overlooked in the provision of health and education. Too often problems and issues begin to be addressed only once they have developed fully, rather than a concerted effort being made to provide the best service of care in the initial stages of life.

The importance of early childhood development and the impact of early intervention in determining future health, social-wellbeing and educational achievement is widely recognised. There is a large and growing body of empirical evidence which highlights the importance of child and parental interaction in the early years of life with regards to the child's physical and mental wellbeing and future developmental path.

These early years have a huge impact in terms of outcomes for the rest of a child's life. Dr Wilson of the University of Glasgow, who provided evidence to the Health and Sport Committee on this very issue in 2009 and the finance committee on preventative spending in October 2010, highlighted the key role that early intervention has in the trajectories of young lives.

He said:

"There has been an enormous blossoming in the evidence base on ways of identifying early in life the children who are going to follow a problematic and painful trajectory."

Investing early in the health and education of young children has been shown to provide a better return on the time and resources spent, both in terms of financial capital in skills-based outcomes, and in terms of emotionally able young people.

Dr Wilson goes on to say

"There is robust evidence that expenditure in the preschool years gives the highest rate of return on investment in human capital...Public expenditure on the under-3s is minimal when compared with expenditure on any other age group... there is no doubt that early intervention with vulnerable families by nurses is highly effective, and cost-effective"

The later it is left, the less the investment actually provides.

Armed with the ability to act early, to identify issues and potential problems before they impact all too greatly on a child's development, it remains a great mystery to us why more emphasis is not put on resourcing all who work in intervention to safeguard the future of Scotland's upcoming generations by affording them a solid start in life.

In terms of education the quality of the child's first years of life is strongly associated with his/ her educational achievements in later life. Investing time and resources in the initial months and years of a child's learning reaps many benefits throughout subsequent years.

In terms of health, it is clear that conditions in early life have long-term effects on health and wellbeing; childhood is the key stage for developing the resources which underpin adults' physical and emotional health, their social identities and their behaviour. For instance, David Old's seminal work in the US on home intervention from health professionals showed that for around 30 hours of input between mid-pregnancy and the age of two years, can halve criminal behaviour, substance abuse, smoking, absconding and high risk sexual behaviour by age 15; many of which, unfortunately, are issues that this parliament has to seek to address through legislation.

The Scottish Conservatives are committed to providing this early intervention to a high standard universally. For too long has the provision of the best supportive care for young children been a postcode lottery, only available to those whose health boards have chosen to provide regular contact with health professions as a matter of course, or only for those in the "additional" or "intensive support" brackets.

As such the Scottish Conservatives have pledged to invest £20 million each year in the recruiting, training and maintaining of health visitors in Scotland, who we believe are one of the most valuable assets that we hold for effective support and intervention.

Members of other parties will rightly ask at this stage, how can this be afforded? We in the Scottish Conservatives have been quite clear that we oppose the abolition of prescription charges for those, like MSPs, who can well afford to pay, when this will take precious resources out of the NHS. By restoring a prescription charge of £5, we would save £37 million, and we would allocate £20 million of this to the vital task of expanding employment of health visitors.

We are also committed to investing in improving parenting skills and support for parents; and creating a more flexible and accessible provision of nursery education, these are both points that my colleague Liz Smith will expand upon in a few minutes.

But let me take a few moments here to explain just why sustained investment in our health visitors is so important. Far from being able to provide a universal and comprehensive service to all parents and young children, health visitors are having to focus on a narrowing number of cases.

The Health for All Children (HALL 4) restructuring of services brought a change in emphasis to health visiting, meaning that the only formal assessment available to all children was at six weeks, and only children that were in additional and intensive care bracket would be offered an assessment at two years. Follow up after two, three or four months of age is no longer expected, and families are left without regular contact, advice and support, a dangerous development in the provision of early years care. Changing to focusing primarily on children in the additional and intensive case bracket has left thousands of parents every year without the expertise and care they could benefit from under a truly universal system, forcing them to identify early signs themselves and approach their GP.

The Royal College of Speech and Language Therapists highlighted the effects of this demise in universal care. Professor Law told the Health Committee that for many years a large proportion of pre-school referrals to speech and language therapists – between 40 and 50%- were from health visitors. A review after the implementation of HALL 4 has seen this number drop to only 15%. Fewer problems are being picked up during these crucial early stages as health visitors' time and resources are being channelled solely into supporting those in a particular bracket of care.

The response to this issue from parents is very clear. When asked whether they thought that health visitors should visit only those parents who are having problems with their child, 91% of parents disagreed. Another nine in ten parents agreed that they found the health visitors advice reassuring, and a significant 76% felt that they would have missed the help provided by the health visitor if they had not had it. Far from supporting these parents, all too often the advice and assistance is only available to them for a brief number of weeks, rarely allowing the all-to-crucial relational links to be made between parents and health professionals.

Indeed these links and the trust that comes from them are invaluable, both between parents and health visitors, and between health visitors and GPs. The continuous contact fostered between GPs and health visitors in working relationship helps to provide a universal and non-stigmatising service for communities, and link together with social work and even education support to provide a powerful service. Removing the health visitor from this equation could not help but limit the reach and scope of care provided.

The sidelining of vital health visitor services is reflected in the number of posts held across Scotland. Despite a small increase over 2009-10, in some health boards – notably Greater Glasgow and Clyde - the overall numbers of health visitors has fallen across Scotland since 1998, with some 25% of health visitors being cut in NHS Lothian over 2009-10. As the motion states, there are seven health boards in Scotland that have seen a fall in health visitor numbers over this last year, that is a reduction of key support for parents and young children in half of Scotland.

Our fourteen NHS Boards each have a separate strategy on the use of health visitors, which leads inevitably to a variation in service delivery across the country. Indeed some boards, for instance NHS Highland, are abandoning the training of health visitors' altogether, under the belief that the profession will soon become obsolete. I have been told that the average age of health visitors in Scotland today is 55, and as they retire they are not being replaced, as Health Boards try to make savings by not filling vacant posts.

Dr Wilson from Glasgow University, in his evidence to the Health Committee, told of the devastating effect that these recent policy developments have had on the morale of the remaining health visitors, a profession which as we have seen provides such an invaluable service to families and should hold their contribution in high regard. The Royal College of Nursing reports that 61% of health visitors feel underpaid and 70% say they are under too much pressure at work.

I am sure my colleagues in the chamber will not have failed to notice the emphasis that the UK government has placed on the provision of health visitors in health boards across England and Wales. The UK government has committed to creating 4200 new positions for health visitors, revitalising training and recruitment, and creating a new identity for the profession. This investment south of the border in early years services, will result in a doubling of the number of health visitors supporting families in England and Wales, and will help to secure many healthy and active generations of families and children. This is an area where Scotland cannot afford to lose out or start to lag behind. Making the effort to invest in these key services now will reduce the need for trying to resolve the problems that will go undetected if we continue to reduce health visitors capacity to help families across the country.

The £20 million investment proposed by the Scottish Conservatives will go a long way to redressing the imbalance in the provision of early years care in Scotland. Through the creation of a truly universal service of health visiting, working with all families throughout the early years of a child's life, we will be able to offer the support and advice that parents need, and work toward combating problems before they take root. This widened provision does not mean a move away from increased care for the most vulnerable. The greater number and provision of fully trained health visitors working in partnership with GPs and health professionals across the community will serve to provide a greater level of care for all, and will allow those most vulnerable to receive the care they deserve, as well as opening up this care for all, regardless of postcode or region.

The benefits of resourcing now for the future are clear and Scotland cannot afford to sit back and watch while children in other parts of the UK are offered a better start in life while we have the ability, the opportunity and the duty to provide them and their parents with the most comprehensive universal system of early years care that we can offer.

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