HL Deb 30 June 1993 vol 547 cc862-72

7.1 p.m.

The Countess of Mar rose to ask Her Majesty's Government whether they will implement the recommendation of the House of Commons Select Committee on Health that: "Pregnant 18–24 year olds who qualify for Income Support should receive it at the full adult rate".

The noble Countess said: My Lords, the Minister must be well aware of the increasing concern for the well-being of single mothers between the ages of 18 and 24 who are dependent upon social security benefits. I have received letters from the Royal College of Midwives, which also gave the views of the Health Visitors Association, Maternity Alliance, social workers and a great many branches of the National Childbirth Trust.

As a member of the farming community I know that if any of my pregnant animals should for any reason become malnourished their progeny, if the pregnancy comes to term, will in all probability be weak, possibly malformed and poor growers. We do our utmost to ensure that our animals are properly housed and that they receive an adequate diet, for they are our assets. That maxim should also apply to human mothers, particularly those who are unable to maintain themselves financially and for whom the Government assume responsibility.

The babies born to each generation are the assets of the community. It is for all of us to ensure that all children who survive are born whole, healthy and with the capacity to grow up to become happy, productive citizens. Try as they might, the Government have been totally unable to convince me and those concerned with the care of pregnant mothers that these young women need less money upon which to survive than those who are over 25 years old.

To say that the day-to-day living expenses of pregnant women between the ages of 18 and 24 are not significantly different from those of others in that age band is nonsense, for a number of reasons. Pregnant women of all ages and from all walks of life are constantly advised to attend ante-natal clinics regularly. That involves travelling costs over and above those for their non-pregnant counterparts. Once at the clinic the usual practice is for expectant mothers to be given a diet sheet and advice about supportive clothing. The diet sheets, which are substantially the same for each clinic, suggest three cooked meals a day with intervening snacks. They include a wide variety of foods which are well beyond the means of women of any age in receipt of income support.

As the Minister knows, Maternity Alliance has calculated that a woman needing to maintain herself and her unborn baby at the bare minimum nutritional level would have to spend over half of her social security benefits on food. That would leave her with about £15 a week to pay for her fuel bills, special clothing, personal needs and travel. She would also want to accumulate clothing and furniture for her baby, for the Social Fund maternity payment is about one-tenth of the amount needed to buy even the minimum of a new baby's needs. So what happens? Spending on food is the most elastic part of the budget of the poor. When other, apparently more pressing, expenses need to be met spending on food will have to be reduced.

Even the witnesses representing the Department of Social Security before the Select Committee on Health floundered when questioned about the ability of people on income support to provide themselves with an adequate diet. To say that the diet of clients must be adequate because there is no evidence pointing the other way is not 'by any stretch of the imagination a sound base. It is easier to refuse to confront a potentially embarrassing situation by stating repeatedly that there is ho evidence to prove that there is a problem in the hope that the statements will eventually be believed than it is to conduct proper scientific research which might prove just the opposite. If such research had been carried out I suspect that the Government would have discovered that the dietary needs of pregnant women aged between 18 and 24 would be substantially the same as those of the over-25s, though there would be variations in needs and tastes within both groups. There also appears to be an assumption that all the young women concerned have easy access to cooking facilities and shops and markets where they can purchase the fresh food they need cheaply. That, of course, is not the case.

Another excuse—I was going to say a reason—which is regularly trotted out by Ministers, is that the under-25s have lower earnings expectations and fewer financial responsibilities. When will the Government accept that income support is not a substitute for earnings? In those halcyon days when the Minister's department was known as the Ministry of Pensions and National Insurance I was trained to advise clients that National Assistance was a subsistence allowance based on need. Has there really been a change in philosophy since then?

The needs of a pregnant woman, whatever her age, are for shelter, food and clothing. Suppliers do not discriminate. What evidence does the Minister's department have to substantiate his oft-made assertion that this group of young women have fewer financial responsibilities than their older counterparts? Does he have any evidence to show that pregnant women over the age of 25 are less likely to share accommodation than those under 25? Do they not all expect to contribute to the expenses of a shared household?

There is plenty of anecdotal evidence, but as far as I can ascertain no sound evidence, that young women get themselves pregnant in order to escape the parental home or to avoid work or training. The legal responsibility of parents for young children ends when the children reach the age of 16. It is natural for a young person to fly the nest and seek an independent life as soon as he or she is able to be self-supporting, but we must remember that there are a number of other reasons why young people leave home. Young girls do not need to become pregnant to do so. It is unlikely that the level of income support will be a sufficient incentive, and to become pregnant deliberately with all that parenthood involves, is surely a major disincentive.

There is copious medical evidence to substantiate that babies born to young, undernourished women are often premature. Those which go to term are frequently under weight and suffer chronic health problems. Mothers are often unable to breast feed and their children fail to thrive. I know that the noble Lord, Lord Rea, will expand on that point.

Finally, we come to the cost. The Government have estimated that it would cost £360 million to increase the level of income support for all 18 to 24 year-olds to the full adult rate. I am conscious of the fact that. the Exchequer could not bear such an increase. The rate of income support is increased to the full adult rate for 18 to 24 year-old women as soon as the baby is born. Why can it not be raised as soon as the: pregnancy is confirmed? The difference is only a. matter of months.

All that I ask tonight is that those babies born to young mothers who must rely upon income support are given the same chance. to live and thrive as those born to older mothers in the same situation. They are.. after all, our future.

7.10 p.m.

Lord Beaumont of Whitley

My Lords, if we are to do anything about the health and well-being of the least well off of our citizens—and I take i t for granted that everyone in this House will at least pay lip service to the thought that we should do that —we must start with pregnant mothers. Some time in the past few years Sweden reached a world landmark in being the first country to record equal average birthweights for all social classes. It is a real mark of shame that Sweden should be the first and only country to achieve that benchmark. One would have thought that it should be the aim of all countries and all political parties. Whether or not we agree with various forms of equality, there is agreement, I should have thought, on the necessity for an equal start for all children.

The Question may be about young mothers but, as the noble Countess pointed out, it refers even more to foetuses and babies. However much noble Lords may fight against it—and some will fight harder than others—there is a tendency to think that pregnant 18 year-olds or 20 year-olds, and especially those who do not have a husband or a supporting family, must somehow be undeserving. I know that that group is only a small number among those about whom we speak this evening, but it is an important small number. I believe that it is right that I should address my remarks today to that extreme case.

We are not talking about mothers and whether they are deserving. We are talking about children. There is nothing deserving or undeserving about a small child. It is the clear duty of any government of this country to ensure that no children born in this country are disadvantaged because their mothers, however marginalised they may be by society, are unable to afford a decent diet for themselves and for their children. I should like to think that it went without saying that the Government accept that duty. Nevertheless, I should like to hear the Government say that they do. Even more importantly, even if it can be shown that in a large number of cases, or even in a small number of cases, that situation does not arise, I should like the Government categorically to assure us that they will take the necessary steps to ensure that it does not arise.

The Government have heard the case that the noble Countess has deployed. When they have heard the evidence which no doubt the noble Lord, Lord Rea, will put before them—that in fact these mothers and children do not obtain sufficient nourishment to start the children off on anything like an equal footing in this world—it will be necessary for the Government to state that they will immediately take the necessary steps to put the situation right.

7.12 p.m.

Lady Kinloss

My Lords, I should like to speak in support of the Unstarred Question of my noble friend Lady Mar.

The dietary needs of a pregnant woman are very important all through her pregnancy, but especially so in the last three months. The Committee on Medical Aspects of Food Policy in the Commons recognised that there were probably modest additional requirements during the last three months of pregnancy. That would seem to be a step in the right direction, as additional requirements have been recognised; especially so during the last three months of pregnancy. That is a time when extra nutrition is desirable both for the mother and for the growing foetus.

Perhaps I may ask the Minister whether the Government would consider ensuring that in any benefit office there is one officer who is trained to assist those young pregnant girls of 18 years to 24 years on how best to manage their benefits. Many of them may have had little experience in managing their finances and are most likely to be worried and frightened, especially if they have been in care and perhaps have no family who will or can help them.

There is, of course, the need not only for a well balanced diet but also for clothing, especially in the later stages; and, of course, the need to keep warm. I should have thought that those requirements would be the same for a 24 year-old as for a 25 year-old. A young girl of 24 years and 11 months must be longing for the day when she is 25 if she is pregnant and on income support.

Perhaps I may ask the Minister to note the following quotation from a report on poverty in York in 1899, when Joseph Rowntree observed, That if York was typical, then the impediment to the rearing of healthy children is not the ignorance of the mothers so much or nearly so much as that the conditions of modern life do not enable them to supply their children with sufficient sustenance". That is the vision of a man living in the last century. It could be said to apply equally today.

Evidence from the Department of Social Security to the House of Commons Select Committee on Health referred to in the second report for the session 1991–92 on maternity services, estimated the cost. Assuming that income support was paid at the 1991–92 rate and was paid throughout pregnancy, and estimating the number of pregnant women aged 18 years to 24 years on that benefit, the cost would be about £4.5 million. The evidence also suggested that the additional annual cost of paying income-related benefits to pregnant women who in 1991–92 received the 18 to 24 year-old rates was around £5.5 million.

Those figures do not agree with the Answer given by the noble Lord, Lord Henley, to a Starred Question asked by the noble Earl, Lord Russell, on 3rd March, reported in Hansard at col. 657. The Minister stated that the added cost of increasing the rates for those under 25 would be about £360 million. Can the Minister say how that figure is arrived at? Does he include all 18 to 24 year-olds on income support, or only those pregnant 18 to 24 year-olds? The figures seem rather disparate and I am puzzled at such a difference in the amount.

I wish to return to the matter of a good diet. As I have already said, it is very important that a healthy diet is maintained, especially in the last three months of a pregnancy. That at least would try to ensure a healthy baby at birth, not forgetting the mother's health as well. Surely it could well save money if the child was healthy and not, sadly, in need of constant medical attention or care in residential accommodation and if possible psychological troubles for the mother which could be very distressing could be avoided.

7.17 p.m.

Lord Rea

My Lords, my noble friend the Countess of Mar is to be congratulated on bringing this issue before the House. I refer to her as "my noble friend" advisedly because it is seldom that I disagree with her when she raises, as she often does, questions relating to injustice or iniquity in the health or social services.

She has put the issue clearly before the House. I do not accept the Government's position in their reply to the Select Committee's recommendations any more than does the noble Countess who described them to us.

I remind noble Lords that we are not talking about the whole range of pregnant 18 to 24 year-old women; we are talking only about those entitled to income supplement, a sizeable proportion of whom may be, or are on the way to becoming, single parents. I suggest that it is highly likely that such young women may be very hard pressed financially, for instance in maintaining an independent dwelling, and in having additional expenses concerned with preparing for their babies' needs. The noble Lady and the noble Countess have referred to those issues.

As was pointed out in evidence to the Select Committee, expenditure on food is a flexible budget item. If other unavoidable expenses such as household bills are heavy, less than is desirable may be spent on food. The noble Countess expanded on that very successfully, I thought.

There has been much discussion about whether it is possible to purchase a "healthy" diet for an average price. I do not intend to enter that discussion, except to say that fruit, vegetables and whole grains, which have recently been shown to be even more important to good health than we already knew, are relatively expensive items. It has been shown in a number of surveys that those on low incomes buy much less fruit and vegetables than those who are better off. Fruit and vegetables contain, as well as vitamin C (which we all know about), dietary fibre, anti-oxidants, trace metals and essential fatty acids, all important in the development of nervous and vascular tissue—in other words brain and blood vessels.

It is now fully documented and accepted that the incidence of low birth weight and prematurity is associated with low socio-economic status, even allowing for other associated factors such as smoking, which is more common in people of low socioeconomic status. In particular, it has been shown that poor nutritional status is much more common among the mothers of low birth weight and premature babies than among those who deliver babies of normal weight. I refer the noble Lord to the work of Wendy Doyle and Professor Michael Crawford, of the Institute of Brain Chemistry, who have published a series of papers based on their work in Hackney, East London.

Low birth weight and prematurity are associated with higher perinatal mortality and subsequent physical and mental handicap—of considerable cost to the state. One estimate is that all cases of congenital mental retardation, blindness, deafness, cerebral palsy or autism cost us about £2 billion per annum in care. Of course, not all cases of those conditions are associated with low birth weight, but a high proportion are, and others are quite likely to be associated with maternal malnutrition or sub-nutrition in early pregnancy.

Doyle and Crawford, together with Professor David Barker of the Medical Research Council's epidemiology unit in Southampton, have evidence that many disorders of later adult life have their origins in early foetal life, just after conception, before the mother is even sure that she is pregnant. They depend on the nutritional state of the mother at that time. This would suggest that to wait until pregnancy is established before increasing income supplement is closing the door after the horse has bolted. (I felt that that was not perhaps the right metaphor, when talking about babies who have not yet been born, but I could not think of another one!)

Logically, all women on income supplement, of child-bearing age, should receive a special dietary supplement. I suggest that it should come with an information pack on how to spend it wisely. If all women of 18 to 24 who are on income supplement were paid at the same rate as adult women or women over 25—the noble Lord may confirm that it would cost £360 million—I believe that as a first step it would be a wise investment. However, I realise that that goes beyond tonight's Unstarred Question. I shall come back to your Lordships with such a suggestion as I have just made when the research necessary to back the proposal has been completed. Professor Crawford has just such a project in mind at the moment.

I am sure that the Minister will inform us that a young pregnant woman in real need can turn to the social fund for emergency help; that her income will be augmented in any case when the baby is born. That would miss the point that we are making and miss the boat as regards the pregnancy. I suggest that in any case personal stresses will be greater for such a young, single pregnant woman, as has already been pointed out. She may not be well enough organised to claim every additional benefit to which she may be entitled.

The number of women under 24, living alone, pregnant and in receipt of income supplement will not be all that great. I do not have the exact figure, but perhaps the Minister can help us in that respect when he replies. A cost of £5.5 million was mentioned by the noble Lady, Lady Kinloss. Possibly that sum would apply to that group of women about whom we are talking. I am sure that the noble Lord will elucidate. Whatever the number of women, the argument for following the advice of the Select Committee in another place, that pregnant 18 to 24 year-olds who qualify for income support should receive it at the full adult rate is to me unanswerable, both in terms of justice and, as the noble Lord, Lord Beaumont, pointed out so well, of even greater importance in terms of the health of a vulnerable part of' the next: generation. Surely that is the responsibility of any government who claim the right to remain in power.

7.25 p.m.

The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)

My Lords, the noble Lady, Lady Kinloss. referred to the Joseph Rowntree report of 1899 relating to conditions in York. I should remind her and the House that we have moved on since then I should also like to say to the noble Lady, Lady Kinloss—and I accept that the noble Countess, Lady Mar, does not agree with what we have to say—that we have in this country what is arguably the most comprehensive social security safety net throughout the whole of Europe, far better than many of our colleagues. Things have moved on a great deal since then.

It is also important to remind the House to bear in mind that on this occasion the debate has been about increasing money directed towards social security benefits at a time when pressures on government: expenditure have never been greater. I shall return to the costs later on.

The debate has centred upon what many would consider to be the special needs of pregnant women. Previously, this question has been raised with the emphasis on the suggestion that young, pregnant women need additional nourishment. I think that. the noble Lord, Lord Rea, asked for a dietary supplement. I have to say that we would not want to return to the old days of supplementary benefit and the various complexities that existed with supplementary benefit. But on that point which the noble Lord raised about some supplement for pregnant women on income support, it is worth reminding the House that those pregnant income support beneficiaries also receive free milk tokens which entitle them to seven pints of milk per week—a very valuable addition, with the added calcium which comes with milk, for pregnant women—and free vitamin supplements. It is therefore not true to say that pregnant women receive no more than others aged 18 to 24 on income support. Further, once the child is born, it is entitled to free liquid milk or dried baby milk and free vitamins. That help will continue as long as the family receives income support and the child is under five years old.

I accept that there has been considerable concern expressed on the question of diet for this particular group. The noble Countess, Lady Mar, stressed this matter very much. I should just like to refer to the report by COMA which advises the Department of Health. In its report on dietary reference values, COMA set down a framework for the United Kingdom of nutritional requirements to be met through diets. Those can be met through an endless variety of diets but, more important, COMA (the committee on the medical aspects of food policy) did not conclude that pregnancy incurred significant additional contributions. Further, the MAFF National Food Survey indicates that the diets of people in all income groups contain adequate levels of most nutrients. However, I am advised that as a whole—and this is what we are informed—the population needs to eat less fat, more bread, cereals, pulses, seasonal vegetables and fruit in order to maintain good health and prevent major diseases. The calculationsby MAFF have shown that a diet which meets the latest dietary advice need not be more expensive, indeed it can very often be cheaper, as I am sure the noble Lord, Lord Rea, who is a doctor, would confirm. In addition, advice from MAFF and the Department of Health indicates that there is no need to buy special, more expensive food in order to eat more healthily. The whole range of foodstuffs available at affordable prices is so wide that a healthy diet is obtainable within anyone's means.

The noble Countess referred to the health of babies generally. I am afraid that I have no break-down of figures dividing them up according to social classes and according to income groups. But I think it is worth reminding the House and the noble Countess of just what has happened to figures showing still-births or deaths within seven days of birth per 1,000 births in England and Wales over the past 10 years. In 1982 it was 11.3—historically, a very low figure, as I think the noble Lord, Lord Rea, will accept. The figure has been coming down steadily over the years. But in as short a time as by 1992 that figure had dropped to 7.9. That is down 3.4 per 1,000. By my calculations, that is a drop of some 30 per cent. That is a fairly large drop between 1982 and 1992 and it belies any accusation that there is a large number of people for whom a healthy diet is not available.

The noble Lord, Lord Beaumont, referred to Sweden and that country's admirable record—it is praiseworthy—and that only Sweden has an average birth weight more or less the same for all social classes. The noble Lord, Lord Rea, referred to low birth weight in the lower social classes, and obviously that was something to be deprecated.

We accept that there is evidence of an association between ill-health and adverse circumstances, but there is little to identify specific causes, such as diet or nutrition. Possibly, there are other causes. The nutritional content of the diets of all people is remarkably familiar. If I may refer back to COMA, that committee and the nutrition task force have jointly commissioned a study looking at methods of investigating the links between nutrition and low income. I can certainly give the assurance that is something we would certainly take into account and bear in mind according to what they might report.

But on the general issue, our support for 18 to 24 year-olds does of course escalate notably following the birth of a child. When their baby is born, single mothers are entitled to a higher personal allowance and additional income support in the form of family premium, the lone parent premium and personal allowance for the child. Taken together with child benefit and one parent benefit the extra income support gives an overall income of £73.60 per week to 18 to 24 year-olds. That is, an increase of £38.80.

Again, it is worth stressing and, to be fair to the noble Countess, she did stress this point, we are talking only in relation to the single 18 to 24 year-olds. When we are dealing with couples in this particular class—this is a very important point to get over to the House—there is no distinction between the 18 to 24 year-olds where at least one is over 18 and 24 year-old or over 24 year-old couples. As I said, as soon as the child is born they will be getting the higher rate. Furthermore, a maternity payment will normally be available from the Social Fund to help with any additional costs due to the arrival of a baby. The maternity payment has increased substantially since its introduction in 1987. Currently it is £100; that is a 25 per cent. increase on the original figure from 1987. That makes the maternity payment a substantial and useful contribution from the state towards the additional expense a new baby brings. Of course, anyone receiving income support is also entitled to receive housing benefit, should they so need it.

The needs of the family figured prominently during the deliberations that led up to the 1988 social security reforms. The cornerstone of those reforms was the creation of a benefit system that would enable us to do more for those in greatest need. It has been the establishment of these benefit reforms that has enabled us to target extra help to low income families with children worth something around £1 billion a year from this April.

There has also been general comment on the lower level of income support paid to all people between the ages of 18 and 24. As I said on earlier occasions, the levels of benefit for this group take account of the fact that the majority live in someone else's household.

I was asked what evidence there was that under-25s were less likely to live independently. I believe the noble Lord, Lord Rea, asked how many there were living independently. The latest available figures reveal that of the more than half a million—that is, 561,000—people receiving the 18 to 24 rate of income support, only around 100,000, a little under 20 per cent. are receiving housing benefit. The implication must be that the others have fewer financial responsibilities and are therefore less likely to live independently.

The noble Countess again pressed me on how we justified the different rates of income support for the 18 to 24 year-olds. The noble Lady, Lady Kinloss, mentioned the Starred Question in the name of my noble kinsman, Lord Russell, on 3rd March. I can only repeat the explanations that I gave on that particular occasion. There are four reasons why we have different rates. The first, as I stressed on that occasion, is the added cost of increasing the rates of those aged under 24—some 360 million. I accept that that is for all 18 to 24 year-olds. The second is that there are the lower earnings expectations of people under 24. The fact that they have fewer financial responsibilities is again a point that I have mentioned. The third reason, as I have just mentioned, is that they are likely to live as part of someone's household. On that occasion, the figures, which were last year's figures, showed something around 15 per cent. of those on income support—it is now something like 20 per cent.—to be in receipt of housing benefit. The fourth reason is that we do not believe that levels of benefit should be an incentive to leave home or an attractive alternative to seeking work or training.

Earl Russell

My Lords, I am grateful to my noble kinsman for giving way. I would be very grateful if he could explain to us why lower earnings when in work are reason for lower benefit when out of work. I simply do not understand this.

Lord Henley

My Lords, my noble kinsman did not listen to me. Lower earnings and financial responsibilities go along together. As I am trying to explain, where there are lower earnings, there are frequently lower financial responsibilities. For that reason, we think that it is quite justifiable having a lower rate of income support. 'We do not see a case, as I have made perfectly clear—and further to that I can add the explanation that there are massive costs involved which even my noble kinsman accepts—for increasing the rate for the 18 to 24 year-olds to the same rate as that for the 25 year-olds and above.

Further, at the last up-rating in April 1993, all income-related benefits were increased by 3.6 per cent., which is fully in line with the Rossi index and the same (the two coincided in that year) as the RPI. Further, 18 to 24 year-olds will have gained from the fact that people receiving income support are no longer required to pay local taxes.

The noble Lady, Lady Kinloss, also asked whether special advice was available in the benefits agency offices. That was a very good point and certainly something which ought to be addressed. I can inform the noble Lady that 16 to 17 year-olds, who are the most vulnerable of this group, are dealt with by specially trained officers advised by a member of the management team. Further, money management advice is available for all income support recipients as part of the Social Fund service. In addition the benefits agency has devoted much effort to improving customer service. I know that certainly from my own personal experience of visiting benefit offices, one of which I visited only today. Certainly, it is something that they would very much wish to do in providing the best possible service for all those who have to make use of the Department of Social Security.

Many points have been made during this debate. I have to say that we see no convincing evidence to suggest that the needs of pregnant women aged 18 to 24 are so significantly different from others in that age band (the 18–24 year-olds) that any special treatment is appropriate over and above what is already available. I can, however, give the assurance that income support is, and will continue to be. closely monitored. We shall continue to ensure that the position of 18 to 24 year-olds and others receiving benefit is maintained.

Viscount Goschen

My Lords, I beg to move that the House do now adjourn during pleasure until eight o'clock.

Moved accordingly and, on Question, Motion agreed to.

[The Sitting was suspended from 7.40 to 8 p.m.]