I beg to move

That this Assembly commends the vital role that health visitors play in supporting the health and development of children under the age of five; expresses alarm that 15% of children in Northern Ireland were not seen by a health visitor for their year 1 review in 2023-24; notes with deep concern that this figure rose to 46% in the Southern Health and Social Care Trust (SHSCT); highlights the critical need to end regional inequalities in the provision of child health reviews in order to ensure that every child and young person has the best start in life; and calls on the Minister of Health to urgently work with all health and social care trusts to drive down the number of health reviews that take place outside of the accepted time frames or not at all.

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. As an amendment has been selected and published on the Marshalled List, the Business Committee has agreed that 15 minutes will be added to the total time for the debate. Diane, please open the debate on the motion.

Thank you, Mr Deputy Speaker. I am going to make some important points at the start of my speech, so it is to be regretted that the Minister is not here to hear them.

[Interruption.]

I am sorry, Minister; thank you. It is good to see you.

I tabled the motion because I believe that the debate is hugely important not just for the Department of Health but for other Departments. Health visitors have a hugely important role in recognising when things are not quite right with children or when they are not reaching their milestones. That will have an impact on every Department. It will have an impact on the Department for Communities through poverty and social cohesion and so on, but it will also have an impact on the Department of Education. We cannot throw our hands up in horror in the Chamber and pretend that we did not know that the children concerned had all those difficulties or that they require statements when they arrive aged 3 or 4 into nursery school or P1 if we do not document those difficulties in the year 1 review.

It is really important to recognise that our children are not only our most vulnerable but our most precious of citizens, and we want to make sure that they are properly looked after and given the best start in life that we can possibly provide. This is about the importance of the role of the health visitor and their relationship with families. We want that to be valued and resourced, because we know the difference that they can make to young lives by maintaining children's good health and well-being. That can also be a huge safety net, however, and it is essential for prevention of and early interventions in ill health.

Health visitors are valuable in helping parents to understand cognitive development, nutrition and the importance of immunisation. The Healthy Child, Healthy Future (HCHF) programme offers a series of reviews to support parents to make choices to give children the best chance of being healthy. The year 1 review includes a family health assessment as well as topics such as growth, language development, oral health and dental registration, parenting support and health promotion.

In 2023-24, 15% of children did not receive a year 1 review. In the Southern Trust, an area that I represent that includes large areas from Dungannon through to Banbridge, Lurgan, Portadown, Newry, Armagh, Kilkeel and Annalong, the percentage of cases in which no contact was made rose to an alarming 46%. That is deeply regrettable and detrimental. A missed year 1 review is a lost opportunity to monitor, among other things, growth, feeding status and speech and language development. The Southern Trust had been struggling with unfilled vacancies, and full provision of all interventions appears to have resumed.

There were commitments that everyone would get their yearly review. I would appreciate the Minister's confirmation that that continues to be the case. At one point, as I understand it, as a result of workforce pressures, the Public Health Agency (PHA) issued interim guidance to trusts that the one-year contact would be omitted in specific circumstances. I understand that those interim measures have been stood down, with a marked rise in the number of contacts taking place on time.

Where one trust is trailing far behind the others, consideration needs to be given at a Northern Ireland-wide level as to how we do more to ensure an equivalent level of service. That goes back to what I continually reference in the House: there are social and economic inequalities in health, but there are also deep structural inequalities, which are perpetuated by trusts not having the same level of service across various parts of the health service. We should have a situation in which staff can work across boundaries. There is no magic wall between the Southern Trust and the South Eastern Health and Social Care Trust or the Western Health and Social Care Trust: staff should be able to work across boundaries and they should do so. That is very important. Minister, you have looked at a regional approach to breast cancer referrals, so maybe that is something that we should be looking at in this case. In September, there were 23 vacancies across our trusts and recruitment was actively under way to fill them, including six vacancies in the Southern Trust and six in the South Eastern Trust.

I was contacted recently by parents, and have been looking into the issue of skeletal dysplasia and the support that children with the condition receive so that they can engage in daily activities in as similar a way as possible to their peers, thrive and realise their full abilities. I tabled a number of important questions on the issue, and, so far, have been discouraged by some of the answers. That is an area where health visitors, through developmental reviews, will help ensure that children are referred to the appropriate services for assessment and receive the appropriate additional support.

The findings of an Institute of Health Visiting survey of health visitors across the UK, which was unveiled in January, showed a rising need among families that face increasingly complex health and developmental challenges, with support becoming harder to access. Service gaps were also flagged, with massive differences in the availability of services across the United Kingdom. Health visitors spoke of being under immense pressure with challenging workloads, and that is no different in our part of the United Kingdom. Mental health problems were considered to be the main reason for increased demand, with the behavioural problems of the child, including growing concerns about neurodevelopmental issues such as autism or ADHD, being the second most common reason for families needing extra help. Practitioners said that work was more dominated by social concerns, with more families impacted on by poverty and safeguarding concerns. That goes back to the coherent service that children and young people should expect from the Department and the lack of social work access experienced by many families, which is particularly acute for families of children with disabilities.

Again in the Southern Trust, I have had conversations recently with families who have real concerns about the development of their children but have not been able to access appropriate social work help. We need to look not only at the health visiting needs but at continuing that work by having a coherent service for children and young people.

In a recent conversation with the Southern Trust — I digress a little because this annoyed me so much — I felt as though the officials were simply going through the motions: "I have to deal with this difficult MLA, and I'll have to have the call and the meeting". Behind that call was a family in real distress. Everybody is under pressure, but it is really important that we look at how we help children to access services at the earliest stage but also as they progress through their lifetime.

Help for mothers who may have difficulties with the birth or development of their children is another issue. I know that you have been doing some work, Minister, on exclusion in areas of social and economic deprivation. This issue neatly fits into that programme. I want children, no matter where they are born in Northern Ireland, to have access to services and to be able to grow up, develop and thrive in the best way possible.

In Northern Ireland, unlike some parts of the United Kingdom, there has been some rise in the birth —.

Diane, will you bring your remarks to a close?

Yes, of course, Mr Deputy Speaker.

Minister, it is a really important debate. It attacks the most fundamental part of a child's development and progress. I hope that you will have some positive things to tell us.

I beg to move the following amendment:

Leave out all after "best start in life;" and insert: "calls on the Minister of Health to urgently work with all health and social care trusts to drive down the number of health reviews that take place outside of the accepted time frames or not at all; and further calls on the Minister to prioritise development of the revised Healthy Child, Healthy Future framework and ensure that the recommendations concerning the role of health visitors from the 'A Fair Start' report and independent review of education are implemented."

Thank you. You will have 10 minutes to propose the amendment and five minutes in which to make a winding-up speech. All other Members will have five minutes. Please open the debate on the amendment.

Thank you, Mr Deputy Speaker. This great motion is really worthwhile, and I thank the proposer for moving it. Our amendment does not seek to remove anything from the original motion; it seeks to do two other things. First, it makes reference to the importance of delivering an updated Healthy Child, Healthy Future framework, which, I know, is advanced in its progress. Secondly, it recognises and underscores the important intersection between health and education in relation to child development. The intention of the amendment is to strengthen and reinforce the central tenet of the original motion that the one-year assessment is a vital tool for tracking a child's development progress in health and early education.

We reference two important, credible reports: the independent review of education and the Executive-endorsed 'A Fair Start'. Both highlight how crucial the health visitor role is in the educational outcomes of our children. I am sure that Members on the Health Committee share the frustration of those of us on the Education Committee about the sheer volume of evidence that shows how vital early intervention is but how relatively little it happens in practice.

Early years assessments provide a perfect opportunity for effective collaboration. Health visitors are one of the clearest examples of the power of early intervention. They play such a wide-ranging role, providing parental education and support, providing positive parenting advice and health advice, safeguarding, assessing development milestones and ensuring early identification of additional needs and interventions. They are there for the child, but they are, importantly, also there for the parents and carers.

There is a growing body of evidence that the first 1,000 days of a child's life, from conception to age two, are absolutely essential to their long-term outcomes. That is why the 'A Fair Start' report highlights the fact that the highest rate of return in terms of childhood development will come from investing as early as possible. That is crucial in reducing the educational attainment gap, which begins at a very young age and continues to widen.

Parenting can be incredibly difficult, especially for those who are struggling financially, those dealing with health issues or those who have little family support. Health visitors can guide and reassure parents. They are a source of trusted information on the daily challenges of parenthood. With social media and the huge amount of non-evidence-based advice that is going around, parents need those trusted sources more than ever.

Given how important the role is, I was extremely concerned when I read the latest Healthy Child, Healthy Future review statistics. They showed that only 59% of year 1 reviews were completed within the accepted time frame, and, as the motion references, 15% were not done at all. In the Southern Trust, 46% or over 2,000 year 1 reviews were recorded as not completed. When I asked about those missed year-1 reviews in a question for written answer, the Minister, in his response, noted the workforce challenges faced, in particular, by the Southern Trust, and that, for those who missed a review, an appropriate in-person review has now taken place. It clearly shows a system that is under great pressure. I do not know whether the impact of a delayed review can be clearly demonstrated.

The current Healthy Child, Healthy Future framework was produced in 2010 and is due to be replaced imminently. It notes that the year 1 review is to include an updated family health assessment, monitor the growth of the child, review speech and language development and promote oral and general health, including dental registration. Those are all vital, let alone the issue of safeguarding, which I have already mentioned, and the role that health visitors play in ensuring that issues are prevented or reported.

Through our amendment, my party is keen to hear from the Minister about whether the new Healthy Child, Healthy Future framework, which has long been delayed, has taken on board the recommendations from the 'A Fair Start' report and the independent review of education. 'A Fair Start' noted:

"Parents and families need supported to understand the child’s developmental milestones and the importance of play based learning."

It recommended that the Department:

"should expand the developmental role of the health visitor...to provide early support, education and sign posting."

The report specifically highlighted the importance of the reviews at one year and two and a half years from an early education perspective, noting that, while those reviews may be of lesser significance than earlier reviews from a health perspective, they are crucial in relation to cognitive development; for example, in relation to speech and language. In a similar vein, the independent review outlined just how vital health visitors are and recommended that the programme of assessing beyond six to nine months should be reviewed to ensure that cognitive development is properly tracked.

We have had little information about the development of the new Healthy Child, Healthy Future framework following the workshops with the voluntary and community sector that took place in 2022. It is my understanding that there will be no formal consultation process. The voluntary and community organisations that provided expert advice during the workshops have not been kept up to date with the progress of the framework.

There is a lot to get reassurance and clarity on from the Minister. What is clear is how fundamental health visitors are — maybe more now than ever before — but the value that they bring through the early assessments can be realised only if they happen and happen consistently. We need reassurances from the Minister that there will be safeguards in place to ensure that the level of missed appointments noted in the motion never happens again, especially as the new Healthy Child, Healthy Future framework is produced.

I call Philip McGuigan. Philip, you have five minutes.

I thank the Members opposite for tabling this important motion. I will begin by saying that, as the father of four children and daideo

[Translation: Grandad]

— it is Irish for "grandfather" but sounds much younger

[Laughter]

— to two gariníonacha

[Translation: granddaughters]

, I recognise and have witnessed first-hand the vital role of health visitors and the work that they do, whether that is monitoring a child's developmental milestones, providing support and advice to parents where required, the prevention and early detection of ill health or developmental challenges or identifying babies and children who are potentially at risk. The role of health visitors is clearly important in ensuring that children have the best start in life to allow them to fulfil their potential and improve their long-term health outcomes. That, in turn, has had a positive impact on those children, as they have developed through life, and on their families, their schools, the health service and the economy as a whole.

Early detection for health and/or developmental challenges is vital, especially at a time when support is becoming harder to access due to growing waiting lists. As we know, schools are struggling with the increasing levels of support required when children enter preschool and primary school. I recognise the difficulties of workforce strain and stresses from the pressures of huge caseloads, but the number of missed year 1 visits and no contacts is concerning, particularly, as the Member across the Chamber outlined, in the Southern Trust area, where those figures are much higher. Regional inequality is being perpetuated as a result of gaps in the accessibility of health visitors in some areas; those gaps can create and exacerbate existing health inequalities.

Sinn Féin will support the motion and the amendment and agrees with their key ask that the Minister should:

"urgently work with all health and social care trusts to drive down the number of health reviews that take place outside of the accepted time frames or not at all."

Sinn Féin also agrees that the Minister should:

"prioritise development of the revised Healthy Child, Healthy Future framework and ensure that the recommendations concerning the role of health visitors from the 'A Fair Start' report and independent review of education are implemented."

As the Member who moved the amendment said, while it is primarily a health issue, it has implications for the education of our young children. She outlined the 'A Fair Start' action plan, which was submitted by the expert panel on educational underachievement to the then Education Minister in 2021 and was endorsed by the whole Executive. It is an New Decade, New Approach (NDNA) commitment. It aims to ensure that children get the support that they need from birth and throughout their early years, up to and including the time when they start school. It prioritises investment in early years and gives prominence to emotional health and well-being. Actions relating to health visitors include that the Department of Education should undertake a review of the Sure Start staffing structure to ensure that there is access to the necessary health professions, including health visitors and midwives. The Department of Health should expand the developmental role of the health visitor/community midwife to provide early support, education and signposting. We have called for it to be fully funded and for the implementation of its recommendations.

The independent review of education commenced in October 2021 and is also an NDNA commitment. The final report was published in December 2023, and, while its key recommendations were education-focused, it noted:

"Health visiting is an absolute priority within early years services with its reach and impact extending well beyond health."

I agree with the proposer of the motion: it is an important issue. It is vital for the health and well-being of our children, and it merges into the educational well-being of our children. We look forward to hearing from the Minister and hope that he will make some good pronouncements on the issue in his conclusion.

I apologise from the Table that we did not reset the clock. You took just about five minutes, so that was spot on.

There is no doubt that home visits are a vital source of support for new parents and their children. The first few weeks and months of a child's life can be a nervous time for any new parent, no matter how experienced. That is why the visits from midwives and health visitors are so important. Those visits and the one-year review also provide a valuable chance for parents to discuss any concerns or observations that they have in the comfort of their home. It is widely recognised that the care given during a child's first stages has more influence on their future than that at any other time in their life. If there are concerns, it is essential that they are identified and responded to at the earliest opportunity.

No doubt, the longer that the Minister is in post, the more staggering he is finding the true scale of health inequalities. The outcomes for children are not immune from health inequalities. Whilst there is a multitude of explanations, children living in households in the lowest socio-economic groups have significantly worse health outcomes than other children. Therefore, it is a matter of concern that a number of one-year reviews are being missed.

The Department told me that it was alert to the problem and that steps were being taken to resolve it. Having recently received a further update on the matter, I was glad to see that real progress has been made. Whilst I hope that the Minister can today provide a further, similarly positive update, I urge his Department to maintain sufficient monitoring and oversight mechanisms to ensure that such variations do not appear again at a later date.

In addressing the motion, it is important that I set it in the context in which we find ourselves. The motion makes the important points that the fact that 15% of children across all health trusts are not being seen by a health visitor is alarming, that the fact that that percentage rose to 46% in the Southern Trust is deeply concerning and that, yes, we:

"need to end regional inequalities in the provision of child health reviews".

Another point that is just as important needs to be made, however. In 2022-23, the year previous to the year that is dealt with in the motion, the number of children who were not being seen across all trusts for their year 1 health review was 33%, so we improved by 18% in 2023-24. In the Southern Trust in 2022-23, the number of children who were not being seen was a staggering 65%, so, again, we managed to improve by 19% in a year. The overall figure for year 1 health reviews across the North that were completed within the accepted time increased from 46% to 59% during the period. There is therefore improvement in the sector, but, in congratulating ourselves on that improvement, we should not overlook the fact that a massive number of children are not being seen in time.

The proposer of the motion will undoubtedly agree that a motion could have been tabled much earlier had this place not been collapsed during the two years that we are talking about, in which time matters were at their absolute worst. We can see that it was through the resilience, determination and hard work of staff in the sector that matters were addressed. We politicians are now able to reflect on that.

Will the Member give way?

Yes, of course.

Importantly, the Member highlights the fact that we could have already debated a motion had this place been up and running. Equally, however, we could have had a Minister pulling ministerial levers to try to address the problem.

The Member has an extra minute.

I will not need it, but thank you very much, Mr Deputy Speaker.

That is the very point that I was making. Had we had a Minister in place, and had this place been up and running, we could have addressed the matter, but it was instead left to the staff to do so. Thankfully, they did the work that they had to do to turn around the figures.

It is really important to note that we can always do better. That much is clear. All of us, regardless of our age or background, want only the best for our children. We want to give them the best start that they can get in life. I spoke to health visitors about the motion, and they detailed to me the work that they do and how they are able to identify certain traits or characteristics in children during those early formative years. Although it is regrettable that 15% of children were not seen by the age of one, there is little that could have been done differently had traits been identified at that age. Even if traits were to be identified at two years of age, we currently see only 93% of children by that age. What can we do at that stage if we do identify traits, however? Health visitors tell me that they notice nuances in behaviour that may indicate autism or ADHD and that may need to be addressed. When children are seen by our expert health visitors, they can identify those particular traits, but there is nothing that they can do about autism until a child is three. By the time that a child gets to that stage, there is a three-year waiting list. Autism could therefore be identified at the age of one or two, yet nothing can be done about it until children are three, and even then they only get placed on a long waiting list.

Many children have the traits of ADHD. Those children cannot be seen until they are seven. At that stage, there is a two-year waiting list. Traits may be noticed at the age of one, two or three, but, again, nothing can be done about them. It is therefore important that the Minister give some consideration to what we could do if we were to identify those traits early. Are there interventions that could be made that would make a difference? It must be deeply frustrating for health visitors when they notice something but know that it may be five years before it can be addressed by an expert.

We have no issues with the amendment. We welcome it. The Healthy Child, Healthy Future framework is 15 years old, however. It is currently under review, and we need to nudge it over the line. Safeguarding has changed, for example, as has the family model. Lots of things are evolving daily, never mind having as our guide a strategy that was implemented 15 years ago. Getting that review completed and those changes implemented will certainly do what we are all looking to do: to give our children and young people the best possible start in life.

I support the motion and the amendment. I thank colleagues for proposing the motion, which emphasises the critical importance of the one-year-old health review and the indispensable role of health visitors in ensuring our children's well-being.

I had already prepared my speech, but on Friday night, as part of the celebrations to mark International Women's Day, I attended a lecture by Dr Avni Amin at Queen's University. She has worked for the past 30 years in the World Health Organization on issues specifically around ending violence against women and girls. Some of her remarks linked to how health systems and health workers can help deal with that issue. I am digressing a wee bit, but we talk about the importance of health visitors in ensuring the well-being of our babies and children; they also play a critical role in supporting the well-being of the mothers whom they go out to visit in their homes. On Friday night, the contributors talked about our context: sadly, since 2020, 25 women have been violently murdered. When a health worker goes out to a mother's home, at that particular time when she has a young baby, it is a key opportunity to pick up on whether any violence is occurring in that home. The broader conversation on what training we can offer to health and social care workers, particularly health visitors, to try to pick up women who may be suffering violence in the home is one that we can maybe have at a later stage in the Health Committee to bring the issue to the Minister's attention.

I return, with apologies, to the specific issue of the motion on the well-being of our children and the importance of our health visitors going into homes. I want to concentrate on my constituency of West Belfast, which, as the Minister will know, is similar to other areas in that these issues are particularly pressing there. West Belfast faces significant health challenges that demand urgent attention. I have to say that the recent inclusion of parts of the Falls Road and Shankill Road in the Minister's Live Better programme is absolutely a step in the right direction in trying to improve health outcomes for our communities.

That initiative seeks to ensure that every child, regardless of background, has an equal opportunity to grow up healthy and thrive. However, much more needs to be done. The fact that 15% of children across the North missed their one-year-old health review in 2023-24 is deeply concerning. Even more alarming is the figure that the Southern Health and Social Care Trust mentioned: nearly half of the children there missed that vital check. The stark postcode lottery means that children's access to essential health services is being determined by where they live, which is unacceptable. In West Belfast, where the socioeconomic challenges are pronounced, the inequalities are even more severe. Higher rates of poverty, unemployment and limited access to healthcare only exacerbate the problem. That is why programmes such as Sure Start are so vital: they provide essential support for families, improving child development and well-being, particularly in disadvantaged communities. The evidence shows that Sure Start reduces hospital admissions and enhances school readiness, making a difference in children's lives. However, nearly two decades of British austerity has led, sadly, to the closure of many Sure Start centres, threatening the progress that has been made. That cannot continue.

It is imperative that the Minister of Health works closely with all trusts to ensure universal and timely access to health reviews for all our children, with a specific focus on areas such as West Belfast and the Southern Health and Social Care Trust region, which face the greatest challenges.

This is an issue in which I have been interested for some time, as it links health and education directly. As mentioned by the Member for Lagan Valley, the first 1,000 days are critical. The first 1,000 days are the time in the womb and post birth. Specifically, it refers to the period until a child turns two, and the child's brain capacity and structure are shaped at an exponential rate during that time. Some 80% of brain development is in the first 1,000 days. It is the period when we notice a child's auditory, visual and learning abilities and when their memory and information processing systems are formed. It is worth highlighting the fact that the first 1,000 days have a lifelong effect on the well-being and health of the child as they grow up. Things such as stress, poverty and violence experienced in the home will have, in many cases, lifelong negative health effects on that baby.

That is why the debate is so important. Very often, we talk about early intervention. In fact, not a week has gone by since I joined the Assembly when somebody has not talked about early intervention in the Chamber, and it is great and important that we are talking about it today, but this is early intervention. Short of prenatal care, it is one of the pathways that identify the earliest intervention mechanisms, whether it is health visitors — the crux of the motion that we are debating today — or the midwives who visit shortly after birth and, perhaps, at 14 days. The Minister rightly talks about what he calls "shifting left", and I agree that shifting left is the right thing to do, as long as it pushes earlier and faster interventions.

The motion is important because the visits that we are talking about today identify speech and language therapy issues. Speech and language therapists can have profound effects, as long as that therapy is introduced early. They can highlight cognitive development issues, and, as the Member opposite mentioned, provide support and help to young mums. Everyone who has spoken so far in the debate, regardless of political party or affiliation, has agreed that the roles are critical. Even if we leave aside the clear benefits to the child and the family, it makes economic sense. The earlier that issues are identified, the more cost-effective and, usually, more effective the intervention will be.

Today, I urge the Minister to address the crux of the motion and the amendment, which we will support. It is to drive down those numbers, not least to give children in Northern Ireland the best possible start in life. If the Assembly is serious about early intervention, that must start when the baby is in the womb. After the baby is born, the next most critical time is the next 700 days. That is why those visits are important, and I ask the Minister to prioritise that area.

Discussions about our health and social care crisis often focus on ambulance waiting times, packed emergency departments and the unsustainability of general practice, pharmacy and dentistry. However, another crisis bubbling underneath the surface is one that involves babies and children missing out on basic healthcare and the opportunities for early intervention.

We have heard that 23% of children who were waiting for their one-year-old review were seen late, and 15% were not seen at all. The statistics are a real indictment of our health service. In Belfast, just 54% of one-year-old reviews were held on time, which is a shocking statistic. Those health reviews are not just casual check-ins or an extra bit of reassurance for families; they are timely, comprehensive child health reviews that promote strong bonds and attachments between parents and their children. I am concerned that the reviews are not happening, and I do not blame those healthcare support workers.

I blame those who have cut and gutted the health service for so many years through the Budget process in this Building.

During preschool health reviews, health visitors identify safety concerns as well as early issues with developmental delay and ill health. Health visitors promote breastfeeding and good nutrition, but the impact of their work extends far beyond the home. Early intervention sets children up for better short-term and long-term health outcomes. It reduces the risk of social exclusion and increases readiness for school.

We also need health visitors who are fluent in Irish and those who are trained to support families whose first language is not English. I am concerned that the Department and the trusts do not gather the data to monitor the number of children who receive appointments from their health visitor through Irish. I suspect that it is probably zero. It is not a luxury. I declare an interest as a father who is raising children through the medium of Irish. I am really concerned that language development and communication skills cannot be monitored if no Irish language is available through the health visitor. Therefore, I implore the Minister to act on that as well.

The current workforce pressures on public health nursing are undoubtedly having an impact on children's health reviews. The PHA previously issued guidance to trusts that the year 1 review could be omitted, and that is completely unacceptable. Children should not be made to pay for the continued failure to invest in the health and social care workforce. Consistent, high-quality and child-focused health reviews are crucial for giving every child the best start in life and to locate neglect or abuse, as we heard.

It is undeniable that children who are born in the most deprived areas are at a stark disadvantage when it comes to access to healthcare. Class shapes everything in this society, including the connection of mother and baby. The rate of breastfeeding in the most deprived quintile of the North is 39%; in the least deprived quintile, the rate is 68%. Mothers who live in the most deprived areas are more likely to give birth prematurely. Babies who are born in low-income areas are almost twice as likely to be born at a low birth weight. Infant death is increasing in the most deprived areas. For families in the most deprived areas, reviews from health visitors are a literal lifeline that can help to reduce health inequalities. Without those regular reviews and interventions from the earliest stages, those health inequalities will only grow as children get older. Children who miss out on crucial opportunities for early intervention will be more likely to experience homelessness, social isolation and mental health issues when they are older.

To give all children the best start in life, they need to grow up in a society that is free from poverty and inequality. Sixteen per cent of children who live in my constituency of West Belfast are impacted on by the two-child limit. That means that 16% of children are being financially punished for being born into a larger family. I declare an interest as somebody who comes from a larger family and was raised through welfare system support and whose mother and father could not have survived without that support. It is a shame that it is not available to constituents in my constituency and beyond.

We need universal free school meals to promote public health and educational attainment and to fight poverty, but, at the most basic level, we need an anti-poverty strategy that is based on objective need with clear outcomes for children and young people. I support the motion and the amendment for those reasons.

I call the Minister. Minister, you have up to 15 minutes.

Thank you very much, Mr Deputy Speaker. I thank the proposer of the motion and the proposer of the amendment for bringing this important issue forward for debate today.

One of the first Committees that I sat on when I was first elected was the Education Committee, and I became a fanboy of the late Professor Ken Robinson, who talked about the "element" that is in a pupil. It reminded me that, as a school governor, I used to talk about "the spark". Inside every child, without exception, there is a spark of ability, creativity and talent, and it is our duty as a society to create the environment where they can find out what that spark is and fan it out into a great forest fire of passion for learning and for life. If we want to afford every child the best possible start in life, surely our first base is to deliver on our commitments. If the commitment is to an assessment for every child in the first year, the only acceptable percentage has to be 100%. Every time that we drop below that, we need to ask why. Sometimes there may be legitimate explanations, but 100% has to be the target.

I thank Peter Martin for pointing out that these assessments are entirely consistent with my desire to shift left. Absolutely; healthcare should be delivered at home or as close to home as possible, and that should include prevention and early intervention to give the child and the family the best possible start. I acknowledge the crucial work that our health visitors deliver daily. They are integral to supporting families in the first few years of life; they are a vital part of the health and social care ecosystem; and they are instrumental in identifying developmental concerns. They provide advice that is often critical to parents, particularly new parents who are wondering how they are going to manage, and they ensure that families have the support that they need to provide the best start in life for their children.

As Members have acknowledged, I have a commitment to addressing health inequalities, which, I am glad to say, is also reflected in the Executive's Programme for Government. The work of health visitors is key in helping to address health inequalities by promoting early intervention, ensuring the health of our children and ensuring that future generations have the best start. Their expertise in child health, child development and family well-being is crucial, and their work is fundamental to ensuring that our children have that best possible start.

I recognise the concerns raised by the motion and the statistics that it highlights on year 1 reviews in Northern Ireland generally and the Southern Trust specifically. The fact that 15% of children here did not receive their year 1 review in the financial year 2023-24 is more than concerning to me. The regional disparity due to the position of the Southern Trust in the same period is also troubling. The figures are unacceptable. Every child in Northern Ireland deserves equal access to healthcare, regardless of postcode. The year 1 health review is one of a number of important health contacts in a child's development, allowing us to identify and address potential health issues and ensuring optimal growth and development.

The Northern Ireland-wide figures highlighted in the motion relate to 2023-24. Regrettably, during that period, health visiting services in some of our trusts faced significant workforce challenges with a large number of unfilled vacancies. Those issues were particularly critical in the Southern Trust, which experienced significant workforce challenges with a large number of unfilled vacancies that impacted on its ability to fully deliver year 1 reviews as recommended in the Healthy Child, Healthy Future policy. The Southern Trust has worked to increase recruitment to its complement of health visitors to allow it to deliver the services that are required. My Department has supported that increase in recruitment by funding significant training opportunities for nurses and midwives who wish to specialise in health visiting. I am pleased that the trust has been able to resume full provision of the Healthy Child, Healthy Future programme, and I have been assured that, based on current internal monitoring processes, uptake has improved significantly. Throughout that period, the trust took action to assess, manage and mitigate the risks involved. It has also reviewed its health visiting caseload and provided assurance that, in any case in which the year 1 review was not completed, an appropriate review has now taken place.

The House will be aware of the wider workforce challenges that we face. The health visitor workforce has, like many other parts of our health and social care system, been under strain. Health visitors are working with and managing much higher levels of complexity in our society, and the recruitment and retention of health visitors has been challenging, which will inevitably impact on service delivery.

Work continues across all trusts to address those challenges through workforce planning and recruitment exercises and the prioritisation of health visiting contacts as appropriate. I reassure the House that any decision to stand down any element of core health visiting reviews, as defined in the existing Healthy Child, Healthy Future framework, will be subject to a risk assessment by the trust in question.

I absolutely agree with the motion's call to end regional inequalities. The early years are critical to a child's lifelong health and well-being, and every child in Northern Ireland therefore deserves the best possible start. It is our responsibility to ensure that health and social care services are equitable, effective and accessible to all. Members will be aware that Healthy Child, Healthy Future is the framework for the universal child health promotion programme in Northern Ireland. The framework outlines the core health visiting and school nursing reviews that all families with children aged from nought to 19 can expect to receive. It is recognised as being central to improving child health across a range of issues and giving every child and young person the best start in life. I am pleased to be able to confirm that a refreshed framework is nearing completion, and I expect to publish it in May of this year. The refreshed framework will bring increased focus on providing additional support in the first two years of life, from conception to age two, and on tackling inequalities by focusing on families at risk of marginalisation and social exclusion.

As the number of children requiring additional support in schools is rising, the framework will have an increased focus on early identification and support, and this should enable children to be school-ready and ready to learn. Improving health outcomes for our school-aged population is a key principle of the refreshed school nursing programme. Improving the emotional health and well-being of our schoolchildren through helping to build resilience and encouragement in the development of healthy lifestyles, together with the promotion of health literacy, is fundamental in improving outcomes for children and young people.

As Members have noted, I have also launched a Live Better initiative, which has one strand and a sole focus on starting well. While not solely focused on the year 1 review, the Live Better initiative presents a unique opportunity to work collaboratively to improve access to early years healthcare in communities experiencing deprivation, and it should also help inform future collaborative work more generally.

The health and well-being of our children must be a high priority, and the year 1 health review is not just a tick-box exercise but a crucial opportunity to support child development and family health. I am committed to working with all health and social care trusts to ensure that every child in Northern Ireland receives that vital health review within the accepted time frame. The refreshed Healthy Child, Healthy Future framework will play a key role in that.

I thank the Minister for giving way and outlining all that. As part of the framework, will he indicate whether children whose first language is not English are being looked at? I am concerned that, potentially, there could be people with developmental or other problems that might not be picked up on if the health visitor does not speak the appropriate language.

I thank the Member for his intervention and understand his concern in that area. I will double-check, but I do not have any concerns that anybody who needs to access healthcare in our HSC system, who lives in Northern Ireland and who does not have English as their first language, experiences any difficulty in getting translation services. However, as I say, I am more than happy to check that.

We owe it to our children to give them the best possible start in life, and that means ensuring that every child, regardless of where they live, receives the support that they need in those critical early years. By strengthening our health visiting services and addressing those regional inequalities, we can and should build a healthier, more equitable future for all our children. I am committed to working alongside health visitors, local communities and all relevant stakeholders to achieve that.

Finally, Deputy Speaker, I address Mr McGuigan, the Chair of the Health Committee. Every day is a learning day: is it Daideo?

[Translation: Grandfather]

It is.

Congratulations. I do not know how long you have been a Daideo, but I am sure that you are enjoying it.

Thank you very much indeed, Minister. I call Michelle Guy to make the winding-up speech on the amendment. Sorry, we have your name down, Michelle, but I shall allow Daniel to do it. I call Mr Donnelly to make a winding-up speech on the amendment. You have five minutes.

Thank you Mr Deputy Speaker. I thank the proposer of the motion and all who spoke for their contributions. I will make a few points before highlighting some of the points raised by Members who spoke previously.

As my colleague from Lagan Valley said when proposing it, our amendment does not seek to change the motion, which is already very good, but to improve it with two additional points. First, the importance of delivering an updated Healthy Child, Healthy Future framework, and, secondly, to recognise the overlap between Health and Education in child development. As mentioned, the first two and a half years of a child's life are extremely important, and these six reviews are a key part of that. Health visitors can play an important role in assessing children and reassuring their parents. That is particularly important given the rise of misinformation on social media, including advice that is promoted without sufficient evidence.

The Minister has stated here and in answers to questions for written answer that workforce pressures are the key problem in respect of the missed one-year-old health reviews, as evidenced by the 2023-24 statistics that other Members have raised. That report also highlights the roll-out of Encompass, and while that will be beneficial in the long term, it can create short-term problems. I encourage the Minister to look into best practice from our other trusts in their roll-out to date, given that the Southern Trust will launch Encompass in less than two months. I also welcome the update from the Minister on the refresh of the Healthy Child, Healthy Future framework, and I look forward to further updates from the Minister in the near future.

I now turn to some of the comments made by other Members during the debate. My Lagan Valley colleague Michelle Guy pointed out that the value of these assessments is that they happen regularly, so they must be able to do that. Our Health Committee Chair, Philip McGuigan, or Daideo

[Translation: Grandad]

, called for the Department of Health to expand the role of health visitors in health and education. Colin McGrath highlighted the regional disparity in service delivery, with 46% of children in the Southern Trust currently not being seen. He also highlighted the fact that that was previously 65% and noted the improvement, albeit with lots more work to do. He also pointed out that the issue got bad when this place was not functioning and that a Minister could have been in post a lot earlier to address that. He is right, of course: when this place goes down, services are impacted on and people suffer. Protecting services such as this is another reason why we need to reform our political institutions to prevent any one party from blocking the formation of a functioning Executive.

Órlaithí Flynn raised the opportunity for health visitors to pick up on the signs of domestic violence in the home, which is obviously a huge issue for women at this vulnerable time. Peter Martin talked about the pace of brain development — 80% in the first 1,000 days — and the lifelong impact of events that take place during that time. He also highlighted the fact that those health visits are early interventions, and there is clearly a lot of cross-party support for those interventions. Gerry Carroll raised concern about the lack of Irish language services available to health visitors and to families who speak Irish. He also raised the impact of poverty on life opportunities and called for the implementation of an anti-poverty strategy.

The Minister of Health, Mike Nesbitt, mentioned the spark within each child and stated that the only acceptable target for assessments is 100%. He said that they are entirely consistent with his desire to shift left and tackle inequalities. He also announced that the refreshed framework will be published in May to help children to be school-ready and ready to learn.

There is a good degree of agreement around the Chamber on the importance of health visits and early intervention, and our intervention —. Sorry, our —

[Pause.]

Apologies.

Amendment.

Our amendment; thank you. Our amendment is to build upon an already strong motion.

I call Alan Robinson to wind up the debate. Alan, you have up to 10 minutes.

OK. Thank you, Mr Deputy Speaker.

I very much appreciate all the contributions, and I thank everyone who contributed. I thank the proposer of the Alliance amendment, which focuses on recommendations that remain outstanding from the 'A Fair Start' report and the independent review of education. As was said earlier, we are content with the amendment.

The health of young people in Northern Ireland is certainly an issue that the Minister's Department needs to get a grip of, and he has certainly given commitments today that that is what he intends to do. The one-year-old health review is key in the early years of a child's life. It helps to identify potential health concerns and provide parents with guidance and support, but it also ensures that children have the best possible start in life. The fact that 15% of children across Northern Ireland miss their health visitor review at that key stage and the fact that, in the Southern Health and Social Care Trust, that figure has soared to a shocking 46% should be sending alarm bells to the Minister's Department. As has been said, missing the one-year-old review could well lead to many lost opportunities to detect developmental delays and the ability to provide an early intervention that could change the trajectory of a child's life.

Whilst health visitors are responsible for monitoring a child's growth and development, they are also an important support pillar for parents. They provide guidance on nutrition, sleep, immunisation and mental health, and they are often the first to identify when a child may need additional support services. Their work ensures that concerns are dealt with and that families do not fall through the sometimes complicated health system. For many parents, especially those facing socio-economic challenges, health visitors offer reassurance, advice and signposting to services that can make an enormous difference in a child's early years.

Missing out on a health review could see some children go without the support that they require, leading to greater difficulties down the line, such as with speech and language development, motor skills and overall well-being. Missing the one-year-old health review can also be a lost opportunity to detect early signs of developmental delay, to support a family struggling with postnatal mental health, or to provide information on immunisation and nutrition. How many times have we heard it said in the House — we have heard it here today — that early intervention is key to improving outcomes? That could not be truer for children. Studies consistently show that, if developmental delays are identified and addressed early, it leads to significantly better outcomes in education, mental health and overall well-being. Missing out on health reviews means that developmental delays may go unnoticed until a child starts nursery or even primary school, by which time interventions are much more difficult, more costly and less effective.

The disparity between different health and social care trusts raises concerns about equity in access to services. Why should a child in one part of the Province have a dramatically lower chance of receiving a health review than a child in another? The postcode lottery flies in the face of the aim of ensuring that every child has an equal chance of a healthy start in life. The Minister must ensure — I am glad, as I said earlier, that he has committed to it — that all health and social care trusts ensure that every child receives their one-year-old health review within the accepted time frame. The Department cannot allow another year in which nearly half of the children in one health and social care trust miss out on their health review.

I will comment on some of the contributions. My eloquent colleague Diane Dodds talked about the importance of the debate. She said that, although it is important for the Department of Health, it is an issue that cuts across a number of Departments. She said that children are precious, which could be the most critical thing that has been said in the Chamber today. Diane also spoke of there being no magic wall between trusts. I am sure that the Minister agrees that all trusts should work and think as one, particularly when it comes to this important issue.

Michelle Guy, in proposing the amendment, talked in depth about the Healthy Child, Healthy Future framework. She also highlighted the importance of the first 1,000 days of a child's life. I am sure that all of us who are parents agree. Philip McGuigan, the Chair of the Health Committee, focused on early detection's being so vital and on the importance of the motion, for which we are all grateful. My Health Committee colleague Alan Chambers talked about the importance of the outcomes for children. He said that he hoped that the issues would not occur again. We all concur. Colin McGrath from the Opposition said that children should always have the best start in life, in keeping with the theme of others who took part in the debate. Órlaithí Flynn talked about the postcode lottery, and the importance of Sure Start. Peter Martin my party colleague also talked about the first 1,000 days and about those starting in the womb. He also talked at length about early intervention. Gerry Carroll talked about this issue's being another crisis in the health service. He said that children should not be made to pay for the problems in the health service.

We are grateful, Minister, for your saying that the target needs to be 100% and that children should have the best possible start in life. That is the crux of the motion. The Minister also said that the figures before us are unacceptable. Furthermore, he talked about the workforce challenges in the Southern Trust, but it would have been good to hear about whether it would have been possible to draft in health visitors from other trusts to fill the void. It was good to hear that a refreshed Healthy Child, Healthy Future framework will be published in May. We look forward to your returning to the House so that we can debate the matter in more detail.

I very much appreciate everyone's contributions today, and I thank Diane Dodds for tabling the motion with me.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly commends the vital role that health visitors play in supporting the health and development of children under the age of five; expresses alarm that 15% of children in Northern Ireland were not seen by a health visitor for their year 1 review in 2023-24; notes with deep concern that this figure rose to 46% in the Southern Health and Social Care Trust (SHSCT); highlights the critical need to end regional inequalities in the provision of child health reviews in order to ensure that every child and young person has the best start in life; calls on the Minister of Health to urgently work with all health and social care trusts to drive down the number of health reviews that take place outside of the accepted time frames or not at all; and further calls on the Minister to prioritise development of the revised Healthy Child, Healthy Future framework and ensure that the recommendations concerning the role of health visitors from the 'A Fair Start' report and independent review of education are implemented.