Transcript of Module 2 Public Hearing on 6 October 2023

(10.00 am)

Mr Keating: Good morning, my Lady.

Lady Hallett: Good morning, Mr Keating.

Mr Keating: Could I call Professor Taylor-Robinson, please.

1. Professor David Taylor-Robinson

PROFESSOR DAVID TAYLOR-ROBINSON (affirmed).

Questions From Counsel to the Inquiry

Mr Keating: Thank you. Do sit down.

Could you give the Tribunal your full name, please. Thank you.

Professor David Taylor-Robinson: Professor David Carlton Taylor-Robinson.

Counsel Inquiry: Professor, thank you so much for attending today and assisting the Inquiry.

Just a few preliminary matters. Firstly, keep your voice up. It’s important that the stenographer, who is just to my left, hears what you say. If a question is unclear, please do say and I’ll just rephrase it.

You’ve produced a report to assist the Inquiry, a child inequalities report, dated 21 September of this year, and that’s at INQ000280060. And we see that there. And at the bottom of that page you have signed a declaration setting out your compliance with your duty as an expert.

Professor David Taylor-Robinson: Yes.

Counsel Inquiry: Is that correct?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: We see at the top your professional background and expertise, and perhaps you’ll forgive me for just dealing with it briefly. You are a professor of public health and policy at the University of Liverpool, you also are a professor of child health at the Copenhagen University?

Professor David Taylor-Robinson: Yes, yeah.

Counsel Inquiry: And you’re an honorary consultant in public health at Alder Hey Children’s Hospital?

Professor David Taylor-Robinson: Yeah.

Counsel Inquiry: You have done significant work in the field of research into child inequalities and their impacts during the pandemic?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: If we could just turn to page 2 of your report, we see the contents. It’s an extensive report, which we’re very grateful for, nine areas you consider in relation to child health inequalities, focusing on the period leading up to the pandemic in 2020, and they range from poverty, mental health, and educational attainment.

I’m not going to cover them all. We have your written evidence. But I want to draw out some of those in the hearing today.

If we turn over to page 3, please, you pose the question, “Why are health inequalities impacting children important?” We see at the top of that page. Perhaps can I invite you to provide an answer to that question by way of overview.

Professor David Taylor-Robinson: Yes. Yes, thank you. I mean, I work in Liverpool in child public health, in a city that’s at the sharp end of health inequalities, and if you take the life expectancy of a child born in Kensington round the corner from where I work, Kensington here, there is a gap of ten years in terms of life expectancy, 20 years in terms of healthy life expectancy for children.

Those are social inequalities in health, and we can say a number of things about those differences. They’re profoundly unfair, there’s nothing natural about them, they’re a consequence of how we organise society, and we can do something about them. We can do something about them through the organised efforts of society.

And inequalities that affect children are particularly important, because we know that early childhood inequalities track through and layer on top of one another over the course of children’s lives to generate inequalities in adult health. So lots of the problems we face in society around pressures on systems, health services, et cetera, have their origins in inequalities in children’s health. So that’s the life course perspective on health. If we want to address inequalities in adult health, we need to address early gaps in health affecting children.

Counsel Inquiry: That’s something that runs through your report, that there is that linkage between childhood inequality which follows it through into adulthood?

Professor David Taylor-Robinson: Absolutely, if you don’t get things right in childhood, it’s very problematic in adulthood. But inequalities affecting children are a moral imperative in of themselves. It’s unfair that children across different parts of the country have a different risk of dying in childhood, of developing asthma, of having poor educational outcomes, et cetera, as outlined in the report.

Counsel Inquiry: You mentioned the role of socio-economic circumstances in child health. Again, just a short overview about the relevance of socio-economic circumstances and how that impacts child health?

Professor David Taylor-Robinson: I guess my expertise is in the impact of socio-economic conditions on children’s health, and we measure those in a number of ways. We often look at family income, we look at parental education or occupation, so it’s about the circumstances of families into which children are born, and then you can look at how those kids grow and develop on the basis of those circumstances.

I guess central to the narrative is the influence of child poverty and the importance of material conditions in early life in structuring what happens over the rest of children’s lives as they grow.

Counsel Inquiry: Let’s move on to child poverty, which is a substantial part of your report, and we see it at page 5. You describe this at paragraph 7:

“Child poverty is a disaster for child health.”

Why is that?

Professor David Taylor-Robinson: Well, I mean, as a child public health doctor, it’s baffling to me that we let an exposure as toxic as child poverty wash over almost – well, a third of the kids in this country. We know from a huge body of scientific evidence that child poverty structures children’s exposure to all sorts of things that are harmful to their health. So child poverty, kids growing up in poverty, they’re exposed to adverse material conditions early on in life, so poor housing, et cetera, which affects health. They’re exposed to psychosocial risks, so they’re more likely to grow up in an environment where there’s stress, there’s toxic stress, there’s exposure to violence. They’re more likely to be exposed to behaviours such as smoking, et cetera, in pregnancy, which affect health. And it’s the layering and clustering of all those exposures with poverty that makes poverty such a toxic exposure for children’s subsequent health.

Counsel Inquiry: Well, let’s look at some of the figures which you have set out in your report. If you look at figure 1 at the bottom of that page and you have set out elsewhere on that document that in 2019/20, on the eve of the pandemic, 4.3 million or 31% of all children in the UK were living in relative poverty.

And in terms of the terminology, there’s different measures as to poverty, we’ve got relative poverty, absolute poverty, relative poverty after housing costs. We perhaps don’t need to overcomplicate it, but if we see the top line of the graph, the green line, which is the most deprived group, we see that high in each of these three graphs; is that correct?

Professor David Taylor-Robinson: Yeah, that’s correct.

Counsel Inquiry: That’s charting from 2015 to 2020, so in the five years leading up to the pandemic?

Professor David Taylor-Robinson: Yeah.

Counsel Inquiry: And you say this, that by any measure children in the most deprived areas of England were moving into poverty by the time of the pandemic; is that correct?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: If you look at paragraph 8, please, you say this:

“Rising relative poverty rates, and high absolute child poverty rates, contributed to worsening child health and wellbeing in the lead-up to the pandemic.”

What was the effect of that, those rising relative poverty rates?

Professor David Taylor-Robinson: Well, you know, as I’ve described, poverty is a major determinant of children’s health, and over the period of the pandemic we saw deteriorating socio-economic conditions for children in terms of poverty, food poverty, material circumstances, and we also started to see increasing inequalities in a number of aspects of health, as we outline in the report: infant mortality, we saw an increase in children dying in the first year of life, particularly in disadvantaged areas; rising inequalities in child obesity; rising inequalities in children entering the care system. All of which have been linked to rising levels of poverty.

Counsel Inquiry: We’ll touch upon those briefly in your evidence this morning. At the bottom of paragraph 8 you say that this rise in child poverty increased children’s vulnerability to the negative health impacts of the pandemic and decreased their resilience to financial shocks. Is that right?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: In terms of differences amongst the four nations, you set that out at figure 2 on page 6, and there is a difference between the different nations. We see Wales at the top, there’s an increase in child poverty as of 2020. But stepping back at the moment we see all these zig-zag lines. At the beginning of the new millennium there was higher child poverty, isn’t that correct, across the board?

Professor David Taylor-Robinson: That’s right, yeah.

Counsel Inquiry: Then we see a decrease, significant decrease in child poverty over the next five to eight years, and then around 2010 there was – that progress stalled, and then we see more recently in certain countries, certain nations, an increase in child poverty; is that correct?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: With Wales and England at the front, and lower levels but still, is it fair to say, significant levels, 25, just below 25% in Scotland and Northern Ireland?

Professor David Taylor-Robinson: Yeah.

Counsel Inquiry: Within England, you mention at paragraph 11 that the rises in child poverty largely occurred in the northern regions and West Midlands, is that the position?

Professor David Taylor-Robinson: Yes, indeed.

Counsel Inquiry: And London still had a particularly high poverty largely due to housing costs?

Professor David Taylor-Robinson: Yeah, that’s correct.

Counsel Inquiry: So a concentration in urban London, but also northern regions and the West Midlands?

Professor David Taylor-Robinson: Absolutely.

Counsel Inquiry: You describe other dimensions of poverty, food poverty being one feature which has increased significantly prior to the pandemic.

If we turn to paragraph 13, you use a phrase, more households with children were more “food insecure” than those without children, and an increase in the number of children supported by food banks, an increase of 49% between 2018/19 and 2019/20?

Professor David Taylor-Robinson: Yeah.

Counsel Inquiry: And digital poverty, perhaps relevant to many families who had children during the pandemic. Prior to the pandemic you touch upon this as a dimension of poverty at paragraph 17 and you cite survey data in early 2020 that there was between 1.1 and 1.8 million children in the UK who had no home access to a computer or a tablet.

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: The access to the internet and access to education for many was via mobile phone; is that correct?

Professor David Taylor-Robinson: That’s correct. Again, we outline the data there. The important thing is that there were social differences in access to a computer – there were inequalities in terms of kids that had access to computers and access to the internet. So more disadvantaged children, as you would imagine, had less access to online learning during the pandemic.

Counsel Inquiry: You use the phrase that there was a digital divide; is that correct?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: At paragraph 25 you talk about – when framing and examining poverty and the different measures of poverty, you speak of in-work poverty that had risen over that period of time. What did you mean by that, in-work poverty?

Professor David Taylor-Robinson: So over 70%, seven in ten children who were in poverty were in families where somebody was working. So it’s not the issue that this is completely a story about employment and unemployment. Part of the problem is that families in work still found that they were, their children were living in poverty prior to the pandemic.

Counsel Inquiry: And a significant proportion of those were actually working who were in poverty?

Professor David Taylor-Robinson: Absolutely.

Counsel Inquiry: The family structures which were impacted the most of this in-work poverty were?

Professor David Taylor-Robinson: So large families and lone families and families from non-white ethnicities were more likely to experience child poverty.

Counsel Inquiry: In examining poverty, you talk about the other axes of inequality, and you probably have seen and heard the evidence of Professor Nazroo yesterday, who provided a report and dealt with ethnicity and the inequalities in relation to that. Perhaps we could very briefly just touch upon this, because you’ve addressed this in your report on page 9 at figure 3.

In terms of ethnicity, how does that impact child health inequality?

Professor David Taylor-Robinson: Well, our report – ethnicity and poverty intersect to influence health outcomes in complicated ways, as we outline in the report. But the report outlines a general picture whereby, as you see in the plot here, minority ethnic groups are much, much more likely to – kids are much more likely to be in poverty, almost twice as likely to be in poverty. The plot also shows the regional differences across the country. And we see that being in a minority ethnic group and being in poverty generally speaking is particularly harmful for children’s health across the data that we present in the report.

Counsel Inquiry: Throughout every region, significant difference?

Professor David Taylor-Robinson: Yeah. I guess it’s smallest in Northern Ireland, but it’s still significantly different.

Counsel Inquiry: You would consider a 5% difference still to be –

Professor David Taylor-Robinson: Yeah, absolutely.

Counsel Inquiry: Disability is another area of inequality which you’ve touched upon, and we see that at paragraph 21, and it says there that just prior to the pandemic 37% of children living in a household where someone was disabled were living in poverty, and the difference is those – this is compared to 25% for children in households where there is no disabilities, so again that’s another feature which feeds into the inequality you spoke about?

Professor David Taylor-Robinson: Yeah, absolutely, that’s the layering of disadvantage. So disabled children or adults are more likely to live in poverty, and that increases vulnerability to the consequences of being disabled or being in ill health.

Counsel Inquiry: If we turn to paragraph 26, please, and drawing those threads together in relation to child poverty, which is really at the heart of your report, you say this: that child poverty was increasing in the lead-up to the pandemic, particularly for children of lone parents and families with multiple children and families with someone with a disability and some ethnic minority households, and the effect of that was widening socio-economic and ethnic inequalities in child health and wellbeing. And you describe how that structures an increased vulnerability to the effects of the pandemic.

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: I want to turn to child and adolescent mental health, and that’s found at your report at page 22, paragraph 58.

What was the position in relation to child mental health prior to the pandemic, in the lead-up to the pandemic?

Professor David Taylor-Robinson: The best data we have is from the NHS Digital survey in England, which clearly showed that mental health problems, children with a likely diagnosis of a mental health problem were rising incrementally. So the prevalence of mental health disorders in 5 to 15-year olds had risen from 9.7 in 1999 to 10.1 in 2004 to 11.2 in 2017. And then the next data wave of that survey was in 2020, just at the start of the pandemic. It’s not included in this report, but what we see is a dramatic rise in the levels of mental health problems and in the social inequalities in mental health problems affecting children.

Counsel Inquiry: So this dramatic rise, you mentioned that, as a health problem, this is one of the leading areas of childhood disability globally and nationally?

Professor David Taylor-Robinson: Yeah. I guess obesity and mental health problems have been described as the modern epidemics of childhood, and they’re of particular concern for the reasons I’ve outlined, because they affect children and there are inequalities in those outcomes, but they also predict outcomes in later life. So the majority of mental health problems present, you know, before the age of 20, and they tend to track forward into adulthood if they’re not picked up and treated. And if you have a childhood mental health problem, you’re much more likely to develop a persistent mental health problem as an adult, and that leads to comorbidity, impacts on productivity, education, et cetera, over the life course.

So poor mental health in children is a critical societal concern.

Counsel Inquiry: You’ve touched upon how socio-economic factors impact this, and how certain groups of children are more impacted than others; is that fair?

Professor David Taylor-Robinson: Yeah. You know, there are social gradients whereby disadvantaged kids are most likely to have poor health, but it’s particularly the case for mental health problems. So mental health problems in children appear particularly sensitive to social conditions and the impact of poverty, and, you know, the graph there at figure 9 shows the double the prevalence of mental health problems, over double the prevalence in the most disadvantaged kids compared to the least. That’s figure 9.

Counsel Inquiry: I’m not sure if I have a figure 9 but you do say at paragraph 73 that in 2017 those children and young persons living in the lowest income quintile were twice as likely as those living in the high income quintile to have a mental health diagnosis?

Professor David Taylor-Robinson: That’s correct. It’s page 23. I don’t know if that helps.

Counsel Inquiry: Thank you. Yes, thank you.

That draws out the point I was just making about the differential according to someone’s child poverty, a child’s positioning in –

Professor David Taylor-Robinson: Yeah. This shows that the children in the highest fifth of income households have – 6.8% of kids have a diagnosis of any mental disorder compared to, you know, the 16% in the most disadvantaged.

Counsel Inquiry: Thank you.

At paragraph 76 of your report, you say this: that the pre-pandemic child mental health was already in crisis, with evidence of rising prevalence in mental health problems for UK children, and that was increasing the inequalities and unsustainable pressure on services.

Is that an accurate summary of the position?

Professor David Taylor-Robinson: Yeah, there was an editorial in the BMJ titled “Child mental health in crisis”, and, you know, there were clearly concerns about rising incidents, but also the ability of services to treat children. You know, we’re still – and we’re still trying to catch up with that, because of pressures on clinical services.

Counsel Inquiry: Looking slightly beyond your parameters, you’re dealing with pre-existing inequalities prior to the pandemic, has mental health been an area where there has been significant issues in relation to child health since the pandemic?

Professor David Taylor-Robinson: Yeah, absolutely. So in that NHS digital survey there’s a step change, there’s almost a doubling in the prevalence of mental health problems and also a doubling of the social inequality, the difference between the highest and the lowest groups. So certainly that data that was published early in the pandemic showed that the pandemic had had a major impact on children’s mental health, particularly for disadvantaged children.

Counsel Inquiry: We’ve touched upon mental health. Physical health is something which you have dealt with in your reports, a number of areas which I’m not going to ask you about and we have in writing, about diabetes, epilepsy and asthma, but you do talk about child obesity, and you mentioned that again in your evidence this morning.

That was described in 2019 by the UK Government as one of the biggest health challenges this country faces; is that correct?

Professor David Taylor-Robinson: Indeed, that was from a report on obesity from the government.

Counsel Inquiry: Again, we have been talking about health inequalities or equity issues in relation to health; were there any equity issues as to health impacts of those children who had child obesity?

Professor David Taylor-Robinson: Yeah, absolutely. Like mental health, obesity is profoundly socially patterned and much more common in disadvantaged children, and I think one of the – am I allowed to refer to the graphs in the – I mean, the graph –

Counsel Inquiry: Yes, if the figure helps –

Professor David Taylor-Robinson: Figure 14, which, you know, shows – which is on page 31 –

Counsel Inquiry: Yes.

Professor David Taylor-Robinson: That shows over time –

Counsel Inquiry: I think we’re just going to bring that up now, and we have it in front of us.

So figure 14, yes?

Professor David Taylor-Robinson: That shows the proportion of children aged 10 or 11 in England who are obese –

Counsel Inquiry: So the least deprived is the bottom graph –

Professor David Taylor-Robinson: Yeah.

Counsel Inquiry: – line on the graph, and the most deprived is the darker blue, and you’re about to describe the differential between 2006 and 2017.

Professor David Taylor-Robinson: Well, you can see on – children living in the most deprived areas are twice as likely, roughly, to be obese at age 10, and that gap was widening prior to the pandemic. So inequalities were increasing. Obesity was just about stable for children in the most affluent areas but it was increasing in the most disadvantaged areas.

Counsel Inquiry: Educational attainment is another topic you deal with and one which is in itself a significant and important topic. Perhaps we can touch upon that briefly at paragraph 126. How would you say inequalities in relation to educational attainment arise and are important?

Professor David Taylor-Robinson: So I guess this goes back to, you know, the life course story, and we know that when you measure children’s development, even – so we have known national data for children aged 2 and a half, we assess all children’s development at age 2 and a half, and then at age 5 when they enter school, and you see social differences. You see differences, big differences, in children’s development, which then track through to influence educational attainment at every level.

So we know that it’s the early years environment, those material factors, whether you’re in a safe, stable home environment with access to books, a healthy learning environment in the early years.

And, you know, one of the big problems is that when children enter school at age 5, there are big gaps. You know, some kids are a year, a year and a half behind their peers, and those differences track through school to influence differences in attainment in GCSEs and A levels. And we saw that pre-pandemic, and in the latest data that’s coming out you see that those differences are increasing, those inequalities in attainment are becoming wider.

Counsel Inquiry: The “education gap” I think is a phrase which is used?

Professor David Taylor-Robinson: Yeah. So, often that’s measured on the basis of free school meals because that’s what’s collected in the data, so you can look at the attainment gap on the basis of children who are eligible for free school meals, who are disadvantaged compared to the rest. Pre-pandemic there was a persistent gap across all countries in attainment, at GCSE level for example, for children who were on free school meals.

But the important thing is that you see that also at reception, when children enter school, meaning that socio-economic circumstances influence children’s cognitive development, socio-emotional development, which influences children’s attainment ultimately as they emerge from school.

That’s the process of the intergenerational transfer of inequalities, where adversity in the early years affects children’s development, which affects their attainment in school, which affects their entry to the labour market, productivity as a society, et cetera.

Counsel Inquiry: I’m going to move on to deal with vulnerable children. A subgroup, and a significant subgroup, is children who are in care. You deal with that at paragraph 131 of your report.

What was the position in relation to the number of children in care in the lead-up to the pandemic, Professor?

Professor David Taylor-Robinson: Well, it’s easiest to refer to the graph, also, if that’s okay.

Counsel Inquiry: Yes, of course.

Professor David Taylor-Robinson: That’s plotted – that’s on page 46. So we were seeing – there was major concern about the rising number of children entering the care system. So from about the time of the financial crisis, around 2008/9 onwards, we saw a rise in children entering the care system. Prior to that there had been a narrowing of inequalities, but the graph shows that the rise particularly occurred in the most disadvantaged children, and that’s continued. So more disadvantaged kids are more likely to be taken into the care system.

What we’ve shown in various analyses is that the rise in children entering care was driven by the rise in child poverty. It was also affected by cutbacks to preventative services that helped – youth justice spending, et cetera, spending on children that helps prevent them entering – helps prevent families who are at risk of entering care.

Counsel Inquiry: Thank you, Professor. So we see from that graph that there was overall an increase, and that increase was more focused on those who were from the most deprived quintile?

Professor David Taylor-Robinson: That’s correct.

Counsel Inquiry: Drawing your oral evidence to a close before you’re asked by one of the core participants, with permission from my Lady, how would you assess in January 2020 the vulnerability of children to the impacts of the pandemic?

Professor David Taylor-Robinson: I think it was – there was clear concern pre-pandemic about health in the UK, about both child health and adult health. So we were seeing rising inequalities in infant mortality, we were seeing rising inequalities in life expectancy, we were seeing life expectancy going backwards, particularly for women in disadvantaged areas. That’s clearly important for children’s health.

People have described mental health as being in crisis; we were seeing more and more children being taken into the care system, we were seeing rising inequalities in childhood obesity, which is one of the biggest public health challenges we face.

So I think it’s fair to – you know, there was agreement beforehand, and lots of people had raised concern and had written about these worrying trends in children’s health prior to the pandemic, and these had occurred at the same time as rising levels of child poverty, and also cuts to services that support the most vulnerable children.

Mr Keating: Thank you. Professor Taylor-Robinson, those are the questions I propose to ask you today.

My Lady, there’s questions now that – Ms Twite is going to ask some questions which you’ve provided leave to.

Lady Hallett: Indeed, yes, she may, except I can’t see her.

Ms Twite: My Lady, I’m behind you.

Lady Hallett: I appreciate it’s difficult, but I would prefer it if those who are going to speak were in places where I could see them without having to move and upset the cameras.

Ms Twite: No, indeed, my Lady, I apologise. We had tried to move me to somewhere the witness could see me and I’m afraid we failed to move me to somewhere where you could see me, and I apologise for that, next time I will try and get into a better position.

Lady Hallett: It’s not your fault. It’s what happens when you have a hearing room with great pillars.

Ms Twite: Indeed.

Mr Weatherby: Before Ms Twite starts, I’m very happy to move. I didn’t know Ms Twite was asking questions, but as a generality I’m happy to move.

Lady Hallett: That’s very kind of you, Mr Weatherby, and we’ll bear that in mind. Thank you very much indeed.

Ms Twite: Thank you, Mr Weatherby.

Questions From Ms Twite

Ms Twite: Professor, I’m going to ask you just a few extra questions on behalf of the children’s rights organisations, Just for Kids Law, Children’s Rights Alliance for England and Save the Children Fund.

Firstly, I wanted to take you to paragraph 55 of your report, where you talk about the right to play. Some people may think that the right to play for children is a relatively trivial right when compared to other policies that the government have to consider. Do you agree with that, and can you explain what is particularly important about play for children?

Professor David Taylor-Robinson: I don’t agree with that, and it is important, as enshrined in the UN Convention on the Rights of the Child, and it’s – play is important for the reasons that we’ve touched on already. In terms of – you know, it’s the key factor in children’s early development, so access to play, interaction with family, with friends, in the early years lays down the – you know, we know children’s brain development, the architecture of the brain is layered, skills beget skills in the early years, and that comes from social interactions with peers and with other people. So a safe play environment for kids is really important from young kids, and I guess one of the things we – you know, the incredible rise in obesity that we saw, that we’ve seen over the period of the pandemic is partly testament to the fact that children didn’t have – older children didn’t have opportunities for outdoor play. So it’s incredibly important for a whole host of reasons and it’s not frivolous.

Ms Twite: Thank you.

Just building on that, is the ability to play with other children particularly important?

Professor David Taylor-Robinson: Yes.

Ms Twite: Again, building slightly further on that, would you therefore say there was a difference between an adult missing three months of socialising with their friends and a child missing three months of socialising with their friends, and if so what is that difference?

Professor David Taylor-Robinson: Yes, they’re completely un – they don’t – you can’t compare. Time – because of the critical and sensitive periods in children’s development that again I’ve already described, the life course approach to health means that you never get those windows of opportunity back again. And, you know, a lot of the action in children’s development happens in the first thousand days, as it’s been termed, but, you know, interaction in those early periods is completely different to missing a few months as an adult. They’re not comparable at all.

Ms Twite: You’ve partly answered this, but, as you’ve just said, it’s difficult to get them back, and you say that at paragraph 55 of your report, that these opportunities in the early years cannot be recovered.

Can you just explain why they can’t be caught up on?

Professor David Taylor-Robinson: Well, you shouldn’t be fatalistic about these things, because you can – there’s – you know, the brain, we talk about neuroplasticity, so the brain has incredible potential to recover subsequently, but it’s much more difficult, you know, the brain – brain development and the development of those early social skills – as I say, skills beget skills, and if you don’t have those firm foundations it’s much more difficult to recover and much more costly for services and treatments, et cetera, to try to recover that missed time later in life. Which is why – you know, which speaks to the critical importance of the first five years of life.

Ms Twite: I have one final question, and again you’ve touched briefly on this, but can you just explain in more detail how relevant it is to have access to outdoor space or playgrounds or green space for children?

Professor David Taylor-Robinson: It’s very important for children’s physical and mental health, as I’ve already outlined. It’s important in – with regards to what happened with obesity over the period of the pandemic, those interactions are important for children’s development, socialisation, and for their mental health.

Ms Twite: Thank you, Professor, I don’t have any further questions.

Thank you, my Lady.

Lady Hallett: Thank you very much indeed.

Thank you very much, Professor. Just to say that, as I’m sure you will know, there will be a separate module dealing specifically with children and young people, so I suspect we’re not saying goodbye today as my guest, and also to emphasise that I will obviously bear in mind all that’s contained in your very helpful report. So thank you very much for your help.

The Witness: Thank you, my Lady.

Mr Keating: Thank you, Professor.

(The witness withdrew)

Mr Keating: My Lady, could we call Anne Longfield, please.