Conception to Age 2: The First 1001 Days

Bill Esterson Excerpts

Thursday 17th December 2015 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

I am grateful to the hon. Member for Congleton (Fiona Bruce), who has been an excellent vice-chair of the all-party group on foetal alcohol spectrum disorder. I congratulate hon. Members on bringing the debate to the House because it gives us a timely opportunity to talk about the initial findings of our inquiry, of which the hon. Member for East Worthing and Shoreham (Tim Loughton) was another valued member.

I want to repeat as forcefully as I can the point that the hon. Lady made about the need for a prevalence study. I have asked the Minister about it previously in questions, and I put it to him that such a study is essential. The evidence we took in our inquiry is backed up by evidence that has come from around the world over many years—the hon. Lady identified a number of those countries. The time has long since passed for us getting that evidence base in this country so that we can understand as well as possible exactly how great a problem it is and what solutions are needed. The Minister can intervene now, but perhaps he will address that point later.

The hon. Member for East Worthing and Shoreham and my hon. Friend the Member for Nottingham North (Mr Allen) mentioned brain development and the damage done by alcohol during pregnancy when a mother and baby are susceptible to that damage. They are frightening results.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

One other area we need to consider is malnutrition and micro-malnutrition. Regardless of obesity or weight, we are seeing a more malnourished diet in this country from poor quality food and reliance on food bank food. Work done has shown low levels of iodine, which increases cretinism, and low levels of folate, in girls in their late teens, which means that, as they enter the child-bearing age, they are at high risk of having children who have major disabilities.

[Bill Esterson]

I am glad the hon. Lady managed to get that point on the record. That is an incredibly important part of the picture of the damage done to brain development. I want to concentrate my remarks on the damage from alcohol and the inquiry report that the all-party group has just published, but I am grateful to her. Her point is very complementary to my remarks.

My hon. Friend the Member for Nottingham North made a powerful point on the potential of early intervention—he said it could be the biggest deficit reduction scheme of all and mentioned the figure of £17 billion. That is an important point when it comes to foetal alcohol spectrum disorders. In Canada and the US, they use the term “million dollar baby”. It refers to the lifetime costs of the damage done by alcohol during pregnancy. The hon. Member for Congleton and others have mentioned many of those costs, whether it is the inability to engage socially or hold down a job. Many end up in the criminal justice system and many of us care for children and young adults who were damaged by alcohol during pregnancy. All of these things have huge economic and social costs. It is incredibly important that we take those points on board, whether on alcohol harm or other forms of damage and deprivation caused during pregnancy and in the early years.

The all-party group took evidence from a great many experts: Martin Clarke of the Adolescent and Children’s Trust; the consultant psychiatrist and nationally renowned expert on FASD, Dr Raja Mukherjee; Sir Al Ainsley Green, now President of the British Medical Association; SABMiller from the drinks industry; the British Pregnancy Advisory Service; Public Health Research; a midwife; and parents and carers, as well as young adults living with foetal alcohol spectrum disorders. We heard heartrending examples of damage done, difficulties faced and the life-limiting effects of alcohol during pregnancy.

I want to pay tribute to and thank the Foetal Alcohol Spectrum Disorder Trust for the secretariat support, and other organisations such as the National Organisation for Foetal Alcohol Syndrome, which has for many years attempted to improve the education of professionals in health, education and other sectors on what is needed to prevent the disorder and to support people who care for children and young adults; and Mencap, which advises GPs.

There have been some puzzling changes over the past 20 or 30 years, something the hon. Lady touched on. In the 1970s, alcohol consumption in the UK was one of the lowest in the western world. From that low base, however, there has been a steady increase. There is a remarkably strong correlation between the increase in alcohol consumption and the increase in the incidence of mental health problems, attention deficit hyperactivity disorder, autism, Asperger’s, and many different kinds of learning and physical disabilities. The remarkably close correlation suggests causality. Brain damage is not reversible and is clearly significant. As the hon. Lady said, the World Health Organisation estimates that 1% of people born today are affected by FASD. Even at 1%, that is 7,000 children born every year. That is 7,000 too many.

For anyone new to this subject, there is a widely shared video of the effect of a small drop of alcohol on an embryo, which is compared with an embryo that does not experience the ingestion of a small drop of alcohol. The difference is stark. For two hours, the embryo stops moving altogether. We can only wonder at the damage done at that very early stage of pregnancy. International evidence suggests that the damage is done in the early days and weeks in particular.

As the hon. Lady said, the advice is far from clear. On the one hand, people are told not to drink. That seems clear. From the evidence heard by the all-party group, that is the right advice. However, the advice also says that if a woman chooses to drink, she should drink only one or two units. The advice appears inconsistent and contradictory. We took evidence from health professionals, the vast majority of whom do not appear to be aware of the real level of risk and danger. They do not appear to be passing on advice to women planning to conceive or who are pregnant. That is why our inquiry recommended it be made clear that the best thing for mother and baby is for the mother not to drink at all.

I hope that the Minister—I am sure he will—and all who are interested will read the report and carefully consider its recommendations. It is only an initial report—we plan to continue our work—and I hope that he or one of his colleagues will come to one of our meetings to discuss this matter in greater detail. As my hon. Friend the Member for Nottingham North said, early intervention gives us a fantastic opportunity not only to improve the life chances of many people but to save a lot of money. When it comes to the damage done by alcohol during pregnancy, the 7,000 figure, which, from the evidence we received, might well be on the low side, suggests that there is a huge opportunity. I hope that, as a result of the work we have done and the fine work of those Members responsible for today’s report, progress can be made and that the Minister will agree to commission the prevalence study, so that we can start to reduce the number of children damaged every year in this country.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

I thank all colleagues who have taken part in what is a most important debate, despite being the last of this parliamentary term. It was handled in an exemplary way by a number of colleagues who know a great deal about the subject. I commend them for the breadth of interest and knowledge they demonstrated. I thank my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) and the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for securing the debate through the Backbench Business Committee.

I also pay tribute, as others have done, to my hon. Friend the Member for South Northamptonshire (Andrea Leadsom). The debate has been graced by a number of colleagues who have taken a huge interest in these matters over a lengthy period, often in quiet rooms, talking to people about the issues, and raising them on the Floor of the House. That often unsung work has been vital in giving us the information we need, and a number of hon. Friends deserve real credit for it, not least my hon. Friend the Member for South Northamptonshire.

I congratulate the all-party group for conception to age two—the first 1001 days on relaunching its manifesto, “The 1001 Critical Days”. I popped into the relaunch for a short time, but a few weeks earlier I was grilled by the group’s members on my interest in the subject. I am not the Minister responsible for children’s health, but one of the issues is that a number of different agencies are involved, and I understand very well that one of the requirements of the manifesto is to ensure that they work more closely together. I also have a particular interest in perinatal mental health, which I will spend a bit of time speaking about today. I certainly take the manifesto’s point about the range of different actors that need to be involved, and the fact that we need to work together more effectively. I will be glad to take that message back to colleagues. I thank the all-party group for its work.

I note that the manifesto includes a foreword by Dame Sally Davies, the chief medical officer. I must say that that is probably at least three quarters of the work done. I do not know how many Members have met Sally Davies, but they should know that anything she gets behind tends to happen. I therefore congratulate the all-party group on securing her support, which will be vital.

At the manifesto’s core is a clear and simple message: the first 1001 days of a child’s life are a critical window of opportunity. Prevention and early intervention at that stage can improve outcomes and transform life chances. There is no dispute about that across the House; there is perhaps sadness and regret that more was not done in the past, but we must all start from where we are and make progress. Much work has been done in recent years, and colleagues have been generous in their praise of it, but clearly there is more to do, and the manifesto sets out some of the challenges.

I will make a few general remarks about the speeches we have heard, and then I will refer to others as I go through my speech. The hon. Member for Nottingham North (Mr Allen), who has spent a great deal of time working on early intervention, spoke about the philosophy that was needed to understand this, and he is absolutely right—few could have done more than he has to bring that forward. Some of these issues are cultural; they are about taking people out of silos. He was generous in his praise of my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith). My right hon. Friend, and I suspect a number of other Members, was much inspired by the work of a chap called Bob Holman—a family worker and an academic who chose to live in Easterhouse in the centre of Glasgow—on social justice. Bob is unfortunately quite ill at present. I would like to send good wishes to him for the remarkable work he has done. He is well known for his work in Scotland, and in the United Kingdom. We are sorry that he is ill and send our best wishes to him and to Annette.

The hon. Members for Foyle (Mark Durkan) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) —thank you, John Ronald, who follows on me on Twitter, for helping me with the pronunciation—pointed out the importance of all of us in the British Isles looking to what work is done by one another. I will certainly inform ministerial colleagues of the work being done by the unit at Queen’s University Belfast, and that being done in Scotland, and we can follow that up. I said to the hon. Member for East Kilbride, Strathaven and Lesmahagow after her intervention on mental health that I am keen to see what is being done in other places, and I will follow that up as well. We do have parenting skills classes in England. That provision has been much boosted by the health visitor programme, and it is as vital to us as it is in Scotland. I am sure that others will be interested in looking further at that.

The manifesto highlights the importance of high-quality universal services from conception to age two, which have rightly been described as a “lynchpin”. For the vast majority of women and babies in England, NHS maternity services provide a positive experience and good-quality care. We also have a good, strong, evidence-based universal public health programme—the healthy child programme from pregnancy to age five—which is delivered by health visitors. To strengthen the delivery of the programme, we have increased the number of health visitors by almost 50% in the past four years—one of the most rapid workforce expansions in NHS history. At the same time, the landscape for delivering services to under-fives is changing. On 1 October, responsibility for commissioning nought-to-five public health services transferred to local authorities. This change is of course a challenge for services, but it also presents an opportunity for local leaders to commission and provide more joined-up services for young children and families, across health, education and social care, based on their understanding of local need.

The manifesto contains a number of recommendations, including one mentioned by my hon. Friend the Member for East Worthing and Shoreham about the attachment needs of families:

“Childminders, nurseries and childcare settings caring for under 2s must focus on the attachment needs of babies and infants, with OFSTED providing specific guidance on how this can be measured effectively.”

The Government absolutely agree. Personal, social and emotional development is one of the three prime areas of the early years foundation stage curriculum, and forming positive relationships, including with adults, is key to this. I will ensure that my colleagues in the Department look particularly closely at that recommendation, for attachment is absolutely crucial.

My hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for Sefton Central (Bill Esterson) raised foetal alcohol issues. I commend them for the report that has, I think, come out today, following the inquiry by the all-party group on foetal alcohol spectrum disorder.

[Bill Esterson]

It is on its way to you.

[Alistair Burt]

Thank you very much.

It is too early to respond to the report, but I can say that it is really important. It is not like a Select Committee report, in that the Government do not have a duty to respond to it, but I would be extremely surprised if colleagues did not want to do so in due course, because it is so important. The official advice given is this:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol…If women choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk.”

We will shortly publish a consultation on the UK chief medical officer’s alcohol guidelines review. This will offer an opportunity to work with clinicians and other professionals to ensure that they are fully informed about the content of the guidelines and able to explain them to the women they care for and help them make informed choices on alcohol consumption. I would imagine that the substance of the inquiry ought to form part of that consultation and discussion. I think that the most important part of the advice is:

“Our advice remains that women who are trying to conceive or are pregnant should avoid alcohol”.

[Bill Esterson]

I am grateful to the Minister for those comments. The international examples given by his colleague the hon. Member for Congleton (Fiona Bruce) are very clear. The advice is not in two parts; it is a simple, single piece of advice: the best advice for mum and baby is to not drink at all. That is what happens around the world. The Minister has mentioned Dame Sally Davies. I hope she will agree with that and that that is what we will end up with, because it would make a massive difference.

[Alistair Burt]

I absolutely understand the hon. Gentleman’s point and hope that comes to pass. The Government will respond in due course.

I am the Minister with responsibility for mental health, which was raised by the right hon. Member for North Norfolk (Norman Lamb) in particular and the hon. Member for Ellesmere Port and Neston (Justin Madders).