Alcohol Harm

Bill Esterson Excerpts

Thursday 2nd February 2017 Westminster Hall

[Bill Esterson (Sefton Central) (Lab)]

It is a pleasure to see you in the Chair, Mr Flello. I congratulate the hon. Member for Congleton (Fiona Bruce) on leading the charge to secure this debate, and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) on the work he does on this subject.

If we all knew that every year in this country 35,000 children were born with brain damage that could be prevented completely, we would of course do everything in our power to prevent it. Yet worrying evidence is emerging that that may be what is happening every year, and that the figures may be going up rather than down. I want to speak about the incidence of foetal alcohol spectrum disorders, which my hon. Friend the Member for Luton North (Kelvin Hopkins) just spoke so well about, among other things. I chair the all-party group on the subject and we produced an excellent report on it just over a year ago.

The worrying sign is that the numbers of people drinking in this country in general are increasing, as we have heard, including the numbers of women. That is especially worrying. It was the culture in the 1970s that few young people, especially young women, drank alcohol at all. That changed from the 1980s onwards and we now see an increase in the numbers. It was very unusual to come across children with foetal alcohol spectrum disorders or, as a recent report in The Lancet put it, “prenatal alcohol exposure”—I will come back to that report, but these days it is increasingly evident. I became interested in this subject because as an adoptive parent, I discovered how common it is among children who are adopted, including my own two children; I should declare that interest.

[Fiona Bruce]

If the hon. Gentleman recalls, when the all-party group received evidence about the impact of foetal alcohol syndrome on adopted and fostered children, one survey indicated that up to 70% of the cohort of adopted and fostered children assessed were affected.

[Bill Esterson]

Yes. I thank the hon. Lady for being the vice-chair of that group, and for the immense support that she has given to everybody in it. She is right; we took evidence from professionals in the children in care sector that as many as three quarters of children in care could be affected by alcohol damage during pregnancy. It is one of the major factors contributing to them ending up in care in the first place. I am glad that she raised that point. We also heard a suggestion that many children put up for adoption are damaged in that way, and we heard adoption described by one adoptive parent as a family-finding service for children with foetal alcohol spectrum disorders. It is a family-finding service with inadequate support; I will come to that shortly.

In our report, to which the hon. Lady rightly brings me, we identified that increasing prevalence, as well as the impact on children for life—not just while they are children—of irreversible brain damage and the impact on carers, parents, schools, health professionals and society of so many people with brain damage being unable to function fully in society, and all that that brings with it. As The Lancet reported on 12 January, the most extreme end of the spectrum, which is generally referred to as foetal alcohol syndrome, includes

“intellectual disability, birth defects and developmental disorders”.

The article goes on to list

“secondary disabilities including academic failure, substance misuse, mental ill-health and contact with the law due to illegal behaviours, with huge resultant costs to our health, education, and justice sectors.”

In our inquiry, we heard that 40% of people in prison exhibit symptoms of foetal alcohol spectrum disorder. High numbers of care leavers and people with mental illness end up in prison. Given the evidence that I have heard, it would come as no surprise to me, once we start to explore the root cause—I hope that such work can be carried out—to find that alcohol during pregnancy is a primary contributory factor.

Our inquiry took evidence from professionals who made the case that action must be taken. My hon. Friend the Member for Luton North spelled out how those in north America have managed to calculate the economic costs; the same will be true here. The societal costs are fairly obvious, from what I have described, but there is also an impact on families. If they must care for a child with the kind of disability that we are describing—believe me, it can be pretty challenging at times, from my personal experience—it can often have a dramatic financial impact, because people have to give up work to care full time, with little or no support.

[Liam Byrne]

My hon. Friend is making an extraordinary speech. As he will be aware, half of families living in poverty in this country have somebody with a disability in the household. It is not just a family issue or a public health issue; it is an inequality issue too.

--- Later in debate ---

[Bill Esterson]

Yes, that is right. My right hon. Friend has described his experience before, and I am sure that he will say more later. Many people are affected by being children of alcoholics; I think that the issue is directly related and a similar concern and challenge. Poverty and inequality are clearly linked to the damage done by misuse of alcohol, and I am afraid that the group on which I am concentrating is one of the most affected in our society.

We heard in our inquiry about the lack of support. There is only one specialist clinic in this country to diagnose FASD—it is in Surrey, and is led brilliantly by Dr Raja Mukherjee, who gave evidence to our inquiry—but that simply is not good enough. If 35,000 children are affected every year, we need a lot more than one clinic to help diagnose them, because diagnosis is needed in order to ensure that support is available.

[Kelvin Hopkins]

I applaud everything that my hon. Friend is saying in his speech. It was reported at one stage during our deliberations on the report that some medical staff literally do not know about FASD, even now. That is appalling.

[Bill Esterson]

That is right. The symptoms are misunderstood and significantly misdiagnosed, and too many professionals dismiss them. I have seen entirely contradictory diagnoses—doctors have described FASD symptoms perfectly well and then said that the child does not have it, due to the kind of misunderstanding that my hon. Friend just mentioned. We must improve understanding among health professionals. We must improve awareness, information and education among professionals, not just in health but in education.

In our inquiry, we also heard that children often cope at nursery, reception and key stage 1, and well into key stage 2, and it is only much later—from about year 6 onwards, as the expectation of independence grows in the school system—that the real problems start to emerge. Children who are damaged in this way find it difficult to cope in the school system, but because they have not been diagnosed early—because there has been no awareness or understanding, and they have got that far in the school system—it is assumed that FASD is not the problem, and that it might be due to what is going on at home or other external reasons, when the true cause is a disability. Again, we need greater support, awareness, understanding and training for education professionals as well as those in health and elsewhere.

What is needed? The Government should consider the following objectives. One objective should be to reduce the number of children exposed to alcohol during pregnancy. The Lancet’s report goes into great depth: international research suggests that just under 10% of the world’s population of women drink during pregnancy, but in this country, the figure is 41%, more than four times the international average. A similar figure was presented last year in the evidence of the FASD Trust, which serves as the secretariat for the all-party group and for which I am very grateful. That level of drinking during pregnancy suggests that the incidence of FASD may be four times higher in the UK than in the rest of the world. If we follow that logic, the World Health Organisation’s international figure is 1%, so in this country it may be 4% or 5%—that is where the figure of 35,000 babies comes from.

As well as an objective to reduce exposure to alcohol during pregnancy, the Government should introduce an objective to increase support and understanding in schools, in the health and care sector, in criminal justice and in wider society. How should they go about that? During our inquiry, we heard that the phrase should be used is

“no alcohol in pregnancy is best for baby and you”.

That fits the description of the strategy that we should adopt in this country. I welcome the fact that the chief medical officer revised the guidelines after we published our report—perhaps not entirely because of it, but I am sure we contributed. That was a big step forward. The guidelines now say that women who are pregnant or are trying to conceive should not drink alcohol at all. That is right, but by no means does it go far enough, because people do not know the guidelines—I am afraid that the increase in alcohol consumption suggests that, sadly, that is all too true.

As part of our strategy, we have to increase awareness, not only among professionals but among the wider population, of the support needed for women before pregnancy. In north America, which my hon. Friend the Member for Luton North mentioned, information is displayed in all the health facilities, education facilities and even airports—I have seen big signs in Canadian airports that say “Don’t drink if you’re pregnant or trying to conceive”.

[Kelvin Hopkins]

Another factor in America that I did not mention, because people draw back from it, is that people who are under the age of 21 cannot drink alcohol, and anyone who supplies alcohol to somebody under 21 can be sent to prison. That actually happened to a young Englishwoman who was on holiday in Florida: she provided alcohol to her younger sister and was sent to prison for corrupting a minor. It is taken very seriously indeed.

[Bill Esterson]

I am sure that the Minister has heard my hon. Friend’s comments. I agree that we must raise awareness among girls—and among boys too, because it is really important that boys and men play their part in influencing their partners in abstaining from drinking.

Awareness among professionals of how to prevent drinking during pregnancy has to be part of our strategy, but so does the support that is needed afterwards. Drinking during pregnancy will still happen, however much we are able to reduce it. Very sadly, some of the worst damage happens straight after conception; if someone has a drink before they know they are pregnant, it is too late to do anything about that drink. Support is essential throughout society, and it begins with awareness.

I was really disappointed that the briefing note for this debate did not make reference to foetal alcohol spectrum disorder. It made some really good points about other issues that we have discussed today, but it did not mention FASD. Given that FASD was one of the topics clearly indicated in the bid for the debate, that was really unfortunate—I shall not say anything stronger.

[Fiona Bruce]

The hon. Gentleman is making a powerful speech. I share his concern about this matter. I also share his concern that the chief medical officer’s guidelines on this issue have not been sufficiently promoted by the Department of Health. I know that some of the chief medical officer’s other guidelines were contentious, but the clear advice that women who are pregnant—or are considering pregnancy, I should add—should not drink has been received and accepted by everyone throughout the drinks industry and by all the organisations that seek to tackle alcohol harm. I join the hon. Gentleman in asking the Minister what her Department will do to ensure that that much needed guideline is much more adequately promoted throughout the country. It is shameful that that has not happened.

[Bill Esterson]

The hon. Lady’s comments are so good that I cannot really add anything to them. However, they bring me to the 2012 alcohol strategy, which makes the risks very clear and which refers to lifelong conditions that can have a severe impact on individuals and their families. Those conditions are caused entirely by drinking during pregnancy, so they are completely preventable. It is all already there in the strategy, which leads to the question of why the Government have not done more to promote awareness and reduce the incidence of this terrible problem. I hope that the Minister will respond to that point.

Let me cite some evidence from elsewhere. In Denmark, improved education and awareness led to an increase from 69% to 83% in the proportion of women abstaining completely from drinking during pregnancy. It did not eradicate the problem completely, but that is a significant improvement and a significant reduction in the number of children affected. It worked in Denmark and it can work here.

In 2015, I presented a ten-minute rule Bill on labelling—I am grateful to hon. Members present who supported it. Labels are just not adequate. They are so small and insignificant that they are ignored or are not noticed, and they are not enough anyway. Again, in north America, such information is displayed in big letters on the walls of pubs, bars and so many other places. That is another suggestion for the Minister: more awareness in places where people are drinking and more information on the bottles themselves.

It is crucial that we get the point across, because many women think that it is okay to have one or two drinks. But define “one or two drinks”! How much is one unit or two units? Most people have very little understanding of or insight into how much alcohol they are drinking—and anyway the evidence is that we just do not know whether there is a minimum level, which is why the only safe advice is abstinence.

[Fiona Bruce]

I apologise for intervening again, but I want to remind the hon. Gentleman of evidence that we have received. The reason that the recommendation has to be not to drink alcohol is that women’s individual alcohol tolerance levels during pregnancy are simply not known. I remember that he once mentioned a dramatic piece of evidence that showed—he will correct me if I have got it wrong—that a single drop of alcohol on an embryo resulted in that embryo becoming completely insentient for two hours. That is a startling piece of information.

[Bill Esterson]

I am pleased that the hon. Lady reminded me of that piece of evidence. Perhaps we should tour the country as a double act, because this is turning into one: she can remind me of all the bits I forget.

The hon. Lady is right about how important this is. It is not just about individual tolerance; tolerance changes as women get older and as they have more children. In families in which, sadly, more than one child is affected by exposure to alcohol during pregnancy, it is invariably younger children who are damaged most.

We all know about the dangers of smoking—now, nobody would dream of saying anything other than, “Don’t smoke during pregnancy”—but we have not got to that point with alcohol. FASD was first diagnosed in 1973. It has been known about since then, so why has so little been done about it in this country? Much more has been done in other countries; they have approached FASD far more effectively. We had good progress from the chief medical officer, but we need so much more.

What do we need to do? We need to have a prevalence study to understand the situation in this country fully, including why women are still drinking during pregnancy. Some of it is about awareness, but there are some other findings from Sweden that I will draw to people’s attention. In a Swedish study, women mentioned societal factors such as peer pressure, not wanting others to suspect that they were pregnant, and insufficient education, as some thought that drinking small amounts during pregnancy was harmless, and we have just heard about the problems that causes. Personal factors were also important, for example not wanting to miss the enjoyment of alcohol. Those were reasons that women in Sweden gave to explain why they felt that abstinence from alcohol during pregnancy was so difficult for them. We must understand those factors in order to do something about them.

That is why it is so long overdue for the Government to go so much further than they have already. We need a prevalence study to understand whether the 35,000 figure that I have cited is correct, and to understand why women are drinking during pregnancy to the extent that they are. Then we can start to make progress in reducing the incidence of problems and providing the support that is needed, because the cost to those children who are affected by alcohol and their families is catastrophic, and it is hugely expensive for us as a society and economy. The situation cannot be allowed to continue.

I urge the Minister to act. I think this is the first time that she has been involved in a debate on this particular issue—

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

indicated assent.

[Bill Esterson]

This is a chance for the Minister to start on the right footing and to really make some progress.

--- Later in debate ---

[Marie Rimmer (St Helens South and Whiston) (Lab)]

I applaud the right hon. and hon. Members who secured this debate with the hope of influencing the Government to update the alcohol strategy, which is absolutely necessary. In particular, the all-party parliamentary group for foetal alcohol spectrum disorder would like an update on action on point 5.15 of the strategy. It reads:

“Fetal alcohol spectrum disorders…result from mothers drinking alcohol during pregnancy. They are lifelong conditions that can have a severe impact on individuals and their families—leading to a wide range of difficulties including low IQ, memory disorders”—

such as forgetting how to swim, “attention disorders”, such as when people detach themselves from family members and adoptive parents—

“speech and language disorders, visual and hearing defects, epilepsy and heart defects. They are caused entirely by drinking during pregnancy, and so are completely preventable. We do not have good information about the incidence of FASD…FASD can be caused by mothers drinking even before they know they are pregnant; so preventing them is strongly linked to reducing the levels of heavy drinking in the population as a whole, and especially among women.”

The rate of alcohol consumption is much higher among women in my constituency than in many others. The alcohol strategy says that we need to reduce consumption in the population as a whole, especially among young women,

“including by increasing the awareness of health professionals.”

There is a lack of understanding and awareness about this problem.

Let me give a general overview. Some 10.8 million people in England drink at levels that pose a risk to their health. Most of us have a drink, which is why we do not recognise the problem—we say, “They are just having an extra one. They might have had a bit more than me, but they have not really got a problem.” Overall, alcohol costs the UK £21 billion every year. It affects millions of lives and places a huge burden on public services. The Government cannot afford not to do something about alcohol, because of the drain on the national health service, social services and children’s social care, and because of the number of children who have been placed in care or are up for adoption because of alcohol.

I have seen younger relatives die from alcohol. A great friend of mine died from alcohol—he was head hunted to work in this place some years ago. That professional, skilled person was lost to alcohol, and nobody recognised or faced the problem.

Alcohol is 54% more affordable now than in 1980, which has helped to drive the historically high levels of alcohol consumption. I could not believe, and could not convince my colleagues on the council, how much cheaper alcohol is than bottles of water. I took them round two local supermarkets where alcohol was cheaper than water—cheaper than milk, even. Supermarkets frequently use heavy discounts to sell alcohol more cheaply. The evidence is still around us today.

The figures suggest a modest drop in overall consumption in recent years, but we are still drinking at historically high levels. It is the culture where I come from. St Helens was born of Irish immigrants; it was as far as people could walk from the docks of Liverpool when they landed there after escaping the potato famine. They worked very hard in the pits and in glass and chemicals manufacturing, so it was normal to have a drink at night. But what has gone wrong is that many of the pubs and clubs where the working men could enjoy good company with their pals on a night out have closed down, largely because supermarkets are selling drinks so cheaply. People buy alcohol and drink it at home, where they do not get the company and other people do not see how much they are drinking—it is just their families, who are least able to cope with the problem.

Some 2.1 million children in England are negatively affected by other people’s drinking every year, and the Government have to do more for them. Children do not ask to be born. Young people in the UK tend to drink more and start drinking earlier than young people in other European countries because they see drinking in the house more. Children exposed to a lot of alcohol advertising are more likely to drink heavily and start drinking at an earlier age—10 to 15-year-olds in the UK view more alcohol ads on TV than adults over the age of 25. By the age of 15, 44% of girls and 39% of boys in the UK have been drunk at least twice.

In England, 100 children end up in hospital each week due to alcohol. I could go on and on with the facts, but I would like to give a general overview. More than anything, I want to focus on children. As a member of the all-party group for FASD, I was driven to this issue. I was alarmed by the number of cases coming up at my surgery, many raised by parents seeking to adopt children. It was heartbreaking. I want to talk about one family in my constituency that came to see me. They were a couple with two children in their late teens and they were on the road to adopting a young child aged eight. They had fostered her and had been given no information at all on health issues, but it soon became obvious that the child was a victim of FASD. She had detachment disorder and had forgotten how to swim, even though she had been taught. She displayed inappropriate behaviour towards visitors and their families, and visitors stopped coming to the home.

A dreadful battle ensued to get a diagnosis and a care package from the local authority. It was difficult because the child was not from the local authority area that the family were living in. They were advised that if the adoption was not completed in a certain timescale, the child would be removed from them. The adoptive parents had taken time off work, but had to return to their jobs. They were prepared to reduce their working hours to care for the child, but they needed a diagnosis and a care package. They were at risk of losing their home—that is how much they loved that child.

[Bill Esterson]

My hon. Friend is speaking incredibly well. I pay tribute to her for the work she has done as a constituency MP and for the support she has given the all-party group as well. The point she is making demonstrates the need for support for adoptive parents. All too often there is no post-adoption support, particularly with this condition of FASD. It is even more important than perhaps we knew in the past, so perhaps I can make that point via my hon. Friend to the Minister to pass on to colleagues in the Department for Education.

[Marie Rimmer]

I totally agree with my hon. Friend.

My constituents needed diagnosis and a care package. They were at risk of losing their home. They were heartbroken at the thought of the child being taken away from the family and put into another foster home, and then going through, again and again, more placements because families cannot cope with such children. It is so difficult to care for them and yet they are so lovable. The parents were absolutely heartbroken. Silent tears rolled down the cheeks of this professional couple. The tears rolled down quietly as they sat facing me. It was heartbreaking to watch them. The child was part of the family. The two teenage children were beside themselves at the thought of losing their little sister who had become a part of the family. It was only through my direct contact with the local authority chief executive that the child was allowed to stay with the family. In the end, the chief executive apologised and gave a commitment to the family that the necessary diagnosis, care and support would be provided.

More than 7,000 children affected by FASD are born in the UK each year. As a member of the FASD all-party group, I have raised the issue with officers at St Helens Council, where statistics show that alcohol-specific hospital admissions of females were the fourth worst in the country. It is a cultural thing. We see drinking in the family: it goes on, becomes the norm and then leads to an extra drink. Where I come from, we never used to see alcohol in supermarket baskets. There was certainly never any alcohol in our homes. Unfortunately, alcohol is in most homes now. That is where families and children see it being drunk and then becoming part of the culture. It becomes the norm and it is much harder to tackle.

In Peterborough, 75% of children referred for adoption have a medical history of pre-natal alcohol exposure. Most of the looked-after children in St Helens come from alcohol-related problem families. I have met officers at St Helens Council who have given me a principled commitment to progress matters. I am delighted that a training programme with all appropriate staff took place last year. It is estimated that 1% of babies born each year in Knowsley have FASD—that could mean 19 babies in the two wards in my constituency that are in that authority.

I am delighted that action is being taken locally by St Helens Council, but without a national response from the Government, FASD as an issue will continue to be overlooked by the population as a whole. As a local MP, I have done my best, but it is certainly not enough. I have supported the awareness strategy and campaign at Whiston Hospital maternity unit. A recent survey found that 72% of people in Merseyside believe the Government have a responsibility to reduce alcohol-related harm, which is a drain on services.

My understanding of where I live in the north-west—not just in the Merseyside authorities but outside—is that well over 50% of the children on looked-after registers and going forward for adoption are damaged by alcohol and are being raised in families with alcohol-related problems. How can the Government not look at that drain on services, but—more importantly—the damage to those children’s lives? What will they grow up to be? What quality of life will they have? They do not ask to be born. The Government must do more than they are doing now.

I commend the hon. and right hon. Members who secured this debate. So many people and families are distraught at the damage caused by alcohol. More must be done and I plead with the Minister to act accordingly.

--- Later in debate ---

[Nicola Blackwood]

My hon. Friend is right that that is not enough in and of itself, but it was an important step, because we did need to review the latest evidence and provide updated risk guidelines. That is also why we remain committed to high-impact public education campaigns. Last year, PHE launched its “One You” campaign, which she may be aware of, which aims to motivate people to take steps to improve their health through action on the main risk factors, including alcohol consumption. “One You” has been used by more than 1.6 million people so far. It includes a drinks tracker app, which helps drinkers to identify risky behaviour and lower their alcohol consumption. PHE will launch a new “Days Off” app on 7 February to encourage people not to drink alcohol for a number of days a week, which is in line with the CMO’s guidelines. Evidence supports that as an effective way to reduce drinking and a good, effective and manageable way in which to use the guidelines.

[Bill Esterson]

I am pleased that the Minister is making practical suggestions to address some of the problems that have been raised. I hope that she will take up the shadow Health Secretary’s offer to work together on this. As an initial step, perhaps she could sit down individually with the three of us who initiated the debate to take things further, because we have said a lot today but there is a lot more to the debate that may be of assistance to her.

[Nicola Blackwood]

The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.

In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.