Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

The hon. Lady should be very careful before talking down nurse associates. They do a fantastic job, they are trained, they are helping our NHS and they are welcomed by their nursing colleagues.

[Bill Esterson (Sefton Central) (Lab)]

Under this Government, there has been an unprecedented fall in the number of nurses: the NHS is short of 40,000 nurses and more than 6,000 have gone since 2010, under this Conservative Government. When will the Secretary of State acknowledge that he is failing the NHS and failing patients, and when will he do something about it?

[Mr Hunt]

With respect, I really think the hon. Gentleman needs to get his facts right. The number of nurses has gone up, not down, since this Government have been in office. The number of nurses in our hospitals has gone up by more than 11,000, because this Government are supporting safer care in all our hospitals.

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.

NHS and Social Care Funding

Bill Esterson Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

Labour MPs have been raising these matters in this House for weeks, including at urgent questions and in Opposition day debates.

[Bill Esterson (Sefton Central) (Lab)]

I presume what the hon. Member for St Albans (Mrs Main) meant to say was that two Back-Bench Labour Members took part in the debate—I was one of them. Does my hon. Friend agree that the point about community pharmacies, GPs and investment in social care is that they save the Government money? That is why they should invest in them now to take pressure off A&Es.

Pharmacies and Integrated Healthcare: England

Bill Esterson Excerpts

Wednesday 11th January 2017 Westminster Hall

[Steve Double]

I thank my hon. Friend for making that point, which I completely agree with. There is much more we could do to increase the general public’s awareness of exactly how highly qualified our pharmacies’ staff are and of the excellent services that pharmacies can provide.

My hon. Friend the Member for Plymouth, Sutton and Devonport talked about the need to integrate IT systems better, which I believe is part of the solution we seek. My understanding is that community pharmacies can access summary care records, but on a read-only basis. Many pharmacists I talk to say that if they had read-write access to that information, so that they could input data about treatments they have given to patients, that would be better. For example, if they could take a patient’s blood pressure and input that reading into the patient’s care record, that would save the patient time as they would not then have to go their GP to have the same reading taken and put into their record. I urge the Government to consider carefully whether read-write access could be granted to pharmacies, because I believe it would save a huge amount of time and reduce what I believe is often duplication of work within our health system.

An interesting fact that I discovered in my discussions on this subject is that the average time that someone waits when they go to see their pharmacist—that is, the time between entering the pharmacy and actually getting to see the pharmacist—is eight minutes. Many people in this country would be absolutely delighted if they could see a health professional within eight minutes of asking to see one. I am sure that many hon. Members here today have in-boxes full of people’s complaints about how long it takes them to see their GP. If people were aware that if they went to see their local pharmacist they would only have to wait eight minutes on average to see a very well qualified health professional who has a good chance of providing them with what they are looking for, I believe they would be delighted. That is another example of how we can promote the work of pharmacists, which would provide a far better service to the people of this country and take pressure off the other parts of our health system.

[Bill Esterson (Sefton Central) (Lab)]

I am grateful to the hon. Gentleman for giving way and I apologise, Mr Bailey, for missing the start of the debate.

The excellent pharmacies in my constituency do much of the fine work that the hon. Gentleman and other speakers have described, but it struck me as I was sitting here listening to him that he is making a very powerful case for investment in our pharmacies, rather than the cuts that the Government have proposed. Does he accept that point? Will he and his hon. Friends take this opportunity to call on the Health Secretary to think again about pharmacies and the important role they play and to see them as an investment, so that they can play their part, particularly in taking pressure off A&E?

[Steve Double]

Although I agree with some of what the hon. Gentleman says, I believe the funding model for pharmacies needs to be looked at because there is a great deal of duplication. The money spent could be better utilised, so the funding model needs to be reviewed. Some of the recent changes are a step in the right direction, but I will always make the case that, particularly in our rural communities, we need to be careful how those changes are applied so that our local pharmacies continue to be viable and able to provide the services that are needed.

--- Later in debate ---

[Bill Esterson]

I do not think I disagree with anything the hon. Lady has said. She is making a very good case for the excellent practice in her constituency and for pharmacists more generally. Does she agree that the logic of her argument is that money is saved by investing in pharmacies? That is a strong argument. She is arguing that cuts should not be made and that the Government should invest in pharmacies to support the whole health system, which is what this debate is about.

[Jo Churchill]

I thank the hon. Gentleman for his intervention and agree with his final point. This is about the whole system and making efficiencies. We are talking about evolution. We are no longer looking at the service as it was perceived in 1948. There was a private element to it even back then, because that is what GPs wanted. We need a 2017 solution to the challenges of a larger population, an ageing population and so on. Pharmacists must play their part in that. They are really keen to step up and deliver more for the Government and more for the patients and people in their communities.

There are issues in the town, but there is an interesting rural situation, where there are rural payments for Elmswell and Thurston, but the GP surgery in Woolpit, which dispenses more scripts, does not get one. There seems to be a bit of discrepancy. I echo the point made by my hon. Friend the Member for St Austell and Newquay (Steve Double): looking at rural constituencies is a very different thing from looking at the whole ecosystem.

There is a Day Lewis pharmacy in my town. An exceptional local resident, Ernie Broom, is keen to note that that pharmacy, because of its location, cannot offer a lot of peripheral things. The local residents are largely mature or on lower incomes, which means that the pharmacy is vital to the community. We also have really poor bus services into town—it would take a young mum or an elderly person nearly an hour and a half to cross town. I want the Government to look at a weighting system, which takes into account what local pharmacies can deliver. They would get points for being in certain areas, or incentives for delivering more. I know that is something that is being looked at.

My questions are similar to those posed by my hon. Friend the Member for St Albans. What more can pharmacies be incentivised to do? How much more capacity can they provide? With people living longer and with comorbidities, how can we remunerate for services? How can we ensure that that is included as part of sustainable transformation plans? It is not something that should be added at the end as an afterthought, but is a hugely integral part of how we make our NHS better and more able to look after the health of us all.

Mental Health and NHS Performance

Bill Esterson Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

That is an absolutely excellent suggestion, and I will be very happy to take it up.

[Bill Esterson (Sefton Central) (Lab)]

The problems in A&E that we have been hearing about this afternoon are symptomatic of problems elsewhere in the system. At Aintree hospital, whose staff are doing a fantastic job in very difficult circumstances, there are 130 patients who are medically fit for discharge today but social services are unable to support them to go home or to go into care elsewhere. The Secretary of State needs to accept that the cut of £4.6 billion to social services was a mistake. He also needs to accept that the better care fund is simply not delivering. It involves money being recycled from elsewhere in the system. Let us look at the figures for Sefton, which was promised £9 million but has received less than £1 million. If he is serious about sorting out the problems in social care in the long term, he needs to get the funding right. He needs to reinstate all the cuts that have been made.

[Mr Hunt]

I accept that more funding needs to go into social care, and that is why we are putting an extra £3.5 billion per annum into social care by the end of the Parliament. Despite the very real pressures in social care, however, there are many local authority areas and hospitals that have no delayed discharges at all. Half of all delayed discharges are in just 20 local authorities. As we wait for that funding to come on stream—it is not all coming on stream at the start of the Parliament—there is lots that can be done.

Community Pharmacies

Bill Esterson Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

The hon. Gentleman has made a good point. A large part of the value added from pharmacies is related to quality, and we need to reward the pharmacies that are trying harder than others to provide it. The hon. Gentleman mentioned healthy living pharmacies, and there are many examples. Part of our package will address the quality issue, which is one of the issues that the Pharmaceutical Services Negotiating Committee asked us to consider.

[Bill Esterson (Sefton Central) (Lab)]

If the Minister wants to make the savings that he has talked about, he should work with the pharmacists and listen to what they have to say, because they have the ideas about how to make those savings. In my constituency, they talk to me about the potential for reducing repeat prescriptions, among other ideas. If he does that, he will play a role in looking after the heart of our community, which is what pharmacists are, and the heart of our NHS, which is also what they are. They also play an incredibly important role in every community in providing much needed footfall for other local businesses.

[David Mowat]

We have been talking to the Pharmaceutical Services Negotiating Committee for 10 months. We have tried to incorporate, in the proposals that we are going to make, some of the points it has put to us. I can only again tell hon. Members, as I have already said to many others, that we value the contribution that the pharmacy sector can make. We wish to see that move over and above what it is now, in terms of dispensing, into more value-added services dealing with minor ailments, repeat prescriptions and long-term conditions. We want to do all those things, and we will.

Land Registry

Bill Esterson Excerpts

Thursday 30th June 2016 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

Everyone who has spoken in this excellent debate has consistently come to the conclusion that the Government consultation should conclude that the Land Registry should remain in public hands, and that privatisation should be rejected. That has been the very clear message from speakers from all parts of the House. The proposal to privatise the Land Registry highlights the choice between a quick buck and long-term stability. It gives us the chance to consider the importance of an impartial register for the ownership of 24 million UK properties. It has revealed, yet again, overwhelming public opposition.

I congratulate my right hon. Friend the Member for Tottenham (Mr Lammy) on securing both the debate and such strong cross-party support. His opening remarks were comprehensive. He said that in bringing this proposal forward the Government had shown that they were itching to privatise, that the status quo had not been offered and that the proposal amounted to profiteering. I am afraid that that is very good summary of what will happen should the proposal go forward.

I will respond to some of the excellent speeches we have heard. The hon. Member for Carlisle (John Stevenson) described the Land Registry’s natural monopoly and pointed out that just as we would not privatise the police service, so too this was a privatisation too far. I agree.

My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) talked of considerable folly. He mentioned the benefits that the people of Hull have derived from the location of Land Registry offices there, which generate Government business and deliver good, well-paid jobs, helping to replace lost industry in Hull, not least the fishing industry. The locating of the Land Registry around the country is a good example of how Governments in previous generations have located offices up and down the country, in an attempt to devolve to and support the regions. I hope the Government will take note of his comments on the importance of continuing that policy in relation to the Land Registry, or indeed in relation to the offices of the Department for Business, Innovation and Skills, such as the one in Sheffield which, sadly, is closing. He made the point well about how Government jobs and Government offices support the economy outside London.

The hon. Member for Harwich and North Essex (Mr Jenkin) talked about the importance to any country, not least ours, of having a reliable registry, and referred to what happened in Iraq. Another hon. Member made a similar point in an intervention about what happened in East Germany after reunification. This is an incredibly important point that underlines the importance of the Land Registry and secure data to the economy and to the reliability of property title.

My hon. Friend the Member for Swansea East (Carolyn Harris) talked about the importance to her constituents of the jobs the Land Registry delivers. She also talked about profitability and the harm that privatisation would do to Government finances, with annual profit being lost to the Exchequer.

The hon. Member for Colchester (Will Quince) said that he was elected to balance the books and was against this privatisation. I am pleased that he understands the economic argument between a one-off capital receipt and a sizeable annual return to the Exchequer. If we want to balance the books, we need to keep that strong annual flow of revenue to the Exchequer.

My hon. Friend the Member for City of Durham (Dr Blackman-Woods) talked about the importance of the register as a live document of the way that transactions are always being added, and the potential danger of a conflict of interest if a private company were to take over responsibility, especially given that it is a monopoly.

The hon. Member for South Dorset (Richard Drax) spoke of the potential destabilisation of the housing market that a sell-off could cause. He said that privatisation might lead to shortcuts by a private operator that could undermine the integrity of the data. He felt that the risks of such changes were too great to be considered.

The hon. Member for Glasgow South West (Chris Stephens) said—the hon. Member for Brighton, Pavilion (Caroline Lucas) made a similar point in an intervention— that the Land Registry would not be subject to freedom of information requests. He urged the Government to abandon what he called damaging plans. I completely agree with him on that.

The hon. Member for Thirsk and Malton (Kevin Hollinrake) made the point that asset sales might cut the debt as a one-off, but that the loss of annual receipts would not help deficit reduction in the long run. I am pleased to hear Conservative Members recognising the importance of economic credibility. I thought, when he talked about BT, that he was going to recommend renationalisation, but he did not quite go that far.

[Kevin Hollinrake]

My point was in favour not of public ownership and renationalisation, but of the introduction of more competition into the telecoms market.

--- Later in debate ---

[Bill Esterson]

Yes, I rather thought the hon. Gentleman might say that— [Interruption.] The Minister correctly points out that was an opportunity for mischief that could not possibly be missed.

My hon. Friend the Member for Llanelli (Nia Griffith) made an excellent speech. She talked about the petition containing 300,000 names that was handed in to the Department for Business, Innovation and Skills. I was there with her on the day, as were a number of our hon. Friends. She rightly asked what on earth we are doing here just two years after the last attempt at a privatisation, at which time very clear and widespread opposition to it was demonstrated.

[Dr Blackman-Woods]

Does my hon. Friend agree that when many of us, with a whole range of organisations and unions, including the PCS, turned up at the Department, it would have been really helpful if the Minister had come out to meet some of the people who wished to hand over that huge petition? [Interruption.]

[Bill Esterson]

The Minister, from a sedentary position, points out that that would not have been him. Perhaps we can take that as him agreeing that the Minister responsible should have been there to meet us all on that day. He can choose whether to respond to that point when he replies to the debate shortly.

The hon. Member for Telford (Lucy Allan) made a point about the importance of the Land Registry’s success to her constituency. That is true for each and every one of us in every constituency in the country.

The Land Registry has existed for 150 years. Currently it does not cost the taxpayer a penny. It makes a significant profit and delivered a surplus in 19 of the past 20 years. A one-off fee from its sell-off is no strategy for deficit reduction, as Conservative Members have acknowledged. It would allow for only a one-off reduction of debt. This is not an economically coherent approach to Government finances. Worse, it is cynical to pretend to taxpayers that the proposal constitutes the responsible management of the economy. I am afraid that, driven by the Treasury and the Chancellor, privatisation is exactly what the Government appear to be trying to do.

The consequences of selling off the Land Registry are far wider and more dangerous than losing a profitable public sector enterprise. Having a trusted impartial register of land underpins our economy. I do not need to repeat to Members the uncertainty and danger that has been caused by the Brexit decision that was taken a week ago. We have seen that uncertainty in the markets and it is spreading to the real economy, with job losses already announced. That uncertainty applies right across our economy, as well as to the role the Land Registry plays.

Any house that families or companies buy or sell relies on the Land Registry granting and transferring title deeds. It is the only proof of title or ownership recognised by law for £3 trillion of UK property. By virtue of it, every property sale, purchase, repossession and mortgage in the UK is carried out transparently and in confidence by the seller, buyer and lender. The Land Registry’s independence is fundamental to the trust that homeowners, mortgage lenders and solicitors place in it. How could that trust remain if the very basis of that trust—the knowledge that the Land Registry is utterly impartial—is removed? How could the Government maintain that its impartiality will remain if it is taken over by private interests?

Let us look at the potential buyers who are showing an interest. Of the private investment firms reported last month by The Times to be interested in running the Land Registry, all have links to offshore tax havens. That makes a mockery of the Government’s claims of being serious about clamping down on tax avoidance and tax evasion. Canadian pension company OMERS, American private equity firms Advent International and Hellman & Friedman, and General Atlantic each have links to such jurisdictions, not least the Cayman Islands. When the Minister responds, will he tell us if he agrees that the Land Registry’s absolute transparency and independence from private interest is fundamental to the trust placed in it by homeowners and mortgage lenders? Does he also agree that this trust would be fundamentally undermined if such firms took over? That is what people up and down the country can see happening.

[Christian Matheson]

It strikes me that the companies that my hon. Friend has just cited as potential owners are also all foreign based. Does he share my concern, apart from their being tax dodgers, that we should resist placing something so fundamental to the UK in foreign hands?

[Bill Esterson]

My hon. Friend is right. Of course, we have seen a steady direction of travel towards foreign ownership of British interests for a great many years. It is surprising that we have anything of any substance left in this country that is not foreign owned, given the way the Government proceed. He puts his finger on an important aspect of the debate and another good reason why the proposal should be turned down.

My hon. Friend the Member for Swansea East (Carolyn Harris) mentioned the timing. The way in which the Government time their announcements is normally a good indication of how conscious they are that they are on thin ice. The proposal to relax Sunday trading laws is one such example, because they slipped out that unpopular policy at the last possible moment—the night before it was debated and after legislation had gone through the Lords, where the relevant Bill started its life.

[Mr Gordon Marsden (Blackpool South) (Lab)]

It did not do them much good.

[Bill Esterson]

As my hon. Friend reminds me, the approach did not do the Government much good on that occasion. I suspect, following today’s debate, it is not going to do them much good this time either.

They chose to release the proposal on the Land Registry on the afternoon of the last day of Parliament before the Easter recess. Were you a cynical man, Mr Deputy Speaker, you might think that that was done deliberately to avoid attention, but of course you are not cynical, so there is no way you would think that.

The Government are fully aware that the public do not want this and that the proposal will not stand up to scrutiny. This is not the first time they have tried to railroad through Land Registry privatisation. The public response that they received last time could not have been more overwhelmingly negative: 91% of those asked in 2014 said that privatisation would not provide a more efficient service, while just 5% thought that it would. Survation’s more recent polling—not that we should necessarily believe everything we read in polls—delivered the same message, with opposition outstripping support among the public by more than 4:1. The online petition that was signed by 300,000 people was handed to BIS just the other week. Those 300,000 people made it clear within a month of the opening of the consultation that they, like many others, were against the privatisation.

If the Government think that they can mask an economically incoherent proposal with a “public sector bad, private sector good” mantra, nobody is going to be fooled. Do they honestly think that a private operator would create a more profitable Land Registry and therefore support broader economic growth? In public hands, it is generating £100 million-plus for the Treasury each year, so that simply does not stack up as an argument. The New Economics Foundation has pointed out that state assets—not just the Land Registry, but Ordnance Survey, NATS and Channel 4—are all examples of publicly owned services that are delivering lean, efficient and profitable business models. If the Government have any interest in long-term growth and stability, they should hold on to those assets, not sell them off. Securing this annual revenue is the economically responsible and more stable approach at a time when we lack the certainty on which the economy and business depend.

Do the Government honestly believe that a private operator would create a more efficient Land Registry? The Open Data Institute says that moving the body out of public hands would build barriers in our data infrastructure, reduce efficiency not just in the Land Registry but across Departments and other public services, and have clear consequences for public confidence. Do the Government honestly believe that a private operator would support a more transparent Land Registry? If it was privatised, it would cease to be subject to the Freedom of Information Act. It beggars belief that the Government can seriously suggest that, in the wake of the release of the Panama papers, it would be reasonable to pursue policies that make it easier to conceal landownership for non-doms?

If the privatisation happens, the Land Registry will go to private interests that are not subject to the same checks and balances, such as freedom of information provisions, as any remaining public sector body. As my hon. Friend the Member for City of Chester (Christian Matheson) said, we are not just talking about any private interests. Judging from the interested parties so far, these are interests that are already tied up overseas, including in tax havens. Given that we are dealing with trillions of pounds of property that underpins our whole housing sector, this can only be downright dangerous.

Privatisation would deny homeowners, mortgage lenders and buyers an independent national register of title deeds. It would be destabilising. The consultation asks how, not whether, privatisation should go ahead. We should enable the Land Registry to continue innovating, and delivering savings and revenue to the Government. It is already a success, so why does the consultation not consider the option of encouraging further improvement, development and success in our public sector, both to improve service and to generate further revenue, if that is what is driving what the Government want?

As I understand it, the Minister for Small Business, Industry and Enterprise has told constituents that this is a ridiculous idea driven by Treasury capital receipts. I agree. Labour will fight this privatisation, and I hope that the Government will once again perform a U-turn in the face of widespread pressure from professionals and the public alike.

--- Later in debate ---

[George Freeman]

The right hon. Gentleman makes an interesting point. I was just setting out the reasons for dealing with sectors such as aerospace, telecoms, gas and other utilities, and British Leyland. Does anyone seriously think we should still have a car industry in the hands of the management of British Leyland? I doubt it. I merely remind the House that the reasons for those privatisations were to do with competition and choice, investment, management and the reduction of liabilities on the public balance sheet.

What would be the rationale were the Government to take privatisation of the Land Registry forward? Well, I can confirm that the Government have absolutely no plans for this. We have carried out the consultation and we are in the process of hearing, loud and clear, what is said. For those watching from the Gallery and wondering why it is even being considered, the rationale would be to create a basis on which the Land Registry, if it needed it, could raise substantial extra investment that the Government could not provide. It could be a mechanism to get a substantial injection of new leadership, to help the Land Registry to deal with the opportunities of globalisation—around the world, newly liberated and fast-growing economies and societies are looking to copy the UK model in many respects, and this might be one of them. And yes, it could be a mechanism to help us to tackle a still ongoing and chronic debt and deficit crisis, which has saddled the next generation of this country with debts. The Government look all the time at the public balance sheet, so those are the reasons why an institution such as the Land Registry might be worth considering.

[Bill Esterson]

The Minister is giving reasons why the Government might look at something. If the Government do not have a view, why was the consultation framed as it was—in terms of how to privatise, not whether to privatise? Does that not suggest a fundamental commitment to the privatisation?

[George Freeman]

I suggest that the best indication of our commitment is what I am saying at the Dispatch Box right now. I will comment in a moment on events going on outside this Chamber, which will determine how this is ultimately taken forward.

I was making the point that the Government have carried out a consultation. It is right that, as a responsible Government, we keep under review whether and how functions that are currently the monopoly responsibility of the state can be better financed and thrive more with new freedoms, and by so doing put the public finances on a stronger footing. I merely set out the rationale on which such matters have been addressed in the past and confirm once again that the Government have no plans. This is merely a consultation. We have received no bids; no decision has been made.

Budget for Community Pharmacies

Bill Esterson Excerpts

Tuesday 24th May 2016 Commons Chamber

[Michael Dugher]

My right hon. Friend is absolutely right. Given the success of community pharmacies, we should be doing far more with them, not cutting them. I shall come to some of the arguments for that during my remarks.

In the course of this campaign, I have been lucky enough to visit some excellent community pharmacies in almost every part of my constituency, campaigning with local councillors, listening to residents who rely greatly on the services these pharmacies provide and meeting staff who are among the very best healthcare professionals in the country.

[Bill Esterson (Sefton Central) (Lab)]

I congratulate my hon. Friend on securing this debate. Like him, I have visited several pharmacies in my constituency. They make the point that we are short of GPs and that, in that environment, it makes no sense to cut a service that can provide the support necessary to make up for the challenging circumstances that GPs face. Pharmacists can often provide advice and support to those who otherwise would go to their GP. In the absence of those GPs, pharmacies are essential.

[Michael Dugher]

My hon. Friend is of course absolutely right. One of the successful community pharmacy operators in my own constituency, Lo’s pharmacy, which has 20 community pharmacies across Yorkshire, was set up by a fantastic individual, Mr Steve Lo, who was brought up in Hoyland Common in my constituency and remains the firm’s managing director. Of the Government’s proposals, he told me:

“There is a real and present danger that these cuts will make many pharmacies unviable. That can only mean a longer trip, not just for your prescription, but for free advice on minor ailments or medicines as well as a number of other NHS led services, and is only going to put more pressure”,

as my hon. Friend just said,

“on GP surgeries and Accident and Emergency departments.”

I wholeheartedly endorse his comments.

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).

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

I thank my hon. Friend for the question. Autism is certainly a growing area of identified special educational need across the country that requires an increasing range of provision to meet the diverse needs of the population. Although it would be inappropriate for me to comment on a particular free school application, where it is needed, a special free school can add to the local continuum of provision, by providing specialist places and specialist expertise that can be shared more widely.

[Bill Esterson (Sefton Central) (Lab)]

The all-party group on foetal alcohol spectrum disorders took evidence last week about the link between alcohol consumed by mothers during pregnancy and the growing incidence of learning disability and autism. In Canada, this has been widely known for many years, and the Canadian Government at national and federal levels have invested heavily in raising awareness. When can we expect the same in this country?