Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 13th October 2015 Commons Chamber

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

5. How much additional investment there will be in children and young people’s mental health services in 2015-16.

[Bill Esterson (Sefton Central) (Lab)]

7. How much additional investment there will be in children and young people’s mental health services in 2015-16.

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

We are investing an additional £173 million this year, which includes £30 million specifically for eating disorders. We are taking a targeted and phased approach to the additional investment to develop capacity and capability across health, education and children’s services, from prevention and resilience building to supporting the most vulnerable.

--- Later in debate ---

[Alistair Burt]

The hon. Lady makes a fair point. While we invest money nationally in services, people complain that locally clinical commissioning groups have not been funnelling the money down. Two things should help: first, for the first time the national access and working time targets, which the Government have introduced, will provide a means of monitoring what CCGs are doing; and, secondly, the new scorecard for CCGs will look explicitly to ensure that a proportion of the increase to a CCG goes into mental health services. The hon. Lady will also be pleased to know that in her own CCG area there will be an extra £521,000 for children’s mental health services.

[Bill Esterson]

Some 23% of the adult prison population were in care as children and many of them have poor mental health. Will the Minister ensure that mental health services are in place for children in care to make the greatest contribution possible to improving their life chances, and not least to ensure we reduce the numbers ending up in prison?

[Alistair Burt]

Yes, the hon. Gentleman makes a point made by successive Governments: care outcomes are terrible and the earlier the intervention the better. We are encouraging the engagement of early prevention therapies, including for those in care, and for the first time the Government have appointed a dedicated mental health Minister, in the Department for Education, further to promote resilience and work more closely with young children, including those in care.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

We will of course publish how we are going to make these efficiency savings. We have already started with a crackdown on agency spend and a crackdown on consultancy spend, and with the work that Lord Carter, a Labour peer, has done to improve hospital procurement and rostering.

Let me gently say to the hon. Gentleman, however, that he went into the election promising £2.5 billion more for the NHS—£5.5 billion less than we did—and most of that was from the mansion tax that Labour now says was a bad idea. So there would have been nearly £8 billion more of efficiency savings under Labour’s plans than under this Government’s plans, and he should recognise the progress we are making.

[Bill Esterson (Sefton Central) (Lab)]

13. What recent assessment he has made of the implications for his policies of guidance from the chief medical officer on the consumption of alcohol by pregnant women.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

We know that too many women may be unaware of the health risks from drinking during pregnancy. The chief medical officer’s review of the alcohol guidelines—the hon. Gentleman knows, because we have spoken about it—includes consideration of the Government’s advice on drinking during pregnancy. The UK chief medical officers are meeting to discuss this in September, and we expect to consult on the new guidance in the autumn.

[Bill Esterson]

I thank the Minister for her answer and remind Members that 7,000 children are damaged every year from irreversible brain damage as a result of alcohol consumed by their mothers during pregnancy. I urge the Minister please to clear up the confusion in the advice available to pregnant women at the moment, which on the one hand says, “Do not drink at all”; and on the other hand says, “If you do drink, have only one or two units”.

[Jane Ellison]

The message is actually very clear, as we have labelling on over 90% of bottles. As the hon. Gentleman knows from the debates we have had on the subject, it is a difficult area and there is no consistent evidence of adverse effects from low to moderate pre-natal alcohol consumption. I have talked this through with the chief medical officer: we have to get the balance right between warning women and responding to the important stats the hon. Gentleman has mentioned, without causing unnecessary worry for the around 50% of women who do not plan their pregnancy and might have drunk alcohol before they realised they were pregnant.

NHS Success Regime

Bill Esterson Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

Every single aspect that is troubling local health economies, including recruitment, I understand, will be within the scope of success regimes.

[Bill Esterson (Sefton Central) (Lab)]

Having listened to the Minister’s answers, it seems to me that patients have every right to be worried about whether care is safe in the NHS. Does he not realise that, unless the Government reverse the cuts in social care, the problems in patient care will not be resolved anywhere in the NHS—not just in the areas covered by the so-called success regimes?

[Ben Gummer]

May I gently remind the hon. Gentleman that this Government and their predecessor changed the culture of trying to suppress bad news, whether on care or money, and instead tried to understand what was best for patients, even when that meant facing up to difficult decisions? That is precisely what NHS England is doing with the success regime, and that is why we are addressing seriously challenged local health economies, rather than pretending that there is not a problem, which I am afraid was the attitude of the Labour Front-Bench spokesman when he was in power.

Health and Social Care

Bill Esterson Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I understand that geographical isolation is a particular issue and may have led to some of the problems at the trust that the hon. Gentleman and I have discussed on many occasions. We need to be sensitive to that in helping the standard of services to improve going forward.

[Bill Esterson (Sefton Central) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I will just make some progress.

Prevention also means transforming mental health services. I paid tribute earlier to my former colleague the right hon. Member for North Norfolk (Norman Lamb), who did a terrific job. I welcome in his place my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the Minister for Community and Social Care, who I know will build on his legacy. It also means a big focus on public health, especially tackling obesity and diabetes. It remains a scandal that so many children are obese. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is working hard on a plan to tackle those issues.

We must continue to make progress on cancer. We have discussed some of the measures that we need to take, but independent cancer charities say that we are saving about 1,000 more lives every month as a result of the measures that have already been taken. We want to build on that.

We have also talked about technology a number of times today. It will remain a vital priority to achieving the ends that I have described. In the last Parliament, I said that I wanted the NHS to be paperless by 2018. In this Parliament, I would like us to go further and be the first major health economy to have a single electronic health record shared across primary, secondary and social care for every patient. Alongside that, our plans to be the first country to decode 100,000 genomes will keep us at the forefront of scientific endeavour, ably championed by the Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman).

--- Later in debate ---

[Mr Hunt]

The hon. Gentleman is right to raise that issue. The previous Minister with responsibility for mental health set up the crisis care concordat, which he got all parts of the country to sign up to, to provide better care. There is a big issue with the quality of child and adolescent mental heath services provision. We want to cut waiting times for people in urgent need of an appointment, so I recognise the problem and I hope that the hon. Gentleman will give us some time to bring solutions to the House.

[Bill Esterson]

rose—

[Mr Hunt]

I said that I would not give way again, but I will take one final intervention.

[Bill Esterson]

The Secretary of State has spoken of the importance of people’s ability to secure hospital appointments. The same applies to GP services, but when I wrote to him about my constituents’ difficulties in securing appointments with their GPs, he told me that that was the responsibility of NHS England, not his Department. Will he now recognise that he must take responsibility for dealing with the problems of GP surgeries, so that my constituents, and those of every other Member, can make appointments with their family doctors when they need them?

[Mr Hunt]

I absolutely do recognise that. One of my key priorities is to deal with the issues of GP recruitment and the GP contract, and to make general practice an attractive profession again. If we are to deal with prevention rather than cure, vulnerable older people in particular will need more continuity of care from their GPs, and we must help GPs to provide it.

None of those big ambitions will be achieved, however, if we do not get the culture right for the people who work in the NHS. One of the reasons that Mid Staffs—and, indeed, so many other hospitals—was in special measures was the legacy which, for too long, put targets ahead of patients. We should never forget that Mid Staffs was hitting its A&E targets for most of the time during which patients in the hospital were experiencing appalling care. In that context, Sir David Nicholson used the phrase “hitting the target and missing the point”.

Through the toughest inspection regime in the world, we are slowly changing the culture to one in which staff are listened to and patients are always put first. However, although we identify hospitals that are in need of improvement much more quickly, we are still too slow in turning them around. I know that the new hospitals Minister, my hon. Friend the Member for Ipswich (Ben Gummer), will be looking closely at that, and I warmly welcome him to my team. Like me, he believes it is wrong that we have up to 1,000 avoidable deaths every month in the NHS, that twice a week we operate on the wrong part of someone’s body, that twice a week we leave foreign objects in people’s bodies, that almost once a week we put on the wrong prosthesis, and that people die because they are admitted on a Friday rather than a Wednesday.

We will leave no stone unturned in our quest to make a seven-day NHS the safest healthcare system in the world. Nye Bevan’s vision was not simply universal access or healthcare for all. The words that he used at this Dispatch Box nearly 70 years ago, in 1946, were “universalising the best”, which meant ensuring that the high standards of care that were available for some people in some hospitals were available to every patient in every hospital. Our NHS can be proud of going further and faster than anywhere in the world to universalise access, but we need to do much more if we are to complete Bevan’s vision and universalise quality as well. The safest, highest-quality care in the world, available seven days a week to each and every one of our citizens: that must be the defining mission of our NHS, and this Conservative Government will do what it takes to deliver it.

National Health Service

Bill Esterson Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.

It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.

[Bill Esterson (Sefton Central) (Lab)]

One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.

[Andy Burnham]

That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?

[Bill Esterson (Sefton Central) (Lab)]

3. What the average waiting time was for a GP appointment in the most recent period for which figures are available.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The latest GP survey results suggest that the majority of patients can get GP appointments at a time convenient to them, but we want to do more. We are offering 7.5 million more people evening and weekend appointments through the Prime Minister’s £100 million challenge fund. NHS England does not directly collect data for GP waiting times.

[Bill Esterson]

I think many people up and down the country will be surprised by the Minister’s answer, including my constituent Lynne Taylor who had a chest infection but was sent to A and E by a locum because of a lack of appointments at her GP surgery. That was done on the phone without seeing her. The A and E doctors told her that she certainly should not have been sent to A and E. Will the guarantee of a GP appointment within 48 hours help patients like Ms Taylor who need to see their own doctor? Would that not also be a big step in reducing the huge pressure on A and Es?

[Dr Poulter]

I hope the hon. Gentleman will be reassured to hear that, according to the latest GP survey, 87% of patients in Southport and Formby clinical commissioning group were able to get an appointment or to see somebody they wanted to see at an appropriate and convenient time. It is important to note that Labour’s 48-hour target did not work. From 2007 to 2010, the percentage of patients who were able to get an appointment within the 48-hour target actually fell.

A and E (Major Incidents)

Bill Esterson Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am sorry to hear the news about the chief executive at Watford. I am aware of the pressures there and I agree with my hon. Friend about the need for stability in management as much as possible over the next few months.

[Bill Esterson (Sefton Central) (Lab)]

One of my constituents wrote to me about her elderly mother who faced a wait of many hours for an ambulance to A and E. My constituent told me that at A and E she saw patients on trolleys backed up through the corridor to ambulances waiting in the car park. Meanwhile, patients were waiting at home, unable to get those same ambulances. She described the scene as “a war zone”. Is it not the case that A and E is unable to cope, the ambulance service is unable to cope, and patients who need to go to A and E are suffering?

[Mr Hunt]

I agree that there are real pressures in A and E across the system, but it is important to remind the public that even under that pressure, nine out of 10 people continue to be seen, treated and sent home within four hours. That is an extremely impressive record for the people working very hard in our A and E departments.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Speaker]

These are splendidly succinct answers. Perhaps the Minister should issue her textbook to her colleagues. That would be extremely useful.

[Bill Esterson (Sefton Central) (Lab)]

The Canadian Government say that foetal alcohol spectrum disorder is the most important preventable cause of severe childhood brain damage. The Minister told me in Westminster Hall last week that the chief medical officer’s review of the evidence is continuing. Is not the truth, however, that the evidence has been available for years, and that the time has come for the review to be published and for there to be much greater protection for the thousands of children who are damaged each year by women drinking in pregnancy?

[Jane Ellison]

We had a good debate last week in Westminster Hall. My reply remains what it was then: there is not complete clarity in clinical evidence on safe levels of drinking. That is exactly why the chief medical officer—[Interruption.] From the Opposition Front Bench, I hear cries of “Yes, there is.” I am sorry, but I am backing the UK’s chief medical officer over Opposition Front Benchers when it comes to the clinical basis for this. The review is important and is under way. I know that all Members will be interested in its outcome, and in how we can help to publicise good guidance to women on this very important issue.

Foetal Alcohol Syndrome

Bill Esterson Excerpts

Tuesday 14th October 2014 Westminster Hall

[Bill Esterson (Sefton Central) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I hope that, like me, having done lots of research on this subject, you will have discovered how important it is and why it is so important that we are debating it this afternoon. I hope that there will be commitments from the Government on concrete action.

Last Thursday, Sir Al Aynsley-Green published on Opendemocracy.net a fantastic letter describing what goes on elsewhere to address problems caused by drinking during pregnancy. The title of his article is “If you could prevent brain damage in a child, would you?” Everybody is going to answer yes to that, but are we preventing brain damage in children? At the moment, there is a large question about whether we in this country are doing enough to prevent such brain damage.

I am going to give the Minister a bit of warning about what I am looking for from her in this debate. I should like her to reiterate the Government’s advice for pregnant women. Is that advice not to drink at all during pregnancy? Will she say what actions the Government are taking to ensure that women and their partners are fully aware of the risks and that society as a whole is aware of the risks? What is her view of and attitude to the potential for mandatory labelling of alcohol products, as in France?

I understand that, at the moment, the Government say that women should not drink at all during pregnancy, but that, at the same time, they say that women who do not want to stop drinking altogether should have only one or two units a week. Some would say that this is contradictory advice. We will return to what the advice should be and discuss whether there should be different advice and whether there is indeed a safe limit.

[Kelvin Hopkins (Luton North) (Lab)]

I congratulate my hon. Friend on securing this debate. Does he accept the recent evidence that suggests that even moderate drinking has an effect on IQ in babies and that the wise advice is that there should no drinking at all during pregnancy?

[Bill Esterson]

My hon. Friend makes a point about whether there is a safe limit, and I will discuss that. From the evidence I have looked at, my conclusion is that we cannot possibly say that there is a safe limit and that the advice should be no alcohol during pregnancy.

The National Organisation for Foetal Alcohol Syndrome UK tells us that there is no way to know for sure what impact drinking alcohol might have on an unborn baby. The same point is made by the British Pregnancy Advisory Service. According to the NOFAS, alcohol could have different effects at different times during pregnancy, and it might affect one baby but not another. We know that heavy drinking and binge drinking during pregnancy could increase the risk of foetal alcohol spectrum disorder, but, as I say, we do not know what the safe limit is. My hon. Friend makes the point that the best advice is to abstain completely. According to the NOFAS, at any stage of pregnancy a woman can benefit her baby by avoiding alcohol.

Foetal alcohol spectrum disorder is an umbrella term that covers foetal alcohol syndrome, alcohol-related neurodevelopmental disorders, alcohol-related birth defects, foetal alcohol effects and partial foetal alcohol syndrome. When a pregnant woman drinks, the alcohol in her blood passes freely through the placenta into the developing baby’s blood. Because the foetus does not have a fully developed liver, it cannot filter out the toxins from the alcohol as an adult can. Instead, the alcohol circulates in the baby’s bloodstream. It can destroy brain cells and damage the nervous system of the foetus at any point during the nine months of pregnancy. Those findings have been backed up by research done around the world.

The effects on a child can be mild or severe, ranging from reduced intellectual ability and attention deficit disorder to heart problems and even death. Many children experience serious behavioural and social difficulties that last a lifetime. Although alcohol can affect the development of cells and organs, the brain and nervous systems are particularly vulnerable. We cannot see the neurological brain damage that is caused, but there are a number of invisible characteristics in babies born with FASD, which include attention deficits; memory deficits; hyperactivity; difficulty with abstract concepts, including maths, time and money; poor problem-solving skills; difficulty learning from consequences; and confused social skills. There are also a number of possible physical effects, including smaller head circumference, linked to smaller brain size and brain damage; heart problems; limb damage; kidney damage; damage to the structure of the brain; eye problems; hearing problems; and specific facial characteristics.

Some studies suggest that 1% of live births in Europe are affected by FASD. Many children born with FASD are not diagnosed or do not receive a correct diagnosis, which makes calculating the prevalence of the condition extremely difficult. Because there is no proven safe level for alcohol consumption during pregnancy, the only risk-free approach is to avoid alcohol completely during pregnancy, when trying to conceive and when breastfeeding.

In considering whether a child has FAS, it is also true that they can be very loving, friendly, gregarious, outgoing and trusting—all good traits—but without a sense of balance, these traits can often leave them open to being taken advantage of and abused by others. It appears that there is no cure but there are actions that can help, including early diagnosis; support for families; health monitoring; therapy and medication; support and safety at home; strong boundaries and routines, allied to flexibility from carers; simple instructions; and training and support in social skills. Above all, prevention is key. There should be better awareness so that fewer women drink in pregnancy, and that means providing more advice and support for vulnerable groups of young women. Drinking among young women has increased, so there needs to be better understanding among young women generally.

[Yvonne Fovargue (Makerfield) (Lab)]

Is my hon. Friend aware of the work done by Gloria and Peter Armistead, from my constituency, who founded FAS Aware? They have a two-pronged approach: educating young women in schools about problem drinking and providing a wonderful booklet for teachers and pupils on diagnosing and working with children with foetal alcohol syndrome. Gloria was awarded an MBE for her work in this area.

[Bill Esterson]

I thank my hon. Friend for mentioning the excellent work done by her constituents. I, too, praise them and many others who have done such good work to raise awareness of the condition, the risks and the need for action.

On greater awareness, the Education Committee is about to start an inquiry into personal, social and health education. What better subject for children at school to learn about than the dangers of drinking in pregnancy? I hope that my comment is taken on board by my fellow Committee members when we consider what to look at during that inquiry.

Al Aynsley-Green describes sitting in a class of seven–year-olds in Canada:

“‘What do you never drink when you have a baby in your tummy?’ asks the facilitator. ‘We never drink alcohol, Miss,’ chorus the children.”

That level of awareness at that age is in stark contrast to anything that happens here. He then mentions a conference in Toronto on prenatal alcohol exposure, attended by several hundred scientists, clinicians, lawyers, parliamentarians and lay people. Emily is 16 years old and has severe learning difficulties. She stood alongside her twin sister, courageously describing what it is like to be affected by the alcohol drunk by their Russian birth mother before they were adopted by their Canadian family. Emily described social isolation, bullying, fidgeting, impulsivity, distractibility, loud noise intolerance and poor concentration, which makes learning difficult.

Canadians take the impact of alcohol before birth seriously. Federal and provincial governments are convinced that prenatal alcohol causing foetal alcohol spectrum disorder is the most important preventable cause of severe brain damage in childhood. It affects affluent families and aboriginal people. Less badly affected children exhibit poor behaviour in their schools and communities and populate the prisons. Canadians express incredulity that the economic cost, let alone the human cost of the syndrome, has not been grasped by politicians in England.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

In that Canadian classroom, the children might well, if my Canadian experience is anything to go by, have also been shouting, “And no drugs and no smoking too.” That is important. I know that the debate is not about that, but it is linked, is it not?

[Bill Esterson]

Indeed it is. Awareness of the dangers, particularly of smoking during pregnancy, is much higher. Why, when we know what we know about smoking and the damage it causes to the unborn child, would we not ensure that the same awareness is in place for alcohol?

We have known about the dangers of alcohol to the foetus for a long time. Judges 13:7 says:

“Behold, thou shalt conceive, and bear a son; and now drink no wine or strong drink”.

Aristotle wrote about the effects of women drinking during pregnancy. Sir Francis Bacon advised women not to drink during pregnancy. The gin epidemic saw a rise in birth defects in Britain in the 1700s. The infant death rate was 20% higher for alcoholic women in prison in 1899 as compared with the rest of the population. Distinct facial characteristics were noted by French researcher Dr Paul Lemoine—I apologise for the pronunciation—who studied families where mothers drank a lot in pregnancy. The term “foetal alcohol syndrome” was first used by English researchers Jones and Smith in 1973.

There has been extensive preventive and clinical work in Canada, the United States and Australia. In 2007, Lord Mitchell’s private Members’ Bill called for it to be mandatory for alcohol sellers to display warning labels. That was seven years ago, and it has not happened yet. We saw recent success when legislation on smoking in cars with children present was passed. The Minister was heavily involved, and I commend her for her work on that. Perhaps we can persuade her to do the same on the labelling of alcohol.

At the severe end of the spectrum, there are some 7,000 live births of children with foetal alcohol syndrome each year in the UK, with three or four times as many babies born with the wider foetal alcohol spectrum disorder. There is, however, a suggestion of under-diagnosis, as symptoms are similar to those resulting from such conditions as attention deficit hyperactivity disorder or autistic spectrum disorder. The neglect of children who end up in care or being adopted can also produce behaviours that are similar to those seen with foetal alcohol spectrum disorder. The combined effects of neglect and FASD can make life difficult for children in care and those around them.

Diagnosis among some groups can be difficult. As the parent of two adopted children, I have no idea whether their birth mother drank during pregnancy. As a result, behaviours consistent with foetal alcohol spectrum disorder, which my children exhibit, could be due to neglect or alcohol consumption during pregnancy or both or neither. There is no way of knowing. The point is that we have to raise awareness, because we have to reduce risk. The education and development needs of this group of children are specialised. I refer the Minister to the research and ask her to look further at what is needed and just how demanding it is to enable children with foetal alcohol spectrum disorders to achieve their potential, given their difficulties in learning and in relating to others.

In 2009, the National Organisation for Foetal Alcohol Syndrome said:

“Teachers and teaching support staff will undoubtedly meet children with FASD in their classrooms. They need to know how to respond to their learning needs effectively, enable them to maximise their potential, improve their life chances and take their places alongside their mainstream peers as citizens…FASD now accounts for the largest, non-genetic group of children presenting with learning difficulties/disabilities. The difficulties that children face in the classroom epitomise that much-used phrase ‘complex needs’…Their unusual style of learning and their extreme challenging behaviour is out of the experience of many teachers”—

and support staff—

“and, as there is significant shortfall in guidance for teachers on how to educate children with FASD in the UK, teachers find themselves ‘pedagogically bereft’.”

We have to look at how we can reduce the number of children with FASD. Advice that says that someone may want to stop could and should be harder hitting. As my hon. Friend said, drinking while pregnant will harm the baby, just as smoking does. The private Member’s Bill introduced by Lord Mitchell in 2007 called for mandatory labelling. In 2005, the French Government made it a legal requirement for alcohol to display a warning for pregnant women on the container. The French research quoted the same dangers, research and risks as I have. Crucially, alcohol, according to the French research, can affect the brain at any stage of pregnancy. There is no safe level. The advice in France is that the safest option is no alcohol during pregnancy. That comes from the alcohol project manager at the National Institute for Prevention and Health Education. It faced a lawsuit in 2004, and later that year moved to change the law. In 2005, the law was changed. In France, it now says on bottles of alcohol that the consumption of alcoholic drinks during pregnancy, even in small amounts, may have serious consequences for the child’s health. There is also the symbol of a pregnant woman drinking in a red circle with a red line through the centre. Why do we not have that here?

The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) was on the Health Committee in 2012. At that time, he was quoted as saying that there should be better warnings on the dangers of alcohol. He and others in the medical profession have warned of those dangers for some time, including those posed by drinking during pregnancy. He called for greater publicising of the dangers to raise awareness. As a Minister—along with his colleagues, whom he can advise—he is in a better position to act than he was in 2012.

Last week, the British Pregnancy Advisory Service raised concerns about the impact on pregnant women of the recent publicity on this issue, of which there has been a significant amount in recent months. The BPAS said that women are considering abortions because they fear they may have harmed their unborn child before they realised they were pregnant. It stated that occasional binge drinking was unlikely to cause harm to the baby. From the research I have looked at and the evidence available to us, it is true that binge drinking may not harm a baby, if it happens on occasion, but the trouble with that advice is that there is no way of knowing which babies will be harmed. The concern raised by the BPAS should not be taken lightly. It says that media coverage has caused panic among some pregnant women. That is the last thing that anyone who takes an interest in this issue wants, but, equally, there is a danger that playing down the risks of damage from foetal alcohol spectrum disorders could lead to some women continuing to drink, thinking it is safe when it is not. The BPAS points out that half of pregnancies are unplanned, so many women do not know that they are pregnant, meaning that many women will be drinking alcohol while pregnant. I agree that women should not be alarmed as there is nothing that can be done about what has already happened. However, if greater awareness of the risks can reduce the number of women drinking while pregnant in future, which is the experience in other countries, that must be a step forward.

[Kelvin Hopkins]

My hon. Friend is making a thoughtful speech. He spoke of unplanned pregnancies. The high level of teenage pregnancies in this country is a serious problem. The number is reducing, but it is still high. Young women who may have been drinking and then become pregnant following unprotected sex and are unaware of that may carry on drinking on a regular basis and cause terrible damage to their babies.

[Bill Esterson]

That is an incredibly important point and is why what Sir Al Aynsley-Green and others have said about Canada is so important. We need to increase awareness among much younger children about the possible damage, so that at the very least young women have the facts available to them. Many other measures are needed to make young women, and young men, aware of concerns around teenage pregnancy.

In 2008, Lord Mitchell proposed that labels on alcoholic drinks should say, “Avoid alcohol if pregnant or trying to conceive.” Some will say that that will not necessarily help the women referred to by the BPAS who are not planning to become pregnant, but it will help those who are planning a pregnancy. I wonder how many other women will consider whether they should drink alcohol if they see the advice and how many men may reiterate the advice and increase awareness, which is what has happened in France. This is not just about women. Men have an important role to play in supporting women, and education of the dangers should target men as well as women. Lord Mitchell also gave the example of tobacco labelling as a good reason for making labelling a legal requirement and not a voluntary code. The damage done to children by alcohol and the damage done by smoking are both important and deserving of maximum attention. I mentioned before the Minister’s support for banning smoking in vehicles with children, so I hope that she will agree when it comes to the labelling of alcohol.

“Foetal alcohol spectrum disorder and foetal alcohol syndrome are completely preventable intellectual and developmental deficits in individuals, resulting from maternal consumption during pregnancy.”

Those are the words of the National Organisation for Foetal Alcohol Syndrome. The time has come to listen to those words and for greater action to reduce the number of children who suffer from foetal alcohol syndrome and the wider spectrum of foetal alcohol disorders to ensure that women in particular have greater awareness of the risks and to ensure that children, families, school staff and all those trying to cope with the results of FASD get more of the support that they need. Some women become pregnant and do not drink alcohol and are giving the best protection against FASD. However, some women drink while pregnant unaware of the risks, and some drink while pregnant unaware that they are pregnant. A further group chooses to drink while pregnant and aware of the risks. Different strategies are required for each group, but it is clear that reducing the number of women who drink alcohol while pregnant is the right way forward and that should be where policy is directed. I have suggested labelling, greater awareness and education at school, and I look forward to hearing the Minister’s suggestions.

As I said earlier, the Canadian federal and provincial governments are convinced that FASD is the most important preventable cause of severe childhood brain damage. The time has come for our Government to decide whether they agree with that statement and whether they will take the necessary action.

--- Later in debate ---

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Turner, as you used to serve under my chairmanship.

I have been interested in this subject for a long time. I am a trustee of the National Children’s Centre, which is based in my constituency, and part of the initiative to form a new children’s commission. Also, for quite a long time, I was Chair of the Select Committee on Children, Schools and Families.

I have to say one slightly party political thing: I still deplore the smaller emphasis placed by the coalition Government on children’s issues. We have a junior Minister, but we should have a Secretary of State and a whole Department. I thought that the Department for Children, Schools and Families was a breakthrough Ministry, and I am sorry that it is much diminished, although I have a lot of respect for some of the ministerial team, as colleagues know. Today, however, there is relative neglect of children’s issues.

I have some practical experience of children: three daughters, one son and nine grandchildren under the age of 10. We are quite a tribe when we are all together. When my wife and I had children, we were aware that we should not drink too much—she said that she should not drink too much—but my generation thought that a little bit of alcohol was all right. That was wrong, but luckily we survived and had healthy children. My daughters, however, never drank during pregnancy.

My hon. Friend the Member for Sefton Central (Bill Esterson) made a brilliant speech, but the speech by the hon. Member for Chatham and Aylesford (Tracey Crouch) was also thoughtful. She mentioned the growing consumption of alcohol by women. Only the other day, I chaired a session—one of those irritating breakfast meetings—by the Parliamentary Advisory Council for Transport Safety, or PACTS, on women and alcohol, and it was explained to us that the likelihood of a man being caught for drink- driving has plateaued for some years, but the figures for women are going up fast.

A senior policewoman from one of the home counties, or perhaps Hampshire, stood up at that breakfast meeting to say, “We have done a study of all the pubs by going in and asking for a small glass of wine, and they all said, ‘No, we only do medium and large.’” Three large glasses of wine in a pub is a bottle of wine. Many of the women pulled over by the police, according to that policewoman, would say, “I have only had two glasses”, but that means that they have had two thirds of a bottle of wine. With the drinks industry trying to increase sales, many more women are drinking high levels of alcohol. Is that binge drinking? Most of the people whom we describe as binge drinkers would not think that they were binge drinkers. Yes, they have a couple of large glasses of wine, but they have learned to feel that that is relatively normal.

There is one point I will take issue with. Why not scare people? When we campaigned for seat belts, against drink-driving and on the dangers of smoking, there had to be a bit of fear. We have to change the culture. If someone went into a pub now and said, “I’m only going to have a couple of pints, and then I’m driving home—I’m a better driver when I’ve had a couple,” they would be excluded from the pub and their local community, because that is not acceptable. We have to have a little element of fear to get over the message that people who drink while pregnant are damaging their unborn child. The message has to be very strong; it has to be from the Department of Health and all the other Departments, and it has to be loud and clear.

Let us not pussyfoot about on this—you and I do not pussyfoot about, Mr Turner. Let us be honest: people from more disadvantaged backgrounds—poorer people—drink more than other people during pregnancy. That is the truth, and we have to accept it; otherwise we cannot get the message across. Of course, a lot of middle-class women drink, but more middle-class women tend to give up drinking when they are pregnant. However, a lot of people who have copied middle-class role models over the years and who are drinking are not seeing the danger signs during pregnancy.

[Bill Esterson]

The point about women from disadvantaged backgrounds is right, but is my hon. Friend aware of some of the research from the United States? In some studies, mentoring of women in at-risk groups has led to something like a 50% reduction in drinking during pregnancy in cities across America. Does he agree that that is the kind of bold action we need here?

[Mr Sheerman]

My hon. Friend is absolutely right. I love that sort of idea, because it is holistic. We have to go right across the piece—mentors, health visitors and GPs. GPs should wake up. For goodness’ sake, what are they doing if they are not telling pregnant women, “Do not drink when you are pregnant.”? I despair when I see the level and quality of advice from some GPs, who should be telling women in very firm terms about the damage they could do to a little child.

--- Later in debate ---

[Luciana Berger]

My hon. Friend’s remarks lead me to the challenge that the Government themselves admit in their alcohol strategy. They say:

“We do not have good information about the incidence of FASD, so it is likely that significant numbers of children are not diagnosed.”

In the response to my parliamentary question, there was no information about what action the Government intend to take to address that information deficit, so will the Minister confirm whether she has any plans to commission a much-needed prevalence study of FASD and foetal alcohol syndrome in England? Will she share with us her plans to improve diagnosis across the country?

[Bill Esterson]

Will my hon. Friend give way?

[Luciana Berger]

Forgive me, but I will not: we must allow the Minister to respond, and we have just 10 minutes.

I move on now to improving support both for people who have a diagnosis and for their families. Many sufferers have special needs that require lifelong help, yet slip under the radar either because they are not diagnosed or because there are no services in place to support them. Lack of diagnosis for those who do not exhibit physical signs means that those children often receive no additional help from support services or at school. I recently met a head teacher, who said she did not have a single student in her school who had been formally diagnosed, but she was sure that some students were affected.

There is no systematic record of the needs of children with FASD and no official guidance on best educational strategies, as my hon. Friend the Member for Sefton Central said. There is just one specialist FASD clinic in the whole of England, which is run by Surrey and Borders Partnership NHS Foundation Trust. It is one of the few places that can confidently diagnose the disorder. It is a national clinic, supposedly serving the entire country, yet it is not commissioned by NHS England. Out-of-area patients must be paid for, and with a cost of £2,500 per patient, many local clinical commissioning groups refuse to refer. Worst of all, I understand that the clinic is not due to be commissioned beyond April 2015. What does the Minister intend to do to ensure that NHS England commissions services and that plans are in place to improve provision and to increase both the number and the spread of specialist FASD clinics? Without specific support, people who are affected are at higher risk of developing mental health problems, getting into trouble with the law, dropping out of school and becoming unemployed. That may come at massive personal cost and in turn produce a tremendous cost for society. The crux of this debate is how to prevent that.

I have highlighted how we need to improve diagnosis and support services. Let me reiterate a point that has been made several times today. FASD is entirely preventable. It is caused by drinking during pregnancy, but the information about the risks of drinking during pregnancy is wholly inadequate. The guidance is inconsistent and confusing, and women receive mixed messages. The Department of Health recommends that pregnant woman should avoid alcohol altogether, but that if they opt to have a drink they should stick to one or two units of alcohol once or twice a week to minimise the risk to the baby. The National Institute for Health and Care Excellence advises women to abstain from alcohol completely during the first three months of pregnancy because of the risk of miscarriage. It then refers to the number of units that they should or should not drink subsequently.

People struggle to use units as a way of monitoring their alcohol consumption. Research from the Joseph Rowntree Foundation found that very few people use units as a way of measuring their drinking or of monitoring their health. Is it any wonder that women are confused? What is the Government’s official advice and what plans does the Minister have to improve much needed awareness throughout the country?

It is not just expectant mums who are not being given the information they need. The hon. Member for Chatham and Aylesford (Tracey Crouch) referred to health professionals and my hon. Friend the Member for Huddersfield (Mr Sheerman) referred to GP training. Earlier this year, I asked a parliamentary question about midwives, but the reply did not fill me with confidence. The issue involves not just women who have mental health or substance misuse support requirements, as the reply suggested; it involves all women, but the Government’s 32-page alcohol strategy makes just one reference to FASD, and that is not good enough.

Voluntary organisations do fantastic work and some local authorities—just some—are raising awareness locally. Some include FAS in their joint strategic needs assessment, but that is far from commonplace. What will be the Government’s concerted and co-ordinated response and where is their national drive? I struggled to find any information on the website of the Department of Health and I found nothing on the website for Public Health England. I would be delighted if the Government pointed me in the right direction.

We have heard a lot this afternoon about alcohol labelling. There is no legal requirement in the UK to display proper warnings about the harm of drinking alcohol during pregnancy. We have heard many references to Lord Mitchell’s Alcohol Labelling Bill, which sadly did not progress beyond the Lords. Today, it is still left to businesses to decide whether to display warnings.

As part of the Department’s responsibility deal, alcohol retailers and producers have made a voluntary commitment to put an agreed warning or a pregnancy warning logo on 80% of labels on bottles and cans. In June, the Minister responded to me saying that an independent market survey is under way to measure compliance. I am keen for an update on how that survey is going.

Many hon. Members on both sides of the Chamber have said that the logos are very small, if they are there at all. They are difficult to see because they are just a few millimetres high. They go unnoticed by many people and fail to convey the seriousness of drinking during pregnancy. Many countries prescribe warning labels about pregnancy on all alcoholic beverages and we have heard about them this afternoon. They include Colombia, South Korea, France and South Africa. I would like to hear from the Minister when the UK will follow suit.

We have heard about other countries that are leading the way. Canada was held up as an exemplar for what it is doing on diagnosis, treatment and specifically prevention. It is spending millions of dollars, because it believes that that will not only prevent something that is very difficult for many people, but comes at great cost to society. It believes that preventing FAS in just 10 babies saves enough to fund all the comprehensive services that it provides.

Very few disabilities are preventable, but FASD is. The message about the risks must be loud, clear and consistent. No woman wants to harm her child, but we know that lack of knowledge about the dangers of drinking during pregnancy can have a devastating impact. The Government’s response to the problem must be thorough, coherent and carried through into effective action. I look forward to hearing the Minister’s response and what more the Government will do to address this serious issue.

--- Later in debate ---

[Jane Ellison]

One of those challenges was touched on by the hon. Member for Sefton Central: there is some concern that a message that did not have clinical consensus behind it might cause undue alarm to somebody, bearing in mind the statistic, which has been quoted in the debate and which we believe to be true, that 50% of people do not plan their pregnancy. There is some concern about that. I accept the point that the hon. Member for Luton North makes—I think one hon. Member said that scare tactics should be used—but nevertheless that is a significant factor in considering this issue.

Let me finish off the point on the CMO’s review, because it is important and I am inevitably not going to get through all the points that I would like to make. That will be an evidence-led approach, considering whether current advice needs to be revised, and it is for people at all stages of their life, not just in pregnancy.

The reason why we need the consensus view and to get agreed guidelines—I see hon. Members shaking their heads, but I have to tell them that in so many areas of my life as Minister with responsibility for public health, somebody will say one thing in the newspapers in the morning, and by afternoon, experts will be all over every news channel disagreeing with it. We need to try to get, wherever possible, a consistent message, and that is exactly what the CMO-led review is undertaking to do.

[Bill Esterson]

Will the Minister give way?

[Jane Ellison]

I will not, I am afraid, because I have given way twice and I have four minutes left. [Interruption.] All right, then.

[Bill Esterson]

May I just urge the Minister to look at what I and other Members have said about Canada, the United States and France, where there is labelling? Canada especially cannot believe that we are not taking this action. I urge her to speed up her look at the evidence and the research. Other countries are doing this, so why can we not?

[Jane Ellison]

The review is not my review. The review is being led by the chief medical officer together with—

[Bill Esterson]

But you are the Minister.

[Jane Ellison]

Indeed, and I will pass on the message that Members would like to see the review speeded up. It has a whole range of the right experts on it, and I will undertake to supply to the review, in evidence, the Hansard of this debate, so that those hon. Members who have cited other research and made very forceful points can feel that those are being taken into account. The CMO’s guidance about avoiding alcohol while pregnant or trying to conceive is the message that we advise to be carried by our producers. If I can, I will come briefly to that point. However, I will undertake to ensure that the message is passed on to that expert review.

I have touched on some of the health professionals who are being trained. By 2018, around 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems—that picks up some of the points about pregnancy.

The hon. Member for Huddersfield (Mr Sheerman) and others—including the hon. Member for Sefton Central—mentioned the US model for early intervention; I think he was talking about the family nurse partnership, which we have adopted here. The family nurse partnership provides dedicated one-to-one support for young, at-risk, first-time mothers, and that will be expanded to 16,000 places by 2015. It is really important to make the point that although sometimes it is not possible to educate people for a first pregnancy, we can pick up second pregnancies. Although teenage pregnancy is at a 40-year low, the family nurse partnership is a very important programme based on an American model that has a very strong evidence base.

I will touch briefly on labelling in the bit of time I have left. We feel that the industry has a big part to play, and we are pushing it hard. We got an agreement from 92 companies, which committed to displaying warnings on drinking in pregnancy on 80% of bottles and cans by the end of last year. Subject to publication of the final independent market survey, we believe that just under 80% of bottles and cans had that information, and the warning is the CMO’s advice. Companies can either have a picture struck through of a pregnant women or carry the CMO’s advice, which is that women who are pregnant or trying to conceive should avoid alcohol altogether. There was some concern that that was not the message we were using, but that is the one that people who have signed up to the responsibility deal are using. We believe that is now getting more widespread market coverage. However, there is more that industry can do, and we are pushing them hard.

One thing that we could do is around duty. Personally, I would love to see the ability to vary the duty by alcohol content in wine, but it is difficult in an EU context. I do not quite know—I have never really had the answer to this—how the French managed to pass their law without suffering EU infraction, but I continue to ask the question and look into that. It is something that we are pushing to be able to do, because we want to see those warnings on as much alcohol as possible. My current understanding is that doing this through the EU would be a very lengthy process, because of the need to get that consensus.

In the 30 seconds I have left, I apologise to those Members whose points I could not respond to, but so many points have been raised. I will reflect further on what has been said in the debate and speak to the chief medical officer about it. I welcome the opportunity we have had in this debate to reinforce some of those points. There is an opportunity, when the revised guidelines are issued next year, really to put some information behind them. I am seeing the head of social marketing campaigns for Public Health England imminently—within the next week—and I undertake to have a preliminary conversation about what might be done, when the new guidelines are issued, to reinforce this very important message.

Special Measures Regime

Bill Esterson Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I agree with my hon. Friend on both points. We have seen 31 more doctors there since special measures, 52 more nurses, a new acute medical admissions unit and better flow throughout the hospital, reducing the number of moves that patients make between wards during their stay, so lots has been done. When I did a stint in the A and E department at George Eliot, I was very well looked after by the nurses there, but they told me how bad the IT systems were—I think they said there were 16 different IT systems in the hospital—and how they were constantly filling out new forms. I therefore hope that the partnership with University Hospitals Birmingham, which has one of the best hospital IT systems in the country—a fantastic system, developed by the trust itself—will mean that George Eliot can move to having really good IT, so that nurses have more time with patients, which is what they want.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State spoke earlier about the need to value staff who work in residential homes. I presume he meant by that people who care for vulnerable, elderly and disabled people in their own homes as well. I completely agree with that, and he knows that we have discussed many times in the House issues such as the 15-minute time slots and the lack of reimbursement for the travel costs that people who care for elderly or disabled people have to bear. Does he agree, therefore, that unless we address issues such as the pay and conditions of staff, whether in residential homes or in people’s own homes, we will struggle to recruit and retain the very best staff, whom we desperately need to look after our vulnerable people?

[Mr Hunt]

I agree with the hon. Gentleman that we need to value staff who work in the social care sector much, much better. I think they do a fantastic and very difficult job for what is not high pay at all, so I recognise that issue. I also agree with his concern about 15-minute slots. I find it hard to believe that anyone can really do everything they need to when visiting someone who is frail or vulnerable in their own home in just a 15-minute slot. The new inspection regime will look at that and if it is unsatisfactory, it will say so.