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.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

[Bill Esterson (Sefton Central) (Lab)]

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

[Mr Hunt]

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Jeremy Hunt]

I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

[Bill Esterson (Sefton Central) (Lab)]

The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?

[Norman Lamb]

I mentioned that NHS England will very soon publish a report following its analysis of existing facilities across the country, so the hon. Gentleman will get the answer in the next few weeks.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

I know that the staff at my hon. Friend’s maternity unit work tremendously hard to look after patients, and it is important that we gave them the right facilities in order to do so. I am delighted that, like over 100 other birthing units in the country, they have received money to make sure that women are treated with greater dignity and that the quality of care is as high as it can be.

[Bill Esterson (Sefton Central) (Lab)]

I cannot speak highly enough of the staff at Southport hospital who cared for me when I spent three days there as a patient last month. They told me that GPs now routinely send older patients straight to A and E because their funding has been cut and that community services are no longer in place to support people in their own homes, which is all leading to a crisis at A and E. Is not the sad reality that what is happening at Southport is being repeated up and down the country as a result of the Government’s disastrous reorganisation and cuts to front-line services?

[Mr Jeremy Hunt]

I am very pleased about the excellent treatment that the hon. Gentleman received. The problems that the nurses talked about are exactly why, from today, we are reintroducing named GPs for everyone aged 75 or over to bring back the kind of personal care and personal responsibility for patients that I am afraid was so sadly abolished previously.

Care Bill [Lords]

Bill Esterson Excerpts

Monday 10th March 2014 Commons Chamber

[Grahame M. Morris]

I echo the sentiments of other hon. Members about the lack of time we have been allocated. I appreciate that it is not your fault, Madam Deputy Speaker, but we have so much to get through and the shortage of time means that although I would like to speak in support of a raft of amendments and new clauses, I will limit my remarks to a discussion of new clause 9.

I am supportive of the Care Bill—changes that make care simpler and fairer are to be welcomed—but there are real concerns about the sustainability of the changes this Bill seeks to make. I do not doubt the integrity and good will of the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), but with all the good will in the world the proposals in the Bill can be implemented successfully only if they are properly funded.

Other hon. Members have raised concerns about the funding implications, and the original Dilnot report, one of the foundation stones of the Bill, made it clear that insufficient funding would hamper the effectiveness of any attempts to implement reforms, including the ones in this Bill, and that long-term social care funding will work only if the current crisis in social care is addressed first. So we must not forget that the success of the Bill will be jeopardised by laying reforms over a system that is underfunded. I do not have time to go into the figures, save to say that adult social care budgets alone have been reduced by £2.7 billion over the past three years—that amounts to 20% of average council budgets.

The impact of such cuts is compounded by rising demand resulting from demographic changes. It has been estimated that to meet the demographic pressures the nation needs to spend another £400 million a year. So local government has real concern that the implementation costs and ongoing running costs of the reforms being implemented through this excellent Bill have not been fully costed and will not be funded, other than as new burdens.

It is unacceptable—and it will damage public confidence and trust—to pretend that new standards will be able to be met if the resources are not in place to deliver them. That is why it is so important that an additional reporting mechanism is in place, such as new clause 9 would establish, to provide assurance that the social care system and reforms in the Bill are adequately funded. If the Government really intend the Bill to be their flagship piece of legislation on social care, we need to know that the numbers add up. Despite councils’ best efforts to protect front-line services, the reality of cuts on this scale has meant that adult social care has not been immune to their impact.

A number of hon. Members have indicated the scale of the impact in their own areas, but the eligibility criteria level for social care has risen dramatically across a range of authorities. It is unclear how the new eligibility threshold will work in practice, both in terms of the effectiveness of care that older and disabled people will receive and the impact that the threshold will have on local government finances. But it is a concern that an eligibility threshold set at “substantial” will, as the hon. Member for Totnes (Dr Wollaston) has said, fail to create a preventive care system—that is what we all want, along with well-being.

A failure to create a preventive care system could result in a false economy in the long term—my hon. Friend the Member for Leicester West (Liz Kendall) mentioned the figures from the Deloitte study. By not delivering the £1.2 billion of investment needed to lower the national eligibility threshold, central Government could be missing out on savings as great as £700 million. The well-being principle of the Bill will fail to become a reality as many old and disabled people will be ineligible to have their needs met, so it is important that the effectiveness and sustainability of the eligibility threshold is reviewed and changed when appropriate.

We have a unique opportunity to improve care, which is why I am in favour of establishing the joint care and support reform programme board set out in our new clause 9, which provides for a report on performance and implementation. A failure to do so could render the well-intentioned reforms in the Care Bill meaningless.

[Bill Esterson (Sefton Central) (Lab)]

Social services are under huge funding pressure, which has a knock-on effect on the NHS. New clause 9 highlights the crucial issue of funding and will contribute to addressing it. Just 10 days ago, I experienced at first hand those pressures on the NHS. I would have added my name to this new clause, but I was unable to be here because I spent three days in Southport and Formby district general hospital. I saw the pressures in the accident and emergency department resulting from beds not being available for the transfer of patients to the wards; the pressures arising from chronic staff shortages; the difficulty in helping patients to return home because of a lack of support in the community; and general practitioners sending older people to A and E with complex needs as there was a lack of other choice or care available. In large part, the cuts in social services funding meant that I saw all those things. Meanwhile, staff in the NHS are working incredibly hard, often doing double shifts to look after patients, for which I am extremely grateful, as are many others. I take this opportunity to thank them and everybody in the ambulance service for what they did for me and have done for many other people.

The evidence I collected during those three days shows just why we need to be confident that funding is in place. Unless the funding is adequate, both in social care and in the NHS, the challenges faced day by day, hour by hour in our NHS will grow worse. We need greater integration, provided through the all-party approach advocated by Sir John Oldham in the report by his Independent Commission on Whole Person Care. As the report says, practice needs to move on so that we can see more care provided at home, with professionals working closer together in the interests of the individual. The whole-person care approach would reduce the number of hospital admissions; it would keep more people at home for longer, reducing hospital admissions and avoiding the huge pressures that I witnessed. In the context of the Bill, we need to be confident that the funding is sufficient to deliver the new responsibilities, which is why we tabled new clause 9. I hope that Members will support it this evening.

New clause 19 calls for health bodies to promote the health and well-being of carers. As the independent commissions report states:

“Most care is delivered by people themselves and their families.”

That makes the health of carers vital. My dad cares for my mum, and his health is a major concern. Carers up and down the country face declining health as they care for loved ones. Caring for the people who care is also a vital aspect of care provision, and paid staff in the health and social care sectors are also carers. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) talked about priority treatment going to volunteer carers—family members, friends and other volunteers. We should also consider that approach for everyone who works in the NHS or in social care. If we read the new clause in its widest sense, we should consider paid carers too, be they in the NHS or in social care.

Some 1.3 million people work in the NHS, and 1.5 million in social care. We should promote the health of NHS and social care staff as well as that of unpaid carers who do a fantastic job up and down the country. I hope that new clauses 9 and 19 receive the support of the House.

[The Minister of State, Department of Health (Norman Lamb)]

I share the frustration of many Members at the shortness of time that we have had to discuss such important issues.

Part 1 of the Bill brings in a long overdue and fundamental reform of care and support. It has been brought before the House after around five years of one of the most collaborative processes ever used to develop legislation, and I am very proud of this historic set of reforms.

I hope to have time to explain Government amendments 1 to 7 and 14, relating to clause 123 on regulations, but before that I shall try to address some of the key points that have been made. I fear that I do not have time to do justice to all the points, but I shall do my best.

On new clause 1 on power of access, which was tabled by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), it is my view that there is no gap in powers that would prevent care or other professionals from accessing those in urgent need of assistance. I am not alone in that view. The Association of Chief Police Officers says:

“Powers of entry are provided to us under both common law and PACE and I am satisfied that these would afford us access to premises where vulnerable individuals are considered to be at risk.”

The Association of Directors of Adult Social Services, which is an important organisation, agrees:

“We have no evidence that the proposed powers of entry would add significantly to the range of tools currently available to practitioners, rather we are concerned that this would encourage a coercive rather than negotiated approach to complex and difficult situations, and increase risk of harm or abuse. Any such power would not assist the complex next steps in assuring and supporting individuals, who have capacity, to stay safe.”

That view is confirmed by the chief social worker for adults, who said:

“An additional power of entry or access on its own would be insufficient, and indeed could make the situation worse.”

The inherent jurisdiction of the High Court to intervene provides a crucial final safety net. Beyond that, the critical thing is to issue, as we intend to do by the end of March, clear guidance on existing powers to ensure that all professionals working in this important area understand what powers they have available to them. I know that my right hon. Friend has been assiduous in pursuing that issue, and I am happy to involve him in the process of confirming those final guidelines that we intend to publish by the end of March.

On amendment 27 about the definition of abuse, the Joint Committee on the Draft Bill stated:

“Abuse is an ordinary English word, capable of being understood without being defined…to attempt an exhaustive definition always has the danger of omitting something which, as subsequent events make clear, should have been included.”

We agree and believe that the Bill is clear as drafted. Last week, I spoke to the all-party group, which is chaired by my hon. Friend the Member for South Swindon (Mr Buckland). I promised to go away and look at the matter and to talk to officials, but I am absolutely satisfied that the plain English words are very clear. The explanatory notes will be expanded to ensure that it is made clear. The guidance and explanatory notes will both have legal force, and courts will use them to interpret the intentions of the Bill.

Turning to amendment 28, the overarching well-being principle applies to safeguarding duties. Where partners become aware of abuse or neglect, it is imperative that they act, and the guidance will be absolutely clear on that point.

On new clause 26, I completely agree that police cells are a totally inappropriate place for someone in a mental health crisis. The crisis care concordat, which, for the first time ever, sets standards of crisis care, lays out our clear expectation that the use of police cells will drop by half by 2014-15. However, that must only be a start. The Home Secretary announced last year that there will be a review of the operation of sections 135 and 136 of the Mental Health Act 1983 on places of safety, and that is the right approach to take. However, I agree that we must end this awful practice of people ending up in police cells completely inappropriately.

I sympathise with new clause 11 on the Human Rights Act, but do not feel that it adds anything in terms of protection for individuals. None the less, I recognise the strength of feeling on the matter, so I expect that it will be discussed further in the final stages of the Bill’s passage in the other place. In the meantime, I am prepared to reflect on the points made and consider whether legislative clarification might be justified in order to make the Government’s position clear.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 25th February 2014 Commons Chamber

[Dr Poulter]

My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.

[Bill Esterson (Sefton Central) (Lab)]

T10. The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS?

[Mr Jeremy Hunt]

We absolutely want to make primary care more accessible and that is why we are introducing named GPs for everyone aged 75 or more from April. This is a significant and important reversal of, I think, a mistake that everyone now agrees was made in 2004 when named GPs were abolished. Its purpose is to make GPs more accessible to the people who need them the most.

Children and Families Bill

Bill Esterson Excerpts

Monday 10th February 2014 Commons Chamber

We can debate whether we should replace the words “smoking in cars” with the words “smoking in enclosed public places”. However, the arguments that are made by Government Members are all too often the wrong arguments and they are being left behind by society, which wants us to move again. That is why I support the Lords amendments.

[Bill Esterson (Sefton Central) (Lab)]

Protecting children is one of the most important responsibilities that we have. We know that smoking kills, we know the dangers of passive smoking and we know that children are more at risk than adults from the effects of smoke.

Half a million children are exposed to potentially toxic levels of second-hand smoke in family cars each week, according to the British Lung Foundation. Children’s lungs are smaller and children have faster breathing rates. They are therefore particularly vulnerable to second-hand smoke, especially in a confined space such as a car.

Children have no choice but to travel in a family car. Would it be good if car drivers, including parents, chose not to smoke when children were present? Absolutely. However, in the case of seat belts, it took a change in the law to ensure that there was a change in behaviour. The proportion of people wearing seat belts went up from 25% to more than 90% after legislation was introduced.

As I said, protecting children is one of our most important responsibilities. We can exercise that responsibility today. We have to choose between the right of an adult to do as he or she chooses in the privacy of his or her car and the protection of the health of children. Throughout the passage of the Bill, Government Members have rightly agreed that the protection of children is paramount. I hope that all Members will agree that we should make it an offence to smoke in a vehicle when children are present.

[Mrs Main]

I have never heard of a more illiberal, nonsensical and unenforceable proposal than Lords amendment 125. I am sorry that it is being proposed by the Government and that Members are being asked not to consider the detail, because the devil is in the detail.

As has been said, the word “vehicle” refers to a broad spectrum of containers, if I may put it like that, including motor homes, Traveller caravans and, potentially, narrow boats. The proposal suggests that smoking while driving an open-top car, to which my hon. Friend the Member for Shipley (Philip Davies) referred, is more injurious to health than a mother smoking while pregnant. I find that impossible to accept.

I do not know how the police will arbitrate between two 17-year-olds in a car if one of them has been smoking. I do not think that we should be considering using this resource if we are not banning cigarettes, full stop. I do not smoke and have never smoked. I am a mother of four children. I fundamentally believe that we should not make bad, unenforceable law.

If the Labour party represented the working class far more than it suggests it does, it would be making a very different argument, because a huge tranche of the population will see itself criminalised. We should be advising people not to smoke in front of their children. We have been winning the argument on smoking. The Government have adverts on the television that show a mum blowing the smoke out of the door and then say, “What if you could see what it does to your child’s lungs?” We will not stop those adverts because we are trying to educate people.

Under the proposal, we will be saying that a child can get into a fog-filled car after their mum has been smoking in it. As long as she is not still doing it, that will not be an offence. We will be saying that it is an offence to smoke in a van if Traveller children or others who live in transit are sitting in the back. However, if I sit in my kitchen and people can see me through the front window, fag in hand and baby over my shoulder, comforting the child, that will not be an offence. It would be easy to track down such behaviour, so why do we not say that smoking in front of children should be banned or that smoking should be banned? It is because we think that it would be illiberal to go into people’s homes. However, some people’s homes are vehicles. I look forward to people explaining that to the communities that will be affected disproportionately.

I cannot believe that we are not supposed to inquire about the detail.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 14th January 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question, and I am immensely proud that this coalition Government are reforming a grossly unfair system—something that should have happened a long time ago and is massively overdue. This Government completely recognise the absolute importance of an awareness-raising campaign, which will be carried out by local government, national Government and the financial services industry.

[Bill Esterson (Sefton Central) (Lab)]

Ministers have repeatedly claimed that no one will pay more than £72,000 in care costs, but given that the cap will be based on the rate local authorities charge for care and not the actual amount people have to pay, will the Minister confirm that people will have to pay more than £72,000 and that the so-called cap is not a cap at all?

[Norman Lamb]

People can always choose to spend more than local authorities deem it necessary to spend in order to secure care. However, we are implementing exactly the scheme that Andrew Dilnot recommended, and when he announced his proposals they were welcomed by the hon. Gentleman’s own party as a significant advance.