Foetal Alcohol Syndrome

Debate between Bill Esterson and Barry Sheerman

Tuesday 14th October 2014 Westminster Hall

[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.

--- 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.

Sure Start Children’s Centres

Debate between Bill Esterson and Barry Sheerman

Wednesday 2nd March 2011 Commons Chamber

[Mr Sheerman]

I take the hon. Lady’s point. We can disagree on that.

Let me get down to what worries me. Our report—which, if my memory serves me right, the present Chairman of the Education Committee voted against—suggested that children’s centres should be maintained. We made some helpful comments. I want to spend a little time on the Government’s response. Paragraph after paragraph, they keep saying how wonderful our report is, but when I look at their response in detail, I am worried about some of their reasons for agreeing with it.

We can all agree that evidence-based policy is good policy, and this policy of ours was the purest example of that. In all my 10 years as Chair of the Select Committee, with some wonderful colleagues—many of us turn up at debates such as this—the best policies that we saw were those based on evidence, and of all the policies in those 10 years, the clearest evidence was on early years intervention and redirecting expenditure to the early years. People carelessly think that we spend a lot of money on early years, but that is not the case. How much we spend increases as a child gets older. All the evidence shows that we have got it the wrong way round. My hon. Friend the Member for Slough (Fiona Mactaggart) often made that case, and made it to you, Madam Deputy Speaker. The money should be piled in during the early years, for the reasons that the House has heard this afternoon.

What worries me about the Government’s response to our report is whether the commitment is still there. It is all very well having the commitment, but without the money and the resources, children’s centres will start to go. My right hon. Friend the Member for Birkenhead (Mr Field) said that his council had not yet made up its mind. I have it on good authority that my local authority, Kirklees, in which Huddersfield sits as the jewel in the crown, is reducing the number of children’s centres from 35 to 17.

[Bill Esterson]

Sefton council proposed reducing the number of children’s centres from 19 to seven, but I am pleased to say that, in the face of huge opposition from the hundreds of families who use the centres, it is reconsidering. My hon. Friend makes his point about the link between policy and the money made available. We could comment on manifesto pledges. I am sure he would agree that it is only by Government guaranteeing that the money is available and that it will be spent on children’s centres that there is any hope of achieving the aims set out in the Select Committee report.

[Mr Sheerman]

Indeed. I hope my own local authority will change its mind under pressure from those who use the excellent children’s centres in my patch. I am sure that throughout the country there will be a large number of closures of children’s centres. That will be a disgrace, because I know what good work children’s centres are doing.

May I take up a remark made by my right hon. Friend the Member for Birkenhead? He visits schools and sees how important the first two years are. I used to boast that I visited more schools than any other MP, and I am trying to keep up that track record. When I visit urban schools I see the difficulties that he has identified, measured against the 10 things that children should be able to do. I visit schools with fantastic heads and children’s centres with fantastic leaders who improve children’s behaviour and performance enormously, but 40% of the children will not be in those primary schools in a year because of the churn in our schools. We do not discuss that enough.

How can children be stimulated when in many of our major towns and cities they live in totally mobile populations? It is not the old-style poverty of the coalfields and shipyards, but the poverty of churn and change. In so many of our constituencies, heads and Sure Start leaders do not know which children will come through their doors in just a few weeks, which is a real problem. However, they do know that children will often have no one at home who speaks English to support them in learning our language. When those children go home, the television will not be in English. Sometimes, because of political correctness, we turn away from the reality of what is happening in our schools.

I fear that, as the world changes and the middle east turns itself upside down, for example, even higher rates of migration will result in even higher rates of change in our schools. I am not against migration and hold no extreme views on the matter, as everyone who knows me would acknowledge, but I know that our children’s centres and primary schools in urban areas are at the front line of that change. We cannot carry on asking teachers, heads and Sure Start leaders to cope with the increasing churn and turmoil resulting from the number of new children, so few of whom have a command of English, or indeed of many of the standard requirements that we expect in schools and children’s centres. We all pick up on that point but sometimes ignore it. We ask professionals to do a job, but not all children live in the leafy suburbs or the countryside.

[Mr Sheerman]

I am pleased that the hon. Gentleman made that intervention, because I was moving on to the funding of health visitors. I am not entirely sure or comfortable about when that money will come in, because I had heard that it is not yet and that it might be in 2012; there is nothing in black and white. I would be pleased if a member of the ministerial team would let us know during the debate whether the funding is coming and whether it is from the health budget, as one Minister has told me. If that is true, it will be a real plus for the overall budget and to be welcomed.

Where the health visitors are based is also important, and I hope that they will be concentrated in children’s centres. Some of us will remember hearing the head of the Royal College of General Practitioners say in evidence to the Select Committee that half its members did not know what a children’s centre was and that the other half thought that it was just competition for health visitors. Integration and working together are important.

It is also important to consider the revolutionary step at the heart of children’s centres, which has been missed out of the debate so far. The revolutionary step is that they view a child holistically. A child is not a child with a bit of educational difficulty here and a bit of early stimulation there, or with a little health problem here and language difficulties there. The beauty of children’s centres is that a child gets all that support and evaluation in one place. Parents do not have to push a pram all over town to go to one clinic for a certain service and somewhere else for another, as my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) said. The fact is that providing a holistic service for a child delivers the best chance of giving that child the environment in which they can thrive.

While the Committee was conducting that inquiry, we were looking at young people who were not in education, employment or training. When we went to Holland, we found the Dutch experience particularly interesting, because they also looked at young people holistically. They have centres where young people can have a health evaluation and an aptitude evaluation, where employers and colleges are represented and there are seminar rooms for people who had been NEETs before gaining employment. Those centres provide an all-purpose focus for young people. When we are talking about people’s lives, it is that holistic approach that seems to work, and I recommend that what we do in children’s centres should be transferred to that older age group, as stated in our report on NEETs. Local authorities have moved in that direction, and some examples in the UK have been extremely successful.

[Bill Esterson]

Will my hon. Friend give way?

[Mr Sheerman]

Not for the moment.

Many of the responses to the Committee’s report have made much play of the big society. I must confess that I actually like the idea of a big society, but I am slightly resentful of it, because I think that the Conservatives stole it from Labour—[Interruption.] I say that in a good-natured way to ensure that Conservative Members are still awake. In fact, we all believe in the big society. I believed in it even when Mrs Thatcher said that there was no such thing as society, so I have a long-term commitment to it. Throughout my whole political life I have involved myself in starting social enterprises as part of that big society, because I think that that is how our society should develop.

My worry about the big society is that it is often linked to the idea that everything should be done by volunteers. I am a little suspicious when people argue that things can be done by volunteers, because the best analysis and professional research suggests some problems with that. I refer the Minister to an interesting article—she might already know it—published in 2006 by Professor Alison Wolf, who is about to publish a report produced for the Government on 14 to 19-year-olds. As the Minister will know, Professor Wolf’s daughter, Rachel Wolf, is in charge of the free schools movement and her son, Martin Wolf, is a senior influence at the Financial Times. I listen carefully to Alison Wolf, and her 2006 article stated that the real problem with volunteering in this country is that it has been dying—first, because of the decline of organised religion, and secondly, because women now work in demanding jobs. Both men and women work in our country.

Professor Wolf also noted that the research suggesting that there is a lot of volunteering left in our communities is poor because it is based on opinion polls, and people tell fibs about how much they put back into the community when they are asked in such polls. If members of a pilot group are asked to keep a diary, the results show that the average time a person gives to volunteering is four minutes a day. If we are to base children’s centres and the big society on all of us volunteering for four minutes a day, we will still need a hell of a lot of good professionals to provide quality health and children’s care.

I shall also briefly touch on something that was central to the Government’s critique of our inquiry—the idea that we would no longer need so many hours. One absolutely fantastic thing about children’s centres in the most deprived areas was that they had to stay open 10 hours a day, 48 weeks a year. The document before me clearly states that that is now finished as an obligation and does not need to delivered. We all know that that is true, because it is in the response to the Select Committee’s report, and, in the hard-pressed and most deprived communities throughout our land, it represents the withdrawal of a guarantee that really meant something and will be sorely missed.

I do not know what my right hon. Friend the Member for Birkenhead, who wrote his own report, would say about that withdrawal. I do not remember hearing whether he was conscious of it when he wrote his report, and I do not know whether he thinks that the fairness premium will counter-balance it, but nobody knows how the premium will work, when people will receive it or who will benefit from it.

At the heart of my concerns about the response to the Select Committee’s report is the fact that localism has become an excuse for saying, “We don’t have the confidence or the courage to say that we believe that there must be a reduction in the number of children’s centres or the services they provide, so we are going to pass it on to local authorities.” The Government must know, however, that local authorities, in straitened times with much smaller budgets, are going to cut back on children’s centres.

This Government—any Government—have a responsibility for knowing that some policies are so fundamental to the welfare of our people that we and they cannot afford to give up the guarantee and say, “Oh, I’m terribly sorry. We believe in children’s centres, in a full service and in the early stimulation of children, but unfortunately those naughty people up there in Oxford, down there in Surrey or up there in the north-east happen to be short of money and it is all their responsibility.” No one can shuffle away from such responsibility. If children’s centres are cut back or cease to exist as fully integrated models, the buck stops with the Government. I hope that all parties in the House recognise that.

There is a very real problem with the final piece of evidence in the Government’s response to the Select Committee report. I was very fond of evidence-based policy, as you know Madam Deputy Speaker. On page 3 of the Government’s response, they say:

“The Government agrees with the recommendation—high quality provision leads to better outcomes for children and families. Research evidence shows that it is the quality of support which makes the difference for children's outcomes, particularly for disadvantaged children. That is why, where children's centres are providing early education and care, it should be led by either an Early Years Professional or a Qualified Teacher to ensure quality and provide expert input to the activities and services on offer.”

Do we all agree with that? I am looking at the ministerial team. Do we agree? Can I have a nod? [Interruption.] I am not going to get a nod, because they know that page 6 says:

“It is crucial that children's centres in disadvantaged areas continue to offer high-quality early education and care to support vulnerable and disadvantaged families. However, since we have removed the requirement for children's centres in disadvantaged areas to provide full day care, we do not want to be as prescriptive as the previous Government in expecting them to employ both a Qualified Teacher and an Early Years Professional. Therefore, we have removed this requirement.”

The Minister responsible for schools became very fond of one little bit of evidence in Clackmannanshire, when he was converted to synthetic phonics, but all the evidence, not just one piece in a relatively obscure part of the United Kingdom—