Abortion Act 1967: 50th Anniversary

Fiona Bruce Excerpts

Monday 6th November 2017 Commons Chamber

[Diana Johnson]

Clearly, 50 years ago Parliament took the view that it was going to allow abortions to take place in certain circumstances. It is right and proper that there is strict regulation around abortion. When I discussed decriminalisation earlier in the year, I talked about decriminalising, not deregulating. All providers have to provide the highest-quality care to women.

Successive British Governments have failed to act to improve abortion provision. They have sometimes hidden behind the false pretext that issues of provision are issues of conscience, thereby setting the issue aside as too difficult to tackle. In the months before and since I introduced my ten-minute rule Bill, yet more compelling evidence has demonstrated the need for long overdue changes to our abortion laws. Women, including desperate victims of domestic abuse, are increasingly ill-served by our current laws and criminalised for buying abortion pills online.

Waiting times for abortion services appear to be on the rise. Recently, figures obtained by investigative journalists at “The Debrief” showed that in 76% of the clinical commissioning groups and NHS trusts they surveyed, average abortion waiting times in 2016 were higher than they were in 2013. The Family Planning Association tells women that they should have to wait only 10 working days for an abortion, but a quarter of CCGs and trusts have average waiting times longer than that. In my local CCG in Hull, waiting times have jumped 6.7 days in just a year—one of the highest jumps identified.

The number of abortion pills seized by the Medicines and Healthcare Products Regulatory Agency posted to addresses in Britain has risen seventy-fivefold, from just five in 2013 to 375 in 2016. From November 2016 to February 2017, Women on Web, an international organisation that prescribes abortion pills in countries where abortion is illegal, monitored the number of British women who sought help on its website. In the space of just four months, the number seeking help had doubled.

Those figures point to this conclusion: there is a rising, and unmet, demand for better abortion provision in this country.

[Fiona Bruce (Congleton) (Con)]

Will the hon. Lady give way?

[Diana Johnson]

I am going to carry on, because I am conscious of time.

The personal cases of these women are often deeply moving. A recent study of Women on Web’s services, published in September, has provided unprecedented insight into the challenges that British women face in accessing abortion services. Of the women who approached its service, nearly one in five did so because of “controlling circumstances” at home—from abusive partners to intolerant families. As one woman told the service:

“I’m in a controlling relationship, he watches my every move. I’m so scared he will find out, I believe he’s trying to trap me and will hurt me. I can’t breathe. If he finds out, he wouldn’t let me go ahead, then I will be trapped forever. I cannot live my life like this.”

Another said:

“I’m never allowed to go anywhere without my husband or a member of his family escorting me. I don’t have a normal life since getting married. Abortion is against his family’s religion and I’m very worried what would happen if I was caught.”

For many women, making two trips to an abortion clinic, as is currently required, is simply not an option. A range of practical factors—the distance they live from a clinic, delays in accessing support, and childcare and work commitments—prevent them from making those trips. Yet each time these women purchase pills online, they are committing a criminal act, and because Women on Web does not prescribe pills in the UK, they are forced to turn to other providers, some of which may not be legitimate.

We are now in the position where the Royal College of Obstetricians and Gynaecologists, the British Medical Association and the Royal College of Midwives, plus the noble Lord Steel all agree that the law needs to be updated, and that abortion should be decriminalised. It is now time for Parliament to act on this. Shortly, I will be publishing the text of a Bill to decriminalise abortion in England and Wales. I am currently working on the Bill with legal experts and professional healthcare organisations. The Bill will contain the same safeguards and regulations as those that I set out in March this year.

Most importantly, it will take women out of the criminal law altogether. Healthcare professionals who assist in abortions before 24 weeks’ gestation will also be decriminalised, and they will receive further protections after 24 weeks. It will also allow us to make the best possible provision for the women who have early medical abortions. We need to look at the requirement to obtain two doctors’ signatures. We should also ask whether the second abortion pill could not be taken at home should women wish to do so, just as it is in the United States, France, Sweden and, as announced recently, Scotland.

[Fiona Bruce]

Will the hon. Lady give way?

[Diana Johnson]

I will carry on, because I am conscious that the Minister has to respond.

I want to make the point that decriminalisation will not mean deregulation. The 24-week time limit will not be changed, and the conditions for accessing abortions post-24 weeks will not change either, but I do want to see stronger protection for women from non-consensual abortions—whether by assaulting pregnant women, or deceiving women into taking abortion medication.

I have a few requests for the Minister. It is time that we acknowledged that abortion provision is not a conscience issue. Access to abortion services is a core part of women’s healthcare. It should be debated in a grown-up way, and Health Ministers should be held accountable for the quality of our abortion services. First, will the Department of Health look into the problems that women are facing in accessing abortions? The Department should be regularly assessing the problem of abortion waiting times. It should be looking to identify local areas where there is poor provision. The problems that extremely vulnerable women face in accessing abortion care should also be investigated.

Secondly, what concrete steps will the Government take to improve abortion provision? A court judgment in 2011 established that the Health Secretary could allow home use of the second abortion pill without the need for new legislation. In the light of that and of what has happened in Scotland, what are the Government planning to do? Furthermore, an increasing number of experts have questioned the two doctor requirement for early stage abortion. Will the Minister comment on that?

Thirdly, how will the Government respond to the calls to decriminalise abortion, supported by three professional medical bodies? Will the Government consider acting on these calls? Finally, we must also recognise the situation in a country where the Abortion Act does not apply. In Northern Ireland, abortion is highly restricted and criminal, even in cases of rape, incest or fatal foetal abnormality. The ongoing Supreme Court case raises the prospect that this may soon go beyond a devolved matter and become a broader human rights matter. What steps are the Government taking for that to be dealt with by the Secretary of State for Northern Ireland?

In conclusion, the House should mark the anniversary of the Abortion Act—not just because of what we have achieved, but to look forward to what we need now. In the face of threats to women’s reproductive rights at home and abroad, the answer is not to become timid and to remain defensive. The answer is to be bolder, to go beyond merely defending what we currently have, and to make a positive case for stronger rights and better women-centred provision. The ’67 Act made Britain a world leader in women’s reproductive rights, but it is time that we took the steps now to ensure that, once again, Britain reassumes this world-leading position.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate to mark an historic occasion: the fiftieth anniversary of the passing of the Abortion Act 1967. As the hon. Lady explained, the Act was introduced as a private Member’s Bill by the then hon. Member for Roxburgh, Selkirk and Peebles—now the right hon. the Lord Steel of Aikwood—and clearly defines the grounds under which an abortion may be carried out in England.

With the exception of emergencies, when it is necessary to perform an abortion to save the life of the woman, two doctors must certify that, in their opinion, which must be formed in good faith, a request for an abortion meets at least one ground set out in the Act, and they should be in agreement as to which ground this is. The hon. Lady asked whether it should remain the case that the opinions of two doctors are required. Well, as long as that remains the law—clearly it is—my emphasis, from a Minister’s perspective, is on delivering the safest possible treatment for women in accordance with that law. The hon. Lady also raised some important issues regarding waiting times, which I would like to go away and reflect on. I am sure that everyone in this House agrees that no woman undertakes a termination lightly. For many, it is extremely traumatic, so it is incumbent on all of us to make that experience the least painful and least traumatic it can be, and as safe as possible. Central to being as safe as possible is that it takes place as early as possible.

[Fiona Bruce]

The Minister is talking about the requirement for two medical practitioners to give their agreement. A ComRes poll of 2,000 adults last week showed that 72% of the public think that abortions should continue to be subject to that legal requirement, because it ensures protection for women, particularly for those in an abusive relationship. It might be the opportunity they have to talk to someone in a safe environment about the pressure that they might be being put under to have an abortion.

Valproate and Foetal Anticonvulsant Syndrome

Fiona Bruce Excerpts

Thursday 19th October 2017 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I pay tribute to the right hon. Member for North Norfolk (Norman Lamb) for so eloquently articulating the concerns that many of us share about the taking of sodium valproate by expectant mothers.

I am speaking today because I believe there is a case for Ministers to answer on the grounds of compassion and justice as to how and why pregnant women were allowed to take sodium valproate for so many years without being better advised and informed, and without their unborn children being better protected from the risks. That is particularly the case since professionals became increasingly aware of those risks over the years—as early as 1973. As we have heard, the risks are huge. At the end of the day, the people who should have been able to weigh them up and choose whether to take valproate while pregnant were the mothers. I appreciate that in 1973 we were, as has been said by a practitioner in medicine, in a more paternalistic era, but that was not the case as the years went by, and certainly not in 2016, when the valproate toolkit—the patient guide that I have here in my hand—was published.

Mothers were not given the relevant information and, sadly, far too many still are not. It is absolutely critical that they are given it, because the toolkit is stark, stating:

“If you take valproate when you are pregnant it can harm your unborn child…Taking valproate…can cause birth defects and problems with development and learning…In women who take valproate while pregnant, around 10 babies in every 100 will have a birth defect”,

such as

“spina bifida…facial and skull malformations…malformations of the limbs, heart, kidney”

and other organs. It goes on to say that

“about 30-40 children in every 100 may have developmental problems”

such as

“learning to walk and talk…lower intelligence…poor speech and language skills”

and “memory problems.” It states that

“it is…important that you…know about these risks”.

But for years women did not know about the risks when medical professionals did. They might not have known, and probably did not know, all those details. However, I have with me a copy of a letter from the Committee on Safety of Medicines—the precursor to the MHRA—from 1973. It refers to a number of studies and says:

“it is now clear from other studies…that the use of anticonvulsants during pregnancy…is liable to produce other abnormalities as well as hare-lip and cleft palate. The risk appears to be low and not sufficient to justify stopping the use of anticonvulsants when they are necessary for the control of epilepsy.”

There we have it—the Committee on Safety of Medicines was aware of this in 1973. The documentation relating to the licensing application in 1974, which the right hon. Gentleman mentioned, says that the product is licensed

“for use in general, focal or other epilepsy. In women of child bearing age, it should only be used in severe cases or those resistant to other treatment”.

So we now know that the dangers were being raised as long ago as 1973 and 1974.

In response to these concerns, the CSM instructed that an alert must

“not go on the package inserts”

so that patients would be protected from “fruitless anxiety”. Because patients did not see anything, they were denied the information and therefore the choice to abstain from this drug. Yet very much more anxiety was caused for many of them when the reality was that thousands of babies were born with life-changing disabilities and deformities that could have resulted from taking this drug during pregnancy.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

Does the hon. Lady find it even more shocking that it was decided to keep this information from women in 1973-74, in the wake of the thalidomide scandal, when it should have been uppermost in people’s minds that pregnant women needed warning about the drugs they took? That should have made it more likely that women were informed about the risks.

[Fiona Bruce]

The hon. Lady makes a very good point.

Further warnings were issued. In 2000, a patient information leaflet from the producer, Sanofi, said:

“It is known that women who have epilepsy have a slightly higher risk of having a child with an abnormality than other women. Women who have to take Epilim in the first 3 months of pregnancy to control their epilepsy have about a 1-2% chance of having a baby with Spina Bifida.”

In 2005, Sanofi added:

“Some babies born to mothers who took Epilim during pregnancy may develop less quickly than normal and may require additional educational support”

and that some

“babies born to mothers who took Epilim…during pregnancy may develop less quickly than normal or have autistic disorders.”

Warnings were emerging over the years, but nothing was done to ensure that patients were told. Why did patients have to wait almost 30 years to be warned of the risks?

Janet Williams and Emma Murphy, whom the right hon. Member for North Norfolk (Norman Lamb) mentioned and whom I have had the privilege of meeting, are tenacious and brave women who have campaigned for years and set up a support group for affected families. I pay tribute to them, and I want to tell the House a little bit about their family situations. Janet has two sons aged 26 and 28: Lee and Philip. Janet took Epilim, but nothing else, during both pregnancies. She told me:

“I wasn’t offered anything else—and no one told me of the risks.”

Lee, at 26, has curvature of the spine, Asperger’s, learning difficulties and memory problems, and he cannot hold down a job. Philip, at 28, has even more problems. He has problems with hearing, vision, speech, language and walking, as well as floppy joints. He is still fully dependent on Janet.

Emma had her children a generation later. She has five children, aged eight to 14: Chloe, Lauren, Luke, Erin and Kian. They have all been diagnosed with a number of symptoms. All have varied problems, including autism, incontinence, deafness, cerebral palsy and curvature of the spine, and all are slow to develop. Emma took the same dose of Epilim during each pregnancy. She told me that she questioned that, but was told that it was the best drug to control her seizures and that her baby would be fine. She took no other drugs during her pregnancies. No one warned her of the risks.

The tragedy is that those two women represent more than 1,000 others in their support group, the Fetal Anti Convulsant Syndrome Association. Together, they founded the Independent Fetal Anti Convulsant Trust, a registered charity, to campaign for better awareness of the risks of taking valproate, to prevent further such difficulties occurring, and to challenge the Government. There is, as I say, a case to answer, and I do not believe that we would be here today were it not for these two women.

[Rosie Duffield (Canterbury) (Lab)]

Does the hon. Lady agree that women such as Janet and Emma are ideally placed to get compensation, should the Government agree to a system similar to the €10 million French compensation scheme for Depakine?

[Fiona Bruce]

I certainly think that has to be looked at as part of the case that Ministers have to answer.

I would like to say much more but time prohibits me. We have heard some of the terrible statistics that have already been cited about the 20,000 children who could have been affected since the risks were first known about, the 400 children who are still born each year with symptoms, the 28,000 women of childbearing age—according to ONS figures—who are still being prescribed the drug, and the 68% of women in this situation who say that they are not properly informed of the risks.

What do I ask of Ministers? I ask the Minister to agree that significantly more needs to be done urgently to raise awareness of the risks of taking sodium valproate among pregnant women and those who could become pregnant. Does he agree that although Ministers might have come to know about the risks only relatively recently, the producer Senofi, the MHRA and its predecessor, the Committee on Safety of Medicines, knew about them and should have done more to address them? They should have published information and improved warnings years ago.

Does the Minister accept that the support needed by mothers such as Janet and Emma, who have to care for their children with foetal valproate syndrome, is major and may be lifelong, and that much more needs to be done to consider how that support can be improved and funded? Janet and Emma tell me that the current provision through local councils and health authorities is wholly insufficient and that care plans are needed for the many affected children.

Is there any reason why, as I said at the outset, Ministers cannot look at what we in this country can do to support these families now, without further delay, and certainly without awaiting the final decision of the European Commission regarding the link between sodium valproate and birth defects? After all, we are leaving the EU. Does the Minister now have full confidence in the MHRA’s ability to effectively inform and guide healthcare professionals on the use of the prescription of sodium valproate for epilepsy, and does he think the same can be said of the MHRA’s involvement over the years? Finally, will the Minister, at an early date, meet Janet Williams and Emma Murphy, as well as a group of Members who are concerned about this issue, to respond to their concerns and to my call that our Government at the very least have a case to answer?

--- Later in debate ---

[Liz McInnes]

The hon. Lady is absolutely right. She and I are well aware of the yellow card system, because we have both worked in the NHS, but how many people out there know that they can report side-effects of drugs, or even suspected side-effects? We really have a job to do in conveying that message to the general public, and we also need people to collate the information and act on it.

A definitive paper stating that there was a clear link between valproate taken during pregnancy and birth defects was published in 1995. It was entitled “Foetal Valproate Syndrome”, and was written by geneticists at St Mary’s Hospital, Manchester. It is clear that the evidence has been building up for a long time, so why does it appear that women were not warned about the potential dangers of taking the drug in pregnancy?

[Fiona Bruce]

That 1995 report concluded that the “risk” of foetal valproate syndrome when babies were exposed to valproate was “significant”.

[Liz McInnes]

That was probably the first research paper to suggest that it was not just coincidence and that there was a causal relationship, which is why it is seen as definitive.

The pharmaceutical company Sanofi, which many Members have mentioned, has stated that it has kept in line with scientific knowledge when reporting side-effects in a foetus. However, from as early as 1983 the CSM and the MHRA reported the problems caused by taking sodium valproate in pregnancy, but did not insist that Sanofi issue warnings in the form of a patient information leaflet.

Even now, to this day, epilepsy charities report that women are not aware of the potential risks when taking the drug in pregnancy. A survey has shown—I know it has already been mentioned, but it does no harm to reinforce these findings—that 18% of women taking sodium valproate were not aware of the risks during pregnancy, and 28% said that they had not been informed of any risks. That is despite the production by the MHRA of a valproate toolkit designed to help healthcare professionals to talk to women with epilepsy about the risks of taking valproate during pregnancy.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Let me tell the hon. Lady what has happened in mental health. Some 30,000 more people are working in mental health today than when her Government left office—a 5.8% increase in clinical staff. On top of that —she asked about money—we have committed an extra £1 billion a year by 2021 so that we can employ even more people. We are the first Government to admit that where we are now is not good enough. We want to be the best in the world; that is why we are investing to deliver that.

[Fiona Bruce (Congleton) (Con)]

21. Parental conflict is recognised as a key cause of children’s mental health problems. What is the Department doing to address that, and will Ministers be willing to meet a group of colleagues who supported the “Manifesto to Strengthen Families”? Its policy proposals seek to discuss how strengthening families can address children’s mental health problems.

[Mr Hunt]

My hon. Friend is absolutely right. Children who come from troubled or chaotic family backgrounds are far more likely to have mental health issues. I am more than happy to meet her and to feed her thoughts into our mental health Green Paper.

Organ Donation: Opt-out System

Fiona Bruce Excerpts

Thursday 13th July 2017 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate the hon. Member for Barnsley Central (Dan Jarvis) on securing the debate and on his sensitive and compassionate tone; I hope I can reciprocate. I agree with the hon. Gentleman that it is imperative to work to increase the number of organs available for donation, because every week people in this country die because there is a shortage of available organs. The critical question that we must ask today is whether presumed consent would help with that.

Presumed consent certainly seems an attractive proposition, but perhaps I may enter a note of caution, to aid our early deliberations on the matter. One of the key legal principles I was taught as a student lawyer was that silence is no reply, which means that, much as we might like to draw conclusions from silence, there are good reasons why it may be inappropriate to do so. Introducing the principle of presumed or deemed consent would involve a major change with respect to organ donation. It would effectively mean that even if someone did nothing at all—did not sign an organ donor register, or opt out or in—a consequence would be triggered. The person’s silence would trigger a quite major action. Their organs could later be taken and transplanted. Consent would be deemed, although they would have done nothing.

Of course, some people, on seeing the publicity that might surround the introduction of presumed consent, would deliberately and knowingly decide to do nothing, aware of the consequence; they would be comfortable with that. Those people would be aware that they had, in doing nothing, effectively chosen to donate. However, there would inevitably be a significant group of people who missed the publicity altogether. We need to be sensitive to that.

Informed consent is an important principle, undergirding the relationship between the citizen and the state, so it is right that the House should explore the issue carefully, which is why I welcome the debate. It is critical to explore whether, for example, it is right in this instance to undermine the principle of informed consent by introducing presumed consent. Is it possible that that could create a precedent that might be appealed to in future for less enlightened purposes?

Some practical concerns were highlighted during the debates in Wales that preceded the legislation there, some of which I did not feel were satisfactorily resolved at the time. When the Welsh Government made the case for introducing presumed consent, they based their case, at least in part, on a piece of research by two academics, Abadie and Gay:

“Evidence...suggests that introducing an opt-out type system could result in a 25 to 30 per cent increase in deceased organ donation rates which could equate to a further 15 donors each year in Wales, each of whom...on average might donate 3 organs. This means around 45 more organs could become available to the UK pool for transplantation.”

I understand that the research compared practices in other jurisdictions, and classified Spain, the country with the highest donation rate in the world, as a presumed consent country. Spain introduced presumed consent legislation in 1979, but the law has never been implemented; Spain is still in practice an informed consent jurisdiction like England. Indeed, rates of donation there started to increase only when, 10 years later, Spain made other changes, in particular investment in the organ donation infrastructure. It increased the capacity, training and availability of medical staff to talk to families about donating the organs of a loved one when a life has tragically been cut short.

A leading expert in the field, Professor John Fabre, unsuccessfully tried to point out to the Welsh Government their misconception. In an article entitled “Presumed consent for organ donation” in the journal Clinical Medicine, he referred to their explanatory memorandum, published in December 2012, to the Bill that became the Human Transplantation (Wales) Act 2013. It stated:

“For example, an opt-out system is operated in Spain and it has the highest donation rate in the world.”

As I have said, Spain, even today, does not operate an opt-out system, so I believe that that statement was incorrect, even though it was cited in official papers in Wales, underpinning the presumed consent legislation. The recognition that the country with the highest donation rate in the world does not in fact operate a presumed consent system is important in any assessment of the efficacy of presumed consent. It is also striking that some of the countries that are least successful with their organ donation rates, including Sweden, Greece and Bulgaria, operate presumed consent.

A second objection raised during the debate in Wales was the fact that in some countries the introduction of presumed consent has been associated with significant numbers of people withdrawing from donation. Some people interpret the introduction of presumed consent, despite its noble motivation, as the state seeking to claim their organs without proper consent. Rather than seeing it as a mechanism for donation, they see it as a mechanism for bypassing consent to donation. There has been some evidence of that in Wales. Giving oral evidence to the Health and Social Care Committee of the National Assembly for Wales, organ transplant specialist Dr Peter Matthews, who was based in Morriston Hospital in Swansea, said:

“My own experience is that the British psyche has a particular view that what it should do is donate organs as an altruistic gift, and if it is felt that the state is going to take over the organs, then there is the potential that people who may have been willing to become a donor will not do so. We have seen two cases in Morriston where patients who were on the organ donation register, on hearing about this, said to their families that if the state was going to take their organs, they were no longer willing to give them. We lost two donations”.

During the debate on the Bill in Wales, three Assembly Members relayed similar stories from constituents.

I want to comment on the impact of presumed consent in Wales. NHS Blood and Transplant records donations on a yearly basis, from April to April, and the first full year of results that we have from Wales is for 2016-17. The data tell us two important things: first, in 2016-17, 61 deceased donors facilitated 135 organ donations. Far from representing the anticipated increase of 15 donors and 45 organs, that apparently constituted a decline by three donors and 33 organ donations from the previous year’s figures. That might come as something of a surprise, because some people have suggested that the system was a great success. However, under informed consent a family can donate the organs of a deceased person if the deceased has signed neither the organ donation register nor the opt-out register, which means that, as we have heard, in Wales prior to December 2015 the families or living representatives of the deceased could—as they can here—decide to donate their loved one’s organs. But under presumed consent those informed consent donations would be reclassified as presumed consent donations. Critically, that does not mean that those donations would not have happened under the old system.

Secondly, and not surprisingly, bearing in mind what Dr Matthews told the Assembly, there has been a huge increase in the number of people in Wales opting out. In 2016-17, 174,886 people in Wales were on the opt-out register. That figure far outstrips comparable figures for other parts of the UK, where consent is not presumed. Only 27,559 individuals in England, 1,834 in Scotland and 204 in Northern Ireland have opted out. That means that a staggering 85.5% of individuals in the UK who have opted out live in Wales, despite the population of Wales representing only 4.8% of the UK population.

I have cited a lot of figures, but I do so to get them on the record and to aid our debate. To appreciate fully the cost of the change in Wales, we must remember that prior to the introduction of presumed consent, people who had signed neither the opt-out register nor the opt-in register were potential donors.

[Paul Flynn (Newport West) (Lab)]

Does the hon. Lady agree with the Welsh Government’s conclusion that 40 lives have been saved under the presumed consent scheme that would have been lost under the previous arrangement?

[Fiona Bruce]

My concern is to demonstrate that we have to look very carefully at some of the evidence that the Welsh Government used to come to their conclusions.

Where someone has signed the opt-out register, conversations cannot even begin. That means that more than 174,000 of the Welsh population have effectively been removed as potential donors. Previously, in the absence of express direction to do otherwise, those people’s families, as their living representatives, might have been happy to donate their loved ones’ organs at their death. When Wales embraced presumed consent, the other UK jurisdictions said that they would wait to review the results in Wales before deciding whether they wanted to go down that path. I ask the Minister to look at the evidence.

We have significantly increased donation levels in England since implementing the recommendations of the organ donation taskforce in 2008, which of course came down very much against presumed consent. Rather than seeking to emulate Wales, England should perhaps seek to emulate Spain and put its emphasis on lowering the family refusal rate by increasing the number of clinicians who are trained and available to discuss this issue with families when the need arises—often at short notice.

Professor Fabre concluded his seminal paper in Clinical Medicine in the following terms:

“Rather than legislating for the consent of donors, we should be addressing the misgivings and misunderstandings of families so that they decline donation much less frequently, as has been done so successfully in Spain. An acceptance rate of 85% is a realistic and achievable objective for the UK over a 5-year period. As previously, we have the Spanish model to guide us. It will not be easy. It will require…a detailed plan at the national level”.

I very much hope that the Minister will consider all those points and confirm that the Government will take into account every possible consideration and concern about this issue before any legislation is introduced. I look forward to her response.

Alcohol Harm

Fiona Bruce Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Flello, and to speak on the importance of tackling alcohol harm. It is a measure of the concern across the House that there are not one but three all-party parliamentary groups concerned with alcohol harm. It was the three chairs of those APPGs who applied for the debate: myself, as chair of the APPG on alcohol harm; the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), who chairs the APPG on children of alcoholics; and the hon. Member for Sefton Central (Bill Esterson), who chairs the APPG on foetal alcohol spectrum disorder. I will leave it to those Members to speak of the harm caused to children and unborn children through alcohol consumption, but as vice-chair of those two APPGs, may I commend and say how much I fully support their work?

We are all here to express, with one voice, our gravest concerns about the harm caused by alcohol consumption to individuals, their families and wider society. As we will hear, one thing is clear: the Government’s alcohol strategy, which is now five years old, must be reviewed. Urgent and much more robust Government action is needed to address the devastating damage caused by alcohol harm. It all too often harms innocent bystanders, whether those injured in road traffic accidents, children and partners caught up in domestic violence, patients needing treatments for serious illnesses—they have to wait because precious NHS resources are being used to tackle the issue—and taxpayers, through the tax bill we all pay.

This is not about saying that people should not drink—like many other hon. Members here, I enjoy alcohol—but about promoting responsible drinking and the need to change our country’s drinking culture and our relationship with alcohol. It is also very much about social justice, because the poorest and most vulnerable disproportionately suffer the most amount of alcohol harm. The Government need to wake up to the urgency of their need to take a lead on this. Urgent words were expressed in the 2012 alcohol strategy, but appropriately urgent action has sadly not followed.

The Minister will doubtless point to a few improvements in recent years, and they are welcome, although with major reservations. For example, although the number of adolescents who drink has gone down, the volume of alcohol that they are drinking has not. That sadly indicates that although fewer adolescents might be drinking, those who do are drinking to excess. A 2012 YouGov report revealed that 41% of 18 to 24-year-olds are drinking at harmful levels. We also hear reports of women of a certain age—around my age—drinking too much, and even of much older people struggling with alcoholism as they try to cope with loneliness and isolation.

The fact is that there is a massive problem in this country resulting from alcohol consumption, both excessive and just above Government guidelines. To evidence that, I refer to the Public Health England report, published in December 2016 at the specific request of the former Prime Minister, David Cameron, entitled, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An evidence review”. It cannot be dismissed as just a thought piece; it has more than 200 pages of evidence-based information and conclusions, has been robustly peer reviewed no less than three times and was produced by Public Health England—an executive agency of the Department of Health that

“exists to protect and improve the nation’s health and wellbeing”.

The report paints a bleak picture. Paragraph 1 states that

“there are currently over 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.”

It continues:

“In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years… More working years of life are lost in England as a result of alcohol-related deaths than from cancer of”—

there are many of these—

“the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

I deliberately read that out as I wanted it recorded in Hansard.

The Institute of Alcohol Studies quotes Public Health England, stating that

“167,000 years of working life were lost to alcohol in 2015”.

That is because alcohol is more likely to kill people during their working lives than many other causes of death—that is, it causes premature deaths. In fact, there were 23,000 alcohol-related deaths in England each year. Alcohol accounts for 10% of the UK’s burden of disease and death, and in the past three decades there has been a threefold rise in alcohol-related deaths.

[Kelvin Hopkins (Luton North) (Lab)]

I congratulate the hon. Lady on everything that she has said. In the mid-1970s, a Home Office report showed that Britain had the second lowest level of alcohol consumption in the whole of Europe; we have risen rapidly while the rest of Europe has been coming down. They have learned from their previous mistakes, and we ought to as well.

[Fiona Bruce]

I thank the hon. Gentleman for his intervention, which reflects his long commitment to tackling the issue. I also thank him for his involvement with our all-party parliamentary group.

The NHS incurs an estimated £3.5 billion a year in alcohol harm costs. Treating liver disease alone now costs £2.1bn a year, for example. However, that is just the financial cost, which I rather suspect is an underestimate. Many other costs are incurred as a result. The all-party parliamentary group on alcohol harm recently produced a report called “The Frontline Battle”, which described the impact on the emergency services—the police, fire services, A&E departments, doctors and so on—of treating or helping people who are inebriated or suffering as a result of excessive alcohol consumption. It found that, on a Saturday night, 70% to 80% of all A&E attendances are alcohol-related.

[Mr Nigel Evans (Ribble Valley) (Con)]

My hon. Friend paints a graphic picture—some cities and towns are like warzones on a Friday and Saturday night. I am the president of the all-party parliamentary group on beer. Does she agree that the Government could work with the industry? For instance, AB InBev is looking to work on lower alcohol-by-volume beers. At the moment, anything below 2.8% ABV is incentivised, yet that is less than 0.5% of the market. If the incentivised ABV rate is increased to about 3.5%, it would introduce far more choice, could lead to people drinking lower strength beer and could hopefully attract people away from some of the higher ABV beers that cause so much harm, as she has so beautifully demonstrated.

[Fiona Bruce]

My hon. Friend represents Ribble Valley, which I know contains many beautiful public houses, some of which I have enjoyed visiting. I would not want any Member here to think that we in any way wish to denigrate community pubs, which we consider to be community assets. He makes a vital point and has saved me from going into detail on that, which I was going to, having been briefed by AB InBev, which has a base in his constituency.

AB InBev UK and Ireland says that the introduction of a reduced rate of duty on beers produced at an alcoholic strength of 2.8% has not had the intended impact. In fact, it is providing only 0.15% of duty receipts. The impact could be achieved if 3.5% beer was included. I very much support what my hon. Friend says. Apparently, the Treasury has said that there is an EU structures directive that might cause a problem regarding that. It is fortuitous that, following yesterday’s vote, we should not be at all put off introducing a pro-health measure, for risk of upsetting our European partners.

[Mr Evans]

Apparently there is legal advice that this can be done within the current rules. If it is for the health of UK citizens, surely the British Government ought to press on and do it now.

[Fiona Bruce]

I absolutely agree. I am aware of that legal advice. I hope that the Government will do so and that the Minister will take note of that.

In preparing our report, the all-party parliamentary group discovered shocking harm, particularly to people working in our emergency services. I would like to refer to evidence we obtained from an emergency services doctor, Zul Mirza, whom I commend for his work in this area. He talked about how patients coming into his wards inebriated not only can be violent towards staff, but on many occasions damage valuable equipment needed by other patients. Our report also found that over 80% of police officers have been assaulted by people who are drinking. I was deeply concerned to hear one police officer tell us this:

“There is one thing that is specific to female officers and that is sexual assault. I can take my team through a licensed premise, and by the time I take them out the other end, they will have been felt up several times.”

That is shocking.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for bringing this extremely important debate to the Chamber. Given the figures she describes, does she agree that alcohol-related aggression needs to be addressed in terms of treatment? Having worked in the criminal justice system, I agree on the wide-scale aggression that is found in A&E departments at weekends and that the police face mainly at weekends, but also on many days of the week. Given that a low number of Members have turned up to this debate, does the hon. Lady agree that politicians should be taking the issue more seriously? More politicians could probably be found in the bars of Westminster today than here in this debate. We should be addressing this problem.

[Fiona Bruce]

The hon. Lady is absolutely right. It is tragic that only 6% of dependent drinkers in this country access treatment, despite it being very effective. We need to do much more to make treatment available to them.

A concerning finding of our all-party parliamentary group’s report was that many of those in the emergency services themselves are suffering from depression or are even thinking of leaving the services simply because coping with this kind of pressure day in, day out is proving too much for them. We must tackle that.

After reflecting on the many and varied aspects of alcohol harm in this country, the Public Health England report goes on to say:

“This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.”

What does this Department of Health review recommend? It talks about tackling three things: affordability, availability and acceptability. Affordability means price; availability means the ease of purchase—in other words, the number of outlets and the times at which alcohol can be bought; and acceptability means tackling our drinking culture. I want to give other Members time to speak, so I will not talk in detail about all those things, but I will touch in particular on affordability.

I had the privilege of asking Public Health England’s senior alcohol adviser this week what his top recommendation to Government would be to tackle alcohol harm, in the light of this substantial report. Without hesitation, he replied that it would be tackling affordability and putting in place policies that increase price. The report is absolutely clear:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement. For example, an increase in taxation leads to an increase in government revenue and substantial health and social returns.”

However, since 2012 the Government have done the opposite: they cut the alcohol duty escalator. The report states:

“According to Treasury forecasts, cuts in alcohol duty since 2013 are projected to have reduced income to the Exchequer by £5 billion over five years”.

The very first recommendation in the 2012 strategy was to implement minimum unit pricing. Indeed, the most recent review states that minimum unit pricing is

“a highly targeted measure which ensures tax increases are passed on to the consumer and improves the health of the heaviest drinkers. These people are experiencing the greatest amount of harm.”

In the foreword to the 2012 strategy, the then Prime Minister said:

“We can’t go on like this… So we are going to introduce a new minimum unit price.”

Five years on, that has still not been done, while the alcohol duty escalator has been cut, even though the No. 1 policy recommendation to tackle alcohol harm in the Government’s own review is to address affordability. Will the Minister, who I know is a good woman, now take a lead on this and make it happen?

The Government introduced a ban on the sale of alcohol below the cost of duty plus taxation, but the review states:

“Bans on the sale of alcohol below the cost of taxation do not impact on public health in their current form, and restrictions on price promotions can be easily circumvented.”

Let us consider for a moment white cider products such as Frosty Jacks, which are almost exclusively drunk by the vulnerable, the young, the homeless and dependent drinkers. Just £3.50 buys the equivalent of 22 shots of vodka. The price of a cinema ticket can buy 53 shots of vodka. The availability of cheap alcohol, bought because of its high strength, perpetuates deprivation and health inequalities. Homeless hostels say that time and again the people staying with them drink these products, and many are drinking it to death.

Ciders of 7.5% ABV attract the lowest duty per unit of any product, at 5p, compared with 18p per unit for a beer of equivalent strength. There simply is no reason not to increase the duty on white cider, and 66% of the public support higher taxes on white cider. It is a matter of social justice that the Government should do that, and do it quickly. It need not impact on small, local brewing companies, which could have an exception, and it will not impact on pub sales. Tackling it would benefit the youngest and most vulnerable and save lives.

As I mentioned, the ban on below-cost sales has had no impact on sales of strong white cider. The current floor price of white cider, at 5p to 6p per unit—that is duty plus VAT—is so low that it can be sold for 13p a unit. Will the Minister ask our right hon. Friend the Chancellor of the Exchequer to increase the duty on white cider in the spring Budget on 8 March? This is not the first time that has been asking. Three hon. Members —my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) and I, and no less a person than the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston)—tabled an amendment to the Finance Bill last September, asking for the duty regime for white cider to be reviewed. I urge the Minister to read the excellent speech made by my hon. Friend the Member for Enfield, Southgate on 6 September. Indeed, my hon. Friend the Financial Secretary to the Treasury, who responded, said that the matter needed to be looked into.

Will the Minister press the Chancellor not only to work with her on that, but to introduce the promised minimum unit price and reintroduce the abandoned alcohol duty escalator, so that the tax system not only tackles alcohol harm, but incentivises the development of lower strength products and provides much-needed funding to help with treatment? Looking at all the evidence, we see affordability come out again and again as the most important driver of consumption and harm. Increasing the price of alcohol would save lives without penalising moderate drinkers.

Apart from tackling price, there are of course many other recommendations, both in the Public Health England report and in the APPG report, which came out a week before, that I would be grateful if the Minister would consider. I am grateful that she has already agreed to meet the APPG to discuss our report. Our chief recommendation is that the Government develop a cross-departmental national strategy to tackle excessive drinking and alcohol-related harm. Will the Minister take a lead on that?

Another key recommendation in the APPG report, which again is supported by the PHE report, is the implementation of training and delivery of identification and brief advice programmes and investment in alcohol liaison teams. I remember hearing one suggestion for brief advice to be given whenever anyone is having their blood pressure tested. Just in those few moments, it would be effective for whoever is doing the test just to ask the individual, “How is your alcohol consumption? Do we need to discuss that?” That kind of brief intervention can make people stop and think.

We must pursue earlier diagnosis of those with alcohol problems or potential alcohol problems. There are 1.5 million dependent drinkers, only 6% of whom access treatment. Many people are just drinking in excess of the chief medical officer’s low-risk unit guidelines. In fact, Drinkaware’s research shows that 39% of men and 20% of women are drinking in excess of those guidelines. It says that nearly one in five adults drink at hazardous levels or above. Many people need help through early intervention programmes, as well as more comprehensive treatment and support. Why are we not providing that when we know that it works?

Implementing such interventions is cost-effective for the NHS. I will give a powerful example that was drawn to my attention by Alcohol Concern. St Mary’s hospital in London has trained staff to give brief advice to patients presenting at A&E. It has designed the one-minute Paddington alcohol test to identify and educate patients who might have an alcohol-related problem. That is called the teachable moment and it has resulted in a tenfold increase in referrals to the alcohol health worker, who then carries out further brief interventions, resulting in a reported 43% reduction in alcohol consumption by the people referred. That is a very effective intervention.

It is interesting to note that the Public Health England report confirms that health interventions aimed at drinkers already at risk and specialist treatment for people with harmful drinking patterns are effective approaches to reducing consumption and harm and

“show favourable returns on investment.”

However, it points out that their success depends on large-scale implementation and funding. Will the Minister look at how her Department can give a national lead to share and implement best practice in this field, such as that which I have described?

I would like to say much more on the subject, but I will turn now to the issue of drink-driving. Unpopular as it might be to talk about this in policy terms today, the Public Health England report is clear. It states:

“Enforced legislative measures to prevent drink-driving are effective and cost-effective. Policies which specify lower legal alcohol limits for young drivers are effective at reducing casualties and fatalities in this group and are cost-saving. Reducing drink-driving is an intrinsically desirable societal goal and is a complementary component to a wider strategy that aims to influence drinkers to adopt less risky patterns of alcohol consumption.”

That could not be clearer. The UK is out of line with almost all of the rest of Europe when it comes to drink-driving alcohol limits.

[Liam Byrne (Birmingham, Hodge Hill) (Lab)]

The hon. Lady might have seen the statistical release from the Department for Transport, which I think came out this morning, that says there has been a statistically significant increase in the number of drivers and riders who are killed or injured while driving over the limit in the last year.

[Fiona Bruce]

I have not seen that release, but I am very interested to hear of it. I hope that the Department of Health will look at that and work with the Department for Transport to review the policy. The APPG would like to see a reduction in the drink-drive limit in England and Wales from 80 mg of alcohol per 100 ml of blood to 50 mg. As we have heard, there is a direct link between increased alcohol consumption by drivers and an increased risk of accidents resulting in injuries or fatalities. The Government need to consider lowering the legal limit and possibly a further lower limit for young drivers. They also need to ensure proper enforcement and strong penalties. If we are taking stronger action against the use of mobile phones at the wheel because we know that such action will help to save lives, surely we should do that to reduce the damage from drink-driving. The signal that that would send out to reduce our drinking culture would be major.

I will close with this. During the first world war, the Government introduced controls on alcohol to help the war effort. The crisis of the war offered the opportunity to develop a national alcohol strategy. We have reached our own crisis today, and the Government must take action.

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[Bill Esterson (Sefton Central) (Lab)]

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

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

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

[Fiona Bruce]

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

[Bill Esterson]

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

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

“intellectual disability, birth defects and developmental disorders”.

The article goes on to list

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

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

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

--- Later in debate ---

[Bill Esterson]

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

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

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

[Fiona Bruce]

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

[Bill Esterson]

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

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

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

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

[Fiona Bruce]

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

[Bill Esterson]

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

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

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

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

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

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

--- Later in debate ---

[Patricia Gibson]

Indeed. That appalling and very sad statistic is one that has touched my own family, as I will come on to explain. Alcohol continues to cause premature deaths in some of our most socioeconomically deprived areas and we must take action—I will go on to say how the Scottish Government have taken action.

The hon. Gentleman’s intervention came at a very personal moment in my speech. Indeed, I have a very personal stake in this debate. By all accounts my own father, of whom I have no memory, was an extremely heavy drinker. Was he an alcoholic? He probably was, but alcoholism was not readily talked about in working-class communities in Glasgow in the 1960s. I did not witness my father’s heavy drinking, because he died when I was nine months old, not least because of his heavy drinking. My husband’s father was an alcoholic, which led to his early death. In Glasgow, where both my husband and I grew up, such deaths were not unusual in the past, and even today alcohol-related deaths are still more common in our communities across Scotland than many people would think.

Here is the main point: I am extremely proud of the fact that against much opposition—some of it, unfortunately, on tribal grounds—the Scottish National party Government in Scotland took a very bold decision. They decided that the damage that alcohol was doing to our population, our families and our communities could no longer simply be measured and talked about and that action was needed. What else could kill 22 people each week in Scotland, cause 670 hospital admissions each week in Scotland, cost Scotland £3.6 billion each year and not require bold action?

Such action came in the form of minimum unit pricing. In our supermarkets and similar outlets, alcohol can cost less than bottled water; in some cases, it sells for as little as 18p per unit, which is disgraceful. There is clear evidence from research that shows there is a direct link between changes in minimum pricing, and changes in alcohol harm and consumption. Estimates show that a 10% increase in the minimum price of alcohol is associated with a 32% reduction in the number of deaths that are wholly attributable to alcohol. Work undertaken by the University of Sheffield shows that a minimum unit price of 50p is estimated to result in 121 fewer deaths a year, a fall in hospital admissions of just over 2,000 a year, and a fall in hospital admissions of just over 2,000 a year by year 20 of the policy.

Minimum unit pricing is more effective than taxation, because it is better able to target the cheap, high-strength alcohol favoured by the heaviest drinkers. Such a public health measure is supported by Ireland, Norway, Finland, Sweden and the Netherlands. I know that England is looking at this measure and I urge everybody in this Chamber to support its introduction. It is bold, but it needs to be bold to help deal with the blight that alcohol has cast over too many of our communities.

Global corporations in the alcohol industry fought a hard legal battle against Scotland’s introduction of minimum unit pricing, but the measure was passed with overwhelming support in the Scottish Parliament. It has been tested in the European courts. The appeal against it in the Supreme Court, following victory for the Scottish Government when the measure was tested at the Court of Session, is the final stumbling block to the introduction of the policy. I hope and believe that it will be resolved by the summer at the latest and introduced in short order thereafter.

Responding to the points made by the hon. Members for Congleton and for Luton North (Kelvin Hopkins), in Scotland we have already reduced the drink-driving limit to 50 mg per 100 ml of blood. That means that the rest of the UK—this is a cause for great alarm—has the highest limit in the EU, alongside Malta. I urge the Minister to follow the lead of Scotland and the rest of our EU partners. Reducing the blood alcohol level for drivers saves lives.

[Fiona Bruce]

I am interested to know from the hon. Lady directly how that change has not only saved lives, but changed the drinking culture. How have people changed their attitude towards drinking? One of the points that has been made to us about the Scottish experience is, “Well, it’s only a very few lives that have been saved,” but there is a bigger picture, is there not?

[Patricia Gibson]

There is indeed a bigger picture. Laws do not necessarily change attitudes, but what they do over time is change a culture. They send out a clear signal. The point was made earlier that when people are out and using a car, they tend not to drink. They are more likely not to drink at all due to the reduction in the drink-driving limit. It has also been a great educator for people who are out drinking and not driving, but who might be driving the following day. They decide, “I had better not drink tonight, because I might still be over the limit tomorrow when I get in my car.” We know that many of the people who have been pulled over, had their blood alcohol level tested and been found to be over the drink-driving limit were simply not aware of it, because it was from the previous evening; they had not considered that they might still be over the limit.

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[Liam Byrne (Birmingham, Hodge Hill) (Lab)]

It is a real pleasure to serve under your chairmanship for the first time, Mr Flello. I offer my thanks and congratulations to the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Sefton Central (Bill Esterson) for bringing this debate to the Chamber.

I am here this afternoon to speak on behalf of Britain’s 2.5 million innocent victims of drink. They are the children of hard-drinking parents, and I start my remarks this afternoon with heartfelt thanks to such charities as the National Association for Children of Alcoholics, Childline, Turning Point, Aquarius in my home city of Birmingham and many, many others for all the difference they have made to hundreds of thousands of children. For every child they have helped, for every life they have saved and for every life they have changed, I want to say on behalf of us all, “Thank you.”

I am here because I, too, am the child of an alcoholic. My father, Dermot, was an extraordinary man, and I would not be in politics—I certainly would not be in this place—had it not been for his inspiration. He was the son of Irish immigrants who came to Britain before the second world war. He was one of that generation of radicals in the 1960s. He was the first in his family to go to university. The first speech that really inspired him was Kennedy’s inauguration, with that immortal line,

“ask not what your country can do for you—ask what you can do for your country.”

That inspired him and my mum to go into public service. It was that ethos of public service that he handed down to me.

My father loved new towns. He was a practical idealist, and that is how I ended up growing up in Harlow. The reality was that as he rose up the ranks of Harlow Council to eventually become its general manager, his dependence on alcohol became deeper. When my mum died of cancer of the pancreas when she was just 52, it knocked him over the edge. He moved from being what I guess would be called a functioning alcoholic to becoming a non-functioning alcoholic.

For much of my life, I have grown up with that gnawing insecurity that is all too common for children of alcoholics—that constant feeling of guilt, constantly asking yourself whether you are doing enough. Why can you not do more to stop your mum or dad from drinking? I know what it is like to feel that cold nausea when you find the empty bottles hidden around the house. I know what it is like to feel sick when you hear your parent being sick first thing in the morning because they have drunk too much. I know what those feelings are like, and I know what the psychological reactions are like. I know all about the drive for perfectionism as you try to make the world perfect and impose some kind of order on it. I know what it is like to build up that kind of armour-plating so that nothing can ever hurt you, and I know all about the insecurity and the shame.

I know what it is like to have your parent on the front page of a paper because he has been caught driving four times over the limit. In fact, it was my little brother who was delivering those papers on his paper round. I know what that insecurity and shame feel like, and I know how it lasts a lifetime. I know what it is like to spend lots and lots of time in A&E. I know what it is like to spend lots of time in intensive care units. In my case, I was holding my dad’s hand as he suffered multiple organ failure, only to see him pull through and start drinking again. I know what it is like to spend the final days of your parent’s life in a hospital. It was almost two years ago, just before the last general election, that I was called to my home town of Harlow to be told that my dad only had days to live. I will remember for ever the compassion and care of the staff of the Princess Alexandra hospital in Harlow. I will remember for ever that cold dawn on St Joseph’s day nearly two years ago when the staff of the hospital folded down my dad’s blanket so that we could hold his hand as he breathed his last. I will never forget the compassion of those national health service staff and the way that they cared for us.

I know what those things feel like. I know how deeply they have affected me, and I know how deeply they have affected my brothers, but in a way I count myself as lucky, because since I first took the difficult decision to speak out on this a year and a half ago, I have been inundated with stories from colleagues here, whether they are in the House of Lords, staff or fellow right hon. and hon. Members. I have been inundated with stories from the public. I suppose I learned that like all children of alcoholics, we cannot change things for our parents, but we can change things for our children. What I want to do with others who are here is help use the experiences of the children of alcoholics in this country to change the policy of Her Majesty’s Government. That is why I am glad to see the Minister in her place today.

The stories I have heard are terrible, and I want to bring some of the voices of children of alcoholics to this place this afternoon. One person wrote to me to talk about their experience, saying:

“I felt alone, confused, guilty and second best.”

Another person said:

“Growing up with an alcoholic parent was not great. You feel like a failure, you feel like it’s your fault, you feel second best to the bottle. You never know what state you’re going to find your parent in.”

Another talked about the feelings of helplessness, hate, devastation, frustration and denial. Some felt worthless. Some were carers. Some had behavioural problems. I have teachers write to me about children they look after who are in that position.

Another person wrote and said:

“I am 36 and grew up in an alcoholic home. My mother drank heavily until she died in 2010. She was a lovely person until she drank when she became hateful and emotionally abusive…She was in and out of rehab, detox centres and mental health units for all of her life.”

Another said that they felt awful, that there was little love shown and that they felt alone the majority of the time, although luckily they had grandparents who were supportive until they passed away. Another described their childhood growing up with an alcoholic as

“horrible. I used to come home from school and see my mum drunk/passed out on the floor. I could never concentrate on school work because I’d constantly worry about her. Is she okay? Was she still alive for when I got home? It was a constant worry.”

Another person talked about their feelings of loneliness and how much they hated the signs that their dad had been drinking or in their mother’s speech. Another wrote:

“I wanted to die at 14. I tried but lived sadly.”

One person described their experience as

“losing my childhood, and becoming a parent to my younger sister and trying to shield her as much as possible. I was quiet and withdrawn, not wanting any attention and associating all attention with the embarrassment I felt when my mum was drinking.”

Another wrote about her experience of living in a household where “don’t mention Daddy’s drinking” was the byword. The year that he died, she got sober too. I could go on and on and on. These are not the experiences of a few people; these are the experiences of 2.5 million children in our country—that is one in five children.

From a public policy point of view, should we care? Of course we should, because the evidence is that those children will be twice as likely to develop difficulties at school, three times as likely to consider suicide, five times as likely to develop eating disorders and four times as likely to become alcoholics themselves. This great epidemic of agony is cascading down the generations. The cost of alcohol abuse that the hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about —that £21 billion, although some say it is £50 billion—is cascading down the generations. In this House, we have to stand together and break the silence and the cycle of this terrible disease.

Given the scale of the problem, we would expect that the Government, local authorities and the national health service would be all over it and on top of it, making sure there was action, yet the opposite is true. In a series of freedom of information requests that I conducted at the end of last year, we discovered that none of the 138 local authorities that responded have a specific strategy to help the children of alcoholics. Almost no local authority is increasing its drug and alcohol substance abuse budget, even though many of them are seeing rises in A&E admissions due to alcohol harm. Just 9% of the local authorities where A&E admissions are going up are increasing treatment budgets. A third are cutting the budgets.

In some parts of the country, referrals for alcohol treatment represent 0.4% of dependent drinkers. In other parts of the country, that figure is 11%. That is a wide variation. In some parts of the country, an average of £6.61 is spent per hazardous drinker. In other parts of the country, it is £419—that is in Sefton.

There is no uniformity in the data used to collect statistics across the system. What is clear is that children of alcoholics fall through the cracks because they sit at the junction and on the borders of three different systems: the adult social care system, the children’s social care system and the public health system. Not one of those systems has explicit defined responsibility for helping children of alcoholics. So what happens? Children of alcoholics just slide through the gaps.

That is why charities such as the National Association for Children of Alcoholics are so important. When I was in an agony of public shame after the last election, it was Hilary Henriques, whose son is here this afternoon, who got me back on my feet. I had the prospect of the Prime Minister wandering around the country waving the leaving note that I left back in 2010, and that brought me immense public shame. What I could not describe at the time was the private shame that I felt, having just lost my father to alcohol. I was at my lowest ebb after the last election. It was Hilary who helped me see that there was something constructive and productive that I could do to aid this particular cause.

NACOA has had 1 million contacts in the last 15 years by phone, email or through the website. The demand for its services is going up and up. What I find most troubling is that a third of people who contact NACOA have not told anybody else about their issues. These poor children are suffering in silence. They feel a profound sense of shame and insecurity. They feel that it is their fault. They curse themselves for not being able to do anything about it, and not only do the suffer in silence, but they feel like they are on their own. No wonder so many go on to suffer difficulties in the future.

On 13 February, we will mark international Children of Alcoholics Week, which is when we get the chance, around the globe, to stand up and speak for the children of alcoholics. Thanks to the concerted effort of the all-party parliamentary group on children of alcoholics, we will be able to launch on 15 February, the day after Valentine’s day, the first ever manifesto of children of alcoholics. It has not been written by me, NACOA or by charities, but by children of alcoholics, many of whose stories I read out earlier. I want to give the Minister some highlights.

First, the clear message is that the Government have to take responsibility for children of alcoholics—no one else is going to help these children. Their parents are not going to help. They cannot tell their neighbours. The Government have got to step into the breach.

We need a national strategy for children of alcoholics. We talk about children’s mental health and we talk about alcoholism, but, again, children of alcoholics are in the middle. They need a national strategy of support.

[Ms Karen Buck in the Chair]

We have to properly fund support for children of alcoholics. Helplines such as those from Childline or NACOA are run on a shoestring, yet they make a world of difference. They need a little bit of extra help from the Government.

We need to increase the availability of support for families. There is clear evidence now that family therapy can make an extraordinary difference. We should be boosting education and awareness among children and for those who have responsibility for working with children. I cannot count the number of times that I was involved in talking to the national health service about my dad’s condition. Even when I spent five days sitting on the ward of an intensive care unit, not once did anyone ever say to me or my dad, “Is there a conversation about alcohol that we need to have? And, by the way, are you okay?” We need to transform education and awareness among those who look after our country’s children.

As the hon. Member for Congleton said, we need to develop a plan to change public attitudes, and we need to revise the national strategy to focus on price and availability. The evidence from Canada and Ireland—and I hope soon from Scotland—is very clear that price makes an important difference.

We need to curtail the promotion of alcohol, particularly to students. When kids put up posters of football teams with alcohol brands plastered across their strips, alcohol is being advertised in their bedrooms. We have to think anew and afresh about how alcohol is promoted in this country.

I say in support of the hon. Lady that the Government should take responsibility for reducing the rate of alcoholism. This is a public health question, pure and simple.

[Fiona Bruce]

The right hon. Gentleman gives me the opportunity to point out that the Public Health England report says that the evidence is sufficient to support policies to reduce children’s exposure to marketing. They are needed, and that is what the report says.

--- Later in debate ---

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

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce), the hon. Member for Sefton Central (Bill Esterson) and the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing this hugely important and deeply moving debate on tackling alcohol harm. I pay tribute to each of them for the work that they have done in leading their APPGs, raising awareness, holding the Government to account and developing policy. We have heard incredibly eloquent testimony from several Members about the harms that alcohol misuse can cause to individuals themselves, but just as much to their friends, family and children. We have also heard about the cost to wider society, and in particular to vital public services such as the NHS.

The majority of people who consume alcohol do so at low-risk levels and as a pleasurable part of their social lives. Pubs and restaurants play an important part in our communities, both as venues for gatherings and, as employers and businesses, as significant contributors to local economies. We should not forget that, but as we have heard, there are very serious harms associated with alcohol misuse that we must not forget either. I would like to take this opportunity to discuss those harms while noting that some progress has been made. I will outline some of the steps that the Government are taking to ensure that consumers have the information that they need to make good choices about their drinking, to equip frontline professionals with the training they need to intervene effectively and to invest in evidence-based services to help people cut back. Of course, that must all be underpinned by the right data and the expertise and advice of Public Health England.

My hon. Friend the Member for Congleton, who gave an outstanding opening speech, rightly pointed to the recent PHE evidence review, which tells us that alcohol is now the leading risk factor for ill health, early mortality and disability among 15 to 49-year-olds in England. It causes 169,000 years of working life to be lost, which is more than the 10 most common types of cancer combined. It is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, several cancers and depression. As many colleagues have said, alcohol-related deaths have increased—particularly deaths due to liver disease, which rose by 400% between 1970 and 2008. That is in contrast with the trends in much of western Europe. More than 10 million people drink at levels that increase the risks to their health, and there are more than 1 million alcohol-related hospital admissions annually, half of which occur in the most deprived communities. It is important for us to face up to that as a nation.

As we have heard, the public health burden of alcohol, including its health, social and economic harms, is wide-ranging. There are direct and tangible costs to the health, criminal justice and welfare systems. According to PHE’s evidence review, the economic burden of alcohol is substantial; estimates place its annual cost at between 1.3% and 2.7% of GDP, and the estimated annual cost to the NHS is around £3.5 billion. Harms can also be indirect, including the loss of productivity due to absenteeism or unemployment, and they can be intangible and difficult to cost, such as the poor quality of life or emotional distress caused by living with a heavy drinker.

Much of that burden of disease and deaths is preventable, so it is right that the matter is given our full attention. Of particular interest to the Government is the strong inequalities profile of alcohol harms, which fall disproportionately on more deprived communities. We estimate that if all local authorities had a mortality rate that matched the most affluent areas, about 4,000 alcohol-related deaths would be avoided each year.

Though I note my hon. Friend’s calls for caution, there are some promising trends that give us cause for optimism. People under 18 are drinking less, attitudes are beginning to change and there has been a steady reduction in alcohol-related road traffic accidents. We have also seen real progress in Government working in partnership with industry. The industry removed 1.3 billion units of alcohol from the market through improving consumer choice of lower-alcohol products, and nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels.

As my hon. Friend the Member for Congleton—and my hon. Friend the Member for Ribble Valley (Mr Evans), who is no longer in his place—rightly said, partnership continues to play an important role in tackling alcohol misuse, and the Government are committed to that principle. In the report produced by the APPG that my hon. Friend the Member for Congleton, recommendation 9 is to educate the public about the harms of alcohol and do a better job in prevention. We are taking a number of actions to try to help people manage their alcohol consumption, because we believe that the most sustainable long-term solution to alcohol misuse is informed and empowered citizens and consumers. To ensure that that is possible, we have a responsibility to provide the most up-to-date and clear information to enable people to make informed choices about their drinking. That includes publishing the low-risk drinking guidelines, as we did last year, which a number of colleagues mentioned. Those guidelines provide the public with the latest information from the four UK chief medical officers about the health risks of different levels and patterns of drinking.

Officials are now working with partners in industry to update the advice provided on packaging and labelling to reflect the latest evidence. That is to ensure, as the hon. Member for Sefton Central mentioned, that awareness is raised and people understand exactly what those low-risk drinking guidelines mean.

[Fiona Bruce]

The Minister talks about increasing knowledge and awareness, but her Department’s own report says:

“Although playing an important role in increasing knowledge and awareness, there is little evidence to suggest that providing information, education…is sufficient to lead to substantial and lasting reductions in alcohol-related harm.”

I support that action, but, without the type of policies I addressed in my speech, I do not believe we will see the difference we need to make.

--- Later in debate ---

[Nicola Blackwood]

The right hon. Gentleman is obviously an expert on the issue, but understanding how to identify those at risk is not specific to this area of public health; it occurs in other areas and is familiar to me from my mental health brief as well. This will be something that we need to sit down and discuss to understand more accurately.

It may be that we need to look at the troubled families programme to see how that could be addressed in order to work more effectively to target those in need of assistance. The key message today is that children of alcoholics in the United Kingdom should not feel as though they are alone—they should feel as though support is there, and they should know that they will find help when they seek it. I must go on to talk about some of the other issues that were raised; I hope I am not taking too much time.

The NHS remains critical to the prevention of alcohol harms. We must incentivise NHS providers to invest in interventions to reduce risky behaviours and prevent ill health from alcohol consumption. NHS England and Public Health England have worked together to develop a national commissioning for quality and innovation—CQUIN—payments framework, which is an important intervention. For those less familiar with the CQUIN payments framework, it was set up to encourage service providers to continually improve the quality of care provided to patients. CQUIN payments enable commissioners to reward innovation by linking a proportion of service providers’ income to the achievement of national and local quality improvement goals. In this case, it means that every in-patient in community, mental health and acute hospitals will be asked about their alcohol consumption. Where appropriate, they will receive an evidence-based brief intervention or a referral to specialist services, which should improve the treatment of children in the care of alcoholics, as in cases like those raised by the shadow Health Secretary. That is something we should be pleased about.

More than 80% of hospitals offer some form of specialist alcohol service, and investment in similar alcohol care teams in every hospital would potentially provide the NHS with an opportunity to maximise its delivery of identification and brief advice interventions to patients. As I said, that has been identified as one of the most important interventions to change behaviours.

Hon. Members will be aware that the NHS and local authorities have been developing sustainability and transformation plans—STPs. Those are now published on NHS England’s website, and the vast majority include actions to reduce the harms from alcohol, including through investment in brief advice, which was one of the recommendations from my hon. Friend the Member for Congleton, and expanding the approaches for those with more problematic alcohol use. That is an encouraging sign. Underpinning all of our work is the expertise of Public Health England, as we have seen from its report. PHE staff work closely with local authorities and the NHS to try to tackle alcohol harms. Building on its recent review, we must ensure that it gives the right data analysis, so that local authorities know how to effectively target their policies.

One issue raised by a number of colleagues is the call for a review of the licensing legislation to include a health objective, as in Scotland. I have some questions about how effective that would be. Although it is easy to link a criminal justice problem to a specific location, it is much more difficult to link a health challenge to an individual establishment. It is quite hard to prove that buying a drink in an individual establishment has caused someone’s liver disease.

PHE is leading our engagement with the Home Office’s second phase of the local alcohol action areas programme and offering support and advice to participating areas that have identified improving the public health response to alcohol-related harms as a key focus of their approach. Successful applicants were announced by the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), on 27 January, with 18 of the 33 successful areas looking at how they can improve the health of their residents. That is one way in which this is being done.

The House of Lords Select Committee on the Licensing Act 2003 is looking at that Act and is due to publish its report in March. We will, of course, carefully consider its recommendations. I gave evidence to the Committee, which is looking at health as part of that issue.

[Fiona Bruce]

On the issue of availability, the Minister’s Department’s own report indicates that reducing the number of hours during which alcohol is available and looking at density—the number of outlets where alcohol is sold—can help to reduce alcohol harm. I hope she will look at that as she proceeds. The local licensing objective could have real teeth if those issues were introduced into it.

[Nicola Blackwood]

My hon. Friend is passionate about this issue. I understand the argument for introducing the health objective. The problem is proving the risk posed by the individual establishment. However, we will consider the evidence that comes forward.

I will briefly turn to taxation, which was raised by a number of colleagues, including Scottish National party Members. I have to say at the outset that making changes to taxation is a matter for the Chancellor and slightly above my pay grade. We also have to note that the UK currently has the fourth highest duty on spirits compared with other EU member states, and higher strength beer and cider are already taxed more than equivalent lower strength products. We are considering the introduction of minimum unit pricing in England and Wales but are waiting for the outcome of the court case in Scotland. Until we hear the Supreme Court’s decision, which is still unknown—we are supporting the process of that case—we cannot proceed with any policy decision in the United Kingdom. It is a little unfair to berate us for not introducing a policy that cannot yet be enforced in Scotland.

On targeted changes in taxation, I am advised that current legislation on alcohol duties requires that duty on wines and ciders is paid at a flat rate within defined bands of alcoholic strength. I understand that my hon. Friends the Members for Congleton and for Ribble Valley have advice that it is possible to do something else, which I would be pleased to see, although that is a Treasury matter. At the moment, my understanding is that the EU directive sets bands for alcohol products in relation to strength and that while we have some flexibility to set rates within the structure of those bands, we are not able to link a duty absolutely to alcohol strength. Obviously, with our vote just yesterday, there is an opportunity with Brexit to consider these issues more specifically going forward, but that is my understanding of EU legislation as it stands and the advice I have received on this specific point.

[Fiona Bruce]

The information I have received is that the Government could just split the general rate into two separate brackets, therefore achieving their goal without the need to go through the EU. If the Minister will permit me, I will pass to her the opinion we have received on that.

[Nicola Blackwood]

My hon. Friend is very kind; I would be happy to see it.

I will close now, as I have cantered through a large number of issues and am sure hon. Members are tired of hearing my voice. I thank colleagues from both sides of the House for taking part. This has been an important debate. There have been very moving speeches, especially from the hon. Members for Sefton Central and for North Ayrshire and Arran (Patricia Gibson), the right hon. Member for Birmingham, Hodge Hill and the shadow Minister. They all illustrated powerfully the devastating impact that addiction and alcohol misuse have on not only people’s own health but, as we heard so eloquently, their families, children and local communities, not to mention the health and social care systems and wider society.

We have to give credit where it is due. We have to thank the many NHS workers, local authority staff, charities such as Childline and Aquarius and volunteers who are making such a difference in this area already. They are saving lives. We must recognise progress where it is being made, especially in the changing attitudes among young people. We must not despair.

However, as we have heard from today’s debate, stories and statistics, we cannot be satisfied with this. There is much more we can and must do, and I hope I have reassured colleagues today of my personal commitment to ensure we strengthen the information, support and, if necessary, treatment we give people to reduce the harms of alcohol misuse. With a health challenge as culturally entrenched as this, it can sometimes feel as though it is a mountain we will never successfully climb, but I take courage from today’s debate. Great social change requires three things: long-term political will, non-partisan partnership and bravery. I have heard all three of those today. I hope that each Member who has spoken here today will continue to work with me as we fight on to tackle this social injustice.

[Fiona Bruce]

I would like to thank the Minister for her response, which showed that she has been as moved as everyone in the Chamber by the speeches we have heard. I not only welcome but deeply thank her for the commitment she has given to continue to work with colleagues who are concerned about the impact of alcohol harm.

I remember a debate in the main Chamber a few years ago about mental health, when many Members spoke for the first time of their personal experiences of mental health issues. That debate was something of a tipping point. Since then, the issue has been discussed again and again in the House, and the Government have taken action to address it. I hope that today will prove something of a tipping point with regard to the impact of alcohol harm.

I thank the hon. Members for Luton North (Kelvin Hopkins), for Sefton Central (Bill Esterson), for North Ayrshire and Arran (Patricia Gibson) and for St Helens South and Whiston (Marie Rimmer), and the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), for their well informed and, in all cases, deeply moving speeches. Although it is probably not normal procedure, I would also like to thank the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), for his equally moving and eloquent speech.

In my speech, I used many statistics on the wide-ranging harm caused by alcohol and its health, social and economic consequences, but I believe that what will really have stirred hearts and minds today—and, I hope, stirred the Minister and her officials into action—are the deeply moving personal accounts from Members of how alcohol has in many cases touched their lives and those of their families devastatingly.

This is not a minor issue. The harm can not only be devastatingly deep for the individuals but touches many more people right across the country than has been acknowledged to date. I have heard it said that there is barely a family in the land not affected by alcohol harm today. Having heard today’s speeches, I doubt anyone could argue against that. I certainly believe it. I have just four members of staff working for me as a Member of Parliament, and of those four, tragically, one lost her husband to alcohol while she was in her 50s, just a short time ago, and another lost her father to alcohol when she was not yet one year old. I thank them for allowing me to relate that. The impact of alcohol harm on our nation is far wider and deeper than we have acknowledged in the House to date.

I thank the Backbench Business Committee for granting a three-hour debate—I believe that was justified. I also thank the Minister not only for her reply but for her willingness to meet us in the future. I look forward to working with her, and across parties, on this issue. If there is any point that she did not manage to address in her very detailed response, we would appreciate it if she were good enough to write to colleagues.

As the hon. Member for North Ayrshire and Arran said, there is no one silver bullet that will solve this issue. But one thing is for sure: we need the Government to take a lead on tackling alcohol harm, which is one of the most serious health challenges of our time, and to do so urgently. We need action—enough reviews have taken place. Public Health England’s report clearly says that there are policies that have significant potential to curb alcohol-related harm, but we need action to be taken urgently. Successive Governments have completely underestimated the challenge. I appreciate what the Government are doing now, but we need more to be done.

As I have said, this is not some moral crusade, it is a matter of social justice. Taking effective action will help literally all of our society, but disproportionately the poorest, the most vulnerable and the youngest. We have heard today about the financial costs of excessive alcohol consumption, but the cost in the loss of life chances and potential, for children in particular, and the sheer heartache that people have suffered and continue to suffer are incalculable. I am pleased that the Minister is determined to look particularly at how we can help the children of alcoholics who are suffering now—how we can help to protect them and prevent that from happening in the future—and, I hope, unborn children, too. Those are real priorities, and I am delighted that she has committed to emphasising that work in particular.

I will close with the following quotes, which are all from David Cameron, the former Prime Minister, in the Government’s own 2012 strategy. He said that

“the responsibility of being in government isn’t always about doing the popular thing. It’s about doing the right thing.”

He also said:

“My message is simple. We can’t go on like this…fast, immediate action…is needed”

and

“we have to do it now.”

Question put and agreed to.

Resolved,

That this House has considered tackling alcohol harm.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 20th December 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am aware of the case that the hon. Lady refers to. In the week of the incident, the London ambulance service received 40,433 emergency calls—an 8% increase on the previous week. We are trying to do something about this. We have recruited 2,200 more paramedics since 2010 and increased the number of paramedic training places by 60% in this year alone. The London ambulance service has recruited 107 more paramedics since September 2015 to help with this increased demand.

[Fiona Bruce (Congleton) (Con)]

T8. Has the public health Minister had an opportunity to consider the recent report sent to her by the all-party parliamentary group on alcohol harm on the shocking impact of excessive drinking by members of the public on the dedicated people who work in our emergency services? Will she meet the APPG to discuss this?

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

I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.

Reducing Health Inequality

Fiona Bruce Excerpts

Thursday 24th November 2016 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

On the doorstep of No. 10, our Prime Minister, taking up her leadership mantle, gave an inspirational social justice speech, aimed at ensuring that we reduce health inequalities, including by addressing the stark realities of the mental health challenges that so many families in our communities live with daily. I want to speak about that, about the importance of healthy early relationships in life—even beginning before birth—and about the mental health challenges that can be involved. I would like to conclude with a reference to the implications of alcohol harm, wearing my hat as the chair of the all-party parliamentary group on alcohol harm.

Building healthy relationships—beginning before birth—and establishing them in our earliest years as building blocks in our family and community life are absolutely key for the prevention and reduction of mental health problems in childhood and throughout later life. That starts in the womb.

Let me commence by setting out some key facts from the early lives of our children here in the UK. Depression and anxiety affect from 10 to 15 of every 100 pregnant women. Over a third of domestic violence begins in pregnancy. One million children in the UK suffer from problems such as attention deficit hyperactivity disorder, conduct disorder, emotional problems and vulnerability to chronic illness, which are increased by antenatal depression, anxiety and stress. The UK has the world’s worst record for breastfeeding. Some 50% of three-year-olds experience family breakdown. Some 15,700 under-twos live in families classed as homeless.

By addressing some of those social determinants of health inequality, beginning even before birth, we could help exponentially, in terms of not just the physical but the mental health of so many of our young people, and that help would last their whole life long. We need to support our youngest, so that we can increase their life chances and reduce the health inequalities that get in the way of their achieving their full potential.

Points on the compass of scientific advancement are increasingly showing us the direction of travel in terms of the social determinants of health, and they significantly point towards the experiences of bump, birth and beyond. The top policy recommendation in Marmot’s “Fair Society, Healthy Lives” report, which was referred to by the hon. Member for Glasgow East (Natalie McGarry), and which was published as long ago as February 2010, was to give every child the best start in life. The “1001 Critical Days” manifesto, which is the UK’s only children’s manifesto with the support of eight political parties, was launched three years ago in response to that report.

A child’s development is mainly influenced initially by their primary care giver—usually their mother but often their father—and by others who are engaged with helping with their parenting. Parenting begins before birth. We have known for a long time that how we turn out depends on our genes and on our environment. Scientists now realise that the influence of the environment begins in the womb, and how the mother feels during her pregnancy can change that environment and have a lasting effect on the development of the child. So we all need to support and look after pregnant women, for their sake and that of future generations.

A stable and secure home learning environment is critical in the early months. Children, right from their infancy, need to be protected, nourished, and stimulated to think and explore and to communicate and interact with their parents and others. Babies are primed to be in relationships, and their earliest relationships really matter for the “ABC, 123” building blocks that lead to school-readiness. A young child’s earliest relationships develop their social brain, which will influence their later life. Eighty per cent. of our brain significantly develops in the earliest years and through our earliest relationships. I am focusing on that because it shows that healthy relationships really matter for our health and well being throughout life.

[Alex Cunningham]

I know we are trying to make this a non-partisan debate, but does the hon. Lady recognise that all the things she is talking about require resources? Some of our most needy communities have seen a loss of those resources in recent times, and we need to do something to redress that.

[Fiona Bruce]

I thank the hon. Gentleman for that intervention.

We need to focus on the fact that learning about and enjoying healthy relationships is a key determinant of future health, both physical and mental. Between 1.3 million and 2.5 million years of lives are lost as a result of health inequality in England. Many children never reach their potential throughout their life partly because of a lack of healthy relationships in their early years. Relationship breakdown is a significant driver of poverty and health inequality. A comprehensive cross-departmental strategy to combat health inequality must include measures to strengthen healthy relationships and combat relationship breakdown, which is at epidemic levels in our country.

I am chair of a mental health charity for children in my constituency called Visyon, which is overwhelmed by requests on behalf of children as young as four. When I asked its CEO how many of the problems of the children it helps are the result of poor early relationships in the home, he looked at me and said, “Virtually all of them.” This is an absolutely critical factor in a child’s early development and healthy life, particularly in relation to mental health. Interestingly, a wide-ranging survey by the Marriage Foundation published in May 2016, involving thousands of young people, found a noticeable difference between the self-esteem levels of children who were brought up in stable households and those who were not. Self-esteem acts as a predictor of a range of real-world consequences in later life.

When relationships break down, as they do in all socioeconomic groups, it disproportionately affects children in low-income families because they are less resilient in combating the impact. Half of all children in the 20% of communities that are least advantaged now no longer live in a home where they have healthy relationships—where, for example, both parents are still with them by the time they start school. I am not saying that a child cannot have a healthy relationship with one parent or another, but it is important that we grasp this nettle and appreciate that healthy relationships with a range of people—including, ideally, a mother and a father—are good predictors of early health. We should support that, and the Government and Health Ministers should be brave enough to tackle the issue. For too long, Ministers have shied away from looking at healthy relationships, yet we are happy to help and educate young people about how to build healthy bodies for physical health in life.

Relationship breakdown is a root cause of poverty. When relationship breakdown happens, households often suffer dramatic income reductions. There is also an impact with regard to infant mortality rates, hospital admissions and mothers in poor health.

I agree that we need more funding to strengthen relationships, to provide the early support that is needed in many different ways. We need to consider extending children’s centres so that they can become family hubs that provide support for the whole family. The recent report of the all-party parliamentary group on children’s centres, of which I am the chair, made that recommendation. We need to look at the availability of couple relationship advice, not just parenting advice. Sex and relationship education lessons in schools need a much stronger focus on relationship education. We need to provide a family services transformation fund, so that local authorities can share best practice. We need to do all of that to ensure that we give children the best start in life, and in particular to tackle the serious challenge of the mental health problems experienced by so many schoolchildren. So many headteachers say that it is a major issue with which they have to grapple.

In the final part of my speech, I want to refer to the different but not entirely linked issue of alcohol harm. I say that it is not entirely linked because people who experience or fall into addiction are often looking for a source of comfort in life that is missing from their relationships. I am not saying that it is not right to enjoy drinking, but it needs to be healthy drinking. Alcohol harm is a major issue in our society and I do not believe that the Government are doing enough to address it.

The Government must do more to tackle health inequality. For example, in January the chief medical officer published her recommendation that it is wisest for women not to drink during pregnancy. Pregnant women are advised to make that choice, yet there has been wholly inadequate publicity for that recommendation. I speak as the vice-chair of the all-party parliamentary group on foetal alcohol spectrum disorder. We have heard heartrending evidence of the impact of alcohol on children’s lives, including their physical and mental wellbeing. It is particularly important to note that, according to the evidence that we have heard, women’s bodies tolerate alcohol at different levels, which is why the best advice is to not drink at all during pregnancy. I challenge Health Ministers, particularly in the run-up to Christmas, to get that message out so that pregnant women hear it and can make that choice.

Alcohol harm impacts on the health not just of the individual, but of those around them. One in five children under the age of one live with a parent who drinks hazardously. Alcohol is implicated in 25% to 33% of child abuse cases, and it generates a substantial bill for UK taxpayers with regard to the impact on emergency services. The all-party parliamentary group on alcohol harm will publish a report on that on 6 December, and I am pleased that my hon. Friend the Member for Totnes (Dr Wollaston) has contributed to it. I hope hon. Members will take note of it, because alcohol abuse has a disproportionate impact not only on emergency services, but on the number of accidents and fires in the home. The report will spell that out. The charity Balance has shown that between 2014 and 2015, the rate of alcohol-related admissions in England from the most deprived decile was more than five times greater than the rate for those from the least deprived decile. That puts pressure on already burdened systems.

I want to finish with a point that now arises continually in my work on alcohol harm, namely the impact of cheap alcohol. Let me tell Members a fact that may surprise or even shock them; it shocked me when I first heard it. For the cost of a cinema ticket, it is possible to buy almost 7.5 litres of high-strength white cider, containing as much alcohol as 53 shots of vodka. Many homeless people, and many people who are in a vulnerable state in life, are drinking that product, which has been likened to a death sentence. In the hostels run by the homeless charity Thames Reach, 78% of deaths were attributed to high-strength alcohol. Not for the first time, I urge Ministers, for the sake of the health of the most vulnerable in society, to consider a minimum unit price for all alcoholic drinks. That is a targeted and effective intervention that would save lives and reduce health inequalities considerably. Potentially, according to the Institute of Alcohol Studies, eight out of 10 lives saved as a result would be from the lowest income groups.

We need better education to inform young people about the effects of alcohol harm, so that they can make better choices and so impact on their own health. We need improved alcohol treatment services because they are inadequate. More than half of drug addicts receive treatment, but only one sixteenth of alcohol dependants do. We need to invest more in recovery for those who are suffering the effects of alcohol addiction and harm. We need better and more effective alcoholism diagnosis in our hospitals and better rehab programmes. We need to support education better to help people not to fall into such difficulties in the first place.

National Arthritis Week

Fiona Bruce Excerpts

Thursday 20th October 2016 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

Thank you, Mr Betts. I shall try to speak quickly, but possibly not as quickly as the hon. Member for Strangford (Jim Shannon), who I think holds the record in this House. I commend him for leading the charge in calling for this debate and for an excellent speech, in which he made some recommendations that I fully support.

As hon. Members are aware, Arthritis Research UK runs an annual campaign to shine a light on the experiences of people with arthritis, and the stories that have emerged are compelling. They give an insight into the pain, isolation and fatigue that is suffered daily by millions of people throughout the UK and caused by this debilitating disease. The campaign is powerfully titled “Share Your Everyday”. I have also heard stories from my constituency of Congleton of people living with arthritis and the detrimental impact on their quality of life. Time prevents me from quoting all the stories that I have, but I will give voice to one of those people. A lady called Christine Walker has given me permission to share her experience, and I pay tribute to her for her bravery in campaigning over many years, as I now know, to raise the profile of the need for greater support for those who suffer from arthritis.

Christine has severe osteoarthritis. The pain started in her knees when she was in her 30s. By her 40s, both hips were affected and she experienced pain doing everyday tasks such as getting out of the car. In her 50s she started to develop painful nodules on her fingers and had problems gripping objects. It became increasingly challenging for Christine to hold a pen, or a needle to sew. Chopping food was difficult, and paintbrushes slipped out of her hand. She even went so far as to say:

“Sometimes I just wanted to get a knife and chop off the lumps on my fingers; they were so painful.”

Of course, Christine is not alone. As we have heard, Arthritis Research UK states that back pain, for example, is very prevalent. Indeed, in my local authority area of Cheshire East, it is endured by more than 66,000 people—almost 18% of the population. Arthritis Research UK further states that about one in seven people in the UK lives with arthritis. At that national level, three in four people live with arthritis or joint pain. The Daily Telegraph and Arthritis Research UK have indicated in a recent survey that that pain stops them living life to the full. Just like Christine, many people are suffering severely owing to this crippling condition.

As the leading cause of pain and disability, arthritis is estimated to cost the NHS £5 billion a year. As we have heard, one in five people consults their GP about a musculoskeletal problem such as arthritis every year. That equates to 100,000 consultations every day. About 21% of patient visits to GP surgeries relate to arthritic conditions, and that goes up to more than 30% in the over-50s. The prevalence of these conditions is set to rise even further with growing levels of physical inactivity, obesity and an ageing population. That is why I greatly support the proposal from the hon. Member for Strangford that we improve advice to prevent, rather than just try to cure, this disease.

Why does arthritis so often find itself at the bottom of the heap, as far as acknowledgement of medical conditions is concerned, with treatment and care too often inadequate or inconsistent? The first annual report of the national clinical audit of rheumatoid and early inflammatory arthritis, published on 22 January 2016, identifies that although most services offer prompt educational support and agree targets for treatment with their patients, quality standards are not always met, so sufferers like Christine are often told that they can do little more than take painkillers. Unless prompt and decisive action is taken, people like Christine throughout the UK will be forced to continue to suffer terrible pain, isolation and fatigue. We need to accept that arthritis is a common and long-term condition that warrants the kind of treatment, monitoring and support that is available for other conditions. When we speak to people like Christine, it emerges as evident that a major focus must be on greater investment in patient education programmes, equipping and resourcing people to manage their condition better and endure less pain.

I want to relay Christine’s story as I come towards the end of my speech. In 2010, after years of having to rely simply on painkillers, Christine, along with about 250 others with hand arthritis, was invited to join a study funded by Arthritis Research UK at Keele University. It was run by Professor Krysia Dziedzic at Keele’s Arthritis Research UK primary care centre. The trial tested the effectiveness of exercises; an occupational therapist taught participants strengthening and mobilising movements.

Christine described the experience as life-changing. She was shown how to squeeze out a dishcloth and hold a kettle with two hands, and told about gadgets that would help her to open cans, peel vegetables and slice bread. Tasks she had avoided were possible again. The trial showed her practical ways of coping and made an enormous difference. NICE guidance recommends that those diagnosed with this condition be offered the opportunity to take part in such activities, including self-management programmes. We must ensure that NICE best practice guidelines are met in that respect. Much work is being done, but it needs to be offered much more widely.

I would like to give the last word to Christine and Arthritis Research UK. Christine says, “Taking exercise to help with my arthritis was a life-saver”. A rehabilitation specialist at her local gym in Cheshire taught her how to exercise better. She began a programme to build her muscles and paid more attention to her diet. She says:

“It’s all about strengthening problem areas—quads, hamstrings, calf muscles and the upper body…By doing this, I’m taking pressure off joints and easing pain. And today I keep the pounds at bay through healthy eating, reducing the pressure on my knees and hips…Because I have stayed active, I can keep gardening and have fun with my grandchildren.”

We should be giving that kind of help to everyone in this country.

Arthritis Research UK says:

“We need MPs to speak up for people with arthritis in the debate and call for decisive action so that everybody can live fuller lives with arthritis today, and without it tomorrow.”

Baby Loss

Fiona Bruce Excerpts

Thursday 13th October 2016 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I pay tribute to my hon. Friends the Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince). My constituency neighbour, my hon. Friend the Member for Eddisbury, made a courageous and gracious speech; my hon. Friend the Member for Colchester made a powerful and practical one. The number of colleagues in the House who have shared their personal experiences shows how many people across the country have been affected by this issue and the great potential there is to make a real difference to so many people’s lives by bringing it forward for debate. I pay tribute to my hon. Friends for doing that.

I add my tributes to those of other hon. Members to the contributions from my hon. Friends the Members for Banbury (Victoria Prentis) and for Gower (Byron Davies), and the hon. Members for Lewisham, Deptford (Vicky Foxcroft) and for North Ayrshire and Arran (Patricia Gibson). They were truly moving. I have never before in more than six years seen so many Members so visibly moved in the Chamber.

I also pay tribute to the many midwives, consultants and other NHS staff, who in many cases provide good medical and bereavement care to families who have experienced stillbirth and miscarriage. As we have heard, for many people, losing a child is the most difficult time in their lives. High-quality, empathetic care is vital. Thanks should go to all those in this country who work with such dedication and commitment in this arena.

I want to tell a constituent’s story that shows that, yes, the NHS does in part provide extremely good care, but also that it requires more rigour. I received a letter from a constituent whose daughter lost a baby at 20 weeks. She had had excellent care from the gynaecological consultant and the hospital staff, who treated the loss very sensitively, but there were failures in her care. My constituent writes:

“Unfortunately the symptoms leading to the loss of the baby occurred at a weekend. Protocols about sending her straight to the gynae department were not followed. (There was a chance that the pregnancy might have been saved). Nor were other protocols, so that, for instance her midwife hadn’t been informed and rang up”—

that must have been some time later—

“asking why antenatal appointments hadn’t been kept. It took a year for my daughter to get the specialist follow-up counselling that should have been offered immediately and she didn’t know she was entitled to some maternity leave.”

That shows, as my constituent says, that there was a “lack of joined-up communication” between different physicians, who were there to assist her daughter. I understand that hospitals in the area are improving the training of staff and support for bereaved parents, but that happened in a large city. In this day and age, that care should have been better. I pay tribute to that young lady because she is setting up a new branch of Sands in her area. It has been wonderful to hear today of the personal experiences of so many Members who, in the course of assisting others, will relive them time and again and put their energies into such organisations.

Stillbirth is a taboo subject but, thanks to this debate, decreasingly so. Stillbirths affect the whole family and, as my constituent says, the

“wider social and work contact groups…Mothers losing babies suffer grief compounded by feelings of guilt and inadequacy”

and

“suffer hormonal effects whilst still trying to hold down jobs. I myself”—

she is the mother of a daughter who lost a child—

“have found this time emotionally very hard…Surely with more openness and appropriate training of staff our country’s shameful record of stillbirths could be improved. Mental health of bereaved mothers would be improved, resulting in less cost and burden to our health services…my daughter had an undiagnosed streptococcus infection. If screening for this during pregnancy were introduced less babies would be lost.”

I therefore support other Members who have called for better screening.

As an adjunct to the contribution of my hon. Friend the Member for Colchester, who mentioned smoking and obesity advice for mothers during pregnancy, may I, as chair of the all-party parliamentary group on alcohol harm, ask that advice on drinking alcohol during pregnancy is added? The chief medical officer recommended earlier this year that the best advice is simply not to drink alcohol during pregnancy because, as the all-party group has heard, different mothers respond to different levels of alcohol very differently. There has been inadequate publicity regarding that clear recommendation, which I welcome because it clears up decades of confusing advice.

I should like to add my support for one or two points that have been mentioned. Finally, I want to mention one other issue that is still a taboo that we must bravely address and endeavour to break in this country. A quarter of a million miscarriages occur every year. As I have said, it is not only the mothers who feel the loss and grieve and mourn when a miscarriage occurs, but fathers, grandparents and the wider family. They need help too.

Statistics cannot compare with the power of personal experiences such as those we have heard today, but to frame some of the problems encountered by women who miscarry, I have a Miscarriage Association survey of 300 women. Forty-five per cent. of the women surveyed said that they did not feel well informed about what was happening to them physically; only 29% felt well cared for emotionally; and nearly four out of five—79%—received no aftercare at all. The association has noted that access to information and emotional support has been shown time and again to help people to cope with the experience of loss, but that we need to make such support available later if needed. The association has also noted that what was said to grieving women and men was not always important; it was just enough that someone was listening. By having this debate and hearing so many individual experiences, I hope the House has shown to the nation that we are listening and that we care.

Another issue that has been raised is how unborn children are treated before the 24-week stage. As we have heard, when a woman has had a miscarriage, she can be in an extremely vulnerable state. As my constituent has said, women are often not in hospital—in fact, only 18% of miscarriages occur in hospital. As such, a mother is likely to ring up the hospital for advice on what to do, particularly to ask what they should do with the miscarried child. It is of grave concern that there appear to be no strict guidelines on how to advise women in such circumstances.

Zoe Clarke-Coates of the Mariposa Trust, an organisation set up to assist those who have experienced baby loss, has told my office recently that she regularly receives calls from women who have been advised to flush the miscarried foetus down the toilet or put it in a jar in the fridge. That is extremely distressing and traumatising for families. Some women have had to buy new fridges afterwards because it has upset them so much.

Hospital mortuaries need to be available for the foetuses for the unborn child to be properly taken to and stored at the request of parents. The staff who take those calls need to have training across the board to be aware of that. Mortuaries need to be open seven days a week for that purpose and it is important that a directive driven by the Government is given to that effect, and that it is not left to trusts to set up their own systems, which has clearly been completely unsatisfactory to date.

[Carol Monaghan (Glasgow North West) (SNP)]

The issue of stillbirths has been raised, with people having to be on wards with celebrating families. Another problem is that women who have suffered miscarriage use the same early-care pregnancy unit. When I had a miscarriage at 16 weeks, I had to sit next to women who had scan photographs. It was very difficult. That must be considered more seriously by medical staff.

--- Later in debate ---

[Fiona Bruce]

The hon. Lady makes an extremely good point. It is vital that we support women in appropriate settings for their situation. As other Members have mentioned, for women who have lost their babies inside the womb but need to go through labour, separate wards should be a priority. They might need to be in hospital for several days. To hear other women around them with their babies must be very distressing. Hospitals need to create better spaces for women at all stages in their pregnancies in such situations.

[Victoria Prentis]

With your permission Madam Deputy Speaker, I would like to share my own experience. As I told the House earlier, I was in hospital for a considerable time because I had been very ill. After I was in intensive care, I was put in a post-natal ward with people with babies. I was in a separate room, but I had to share the bathroom, the midwives and all the other staff, with mothers of live babies. I found it terribly difficult when nice people who had not been told, who were bringing me cups of tea, food and all sorts of care, repeatedly asked me where my baby was. That was so distressing.

[Fiona Bruce]

My heart goes out to my hon. Friend. The compounding of grief in that way is so unnecessary.

Families who have lost babies have spoken about the importance of acknowledging their child’s life. Unfortunately, this is an area where the law adds to distress. Under current UK law, a baby is effectively only considered a person at 24 weeks. This often means that that acknowledgement is not there as it could be. I have even heard of parents lying about the gestation period in order to try to obtain a birth certificate. Alongside other hon. Members, I appeal to Ministers to look again at this. As modern technologies improve, unborn babies are increasingly viable earlier than 24 weeks. The law should move not only with technology, but compassion. I ask Ministers to look at that, too.

There is one last point I would like to mention. It is very sensitive, but I feel I need to mention it. It is the taboo I mentioned earlier, but as one colleague said, if there is one thing we can do in this House it is break taboos. Parents can also suffer a deep sense of loss and bereavement when their longed-for child is not lost during pregnancy due to a miscarriage or stillborn, but due to a disability being diagnosed while their child is in the womb, leading them to have to make the often heart-rending decision to have a termination, sometimes late in pregnancy. There is little, if any, bereavement support or adequate counselling for such parents either before they make that decision or sometime after, yet they too have lost a much-loved child.

In 2013, the all-party pro-life group conducted a detailed, year-long inquiry into abortion on the grounds of disability. I have a copy here with me today. We were repeatedly told by witnesses about the lack of proper counselling and bereavement care for such parents should they want it, which many do. We were also told of some examples of very good practice. One parent told us that they had had a funeral service, which helped enormously. Another told of how they were able to bathe their child before the child was appropriately cared for following the termination. Other witnesses were amazed that this kind of care was available, because they had received none at all. One of our report’s key recommendations was that appropriate bereavement support and counselling should be available for all parents who want it in such situations, even if it is some time later.

I regret to say—I am following slightly in the footsteps of my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) who spoke earlier about an uphill struggle—that I have had an uphill struggle in trying to gain the attention of the Department of Health on this issue. I thank hon. Members who have raised their losses in this debate. I hope now that the Department will consider it. Our report was issued in 2013. After the deeply moving Adjournment debate led by my hon. Friends the Members for Eddisbury and for Colchester, I spoke with the then Minister responding to that debate. We agreed that I would send the report to the Department of Health after the debate, which I did. Unfortunately, I received no reply. I sent a reminder some time later. Again, I received no reply. I hope that as a result of today’s debate, the Department of Health will take seriously the additional point that parents in this situation need the same kind of care and support as the others who have been spoken about in this debate today.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 11th October 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is clearly unacceptable if the situation that the hon. Lady sets out is the case. I am happy to meet her and work with her to take the action that is needed to make things better.

[Fiona Bruce (Congleton) (Con)]

T6. The Government have provided a welcome increase in funding for mental health support, yet it does not appear to be reaching my constituency effectively, particularly for children. Now there are concerns that the Millbrook unit at nearby Macclesfield hospital might close. Will the Secretary of State look into those concerns?