Foetal Alcohol Syndrome

Jane Ellison Excerpts

Tuesday 14th October 2014 Westminster Hall

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

I thank all hon. Members who have spoken during this thoughtful and sometimes passionate debate. Many hon. Members have pursued the issue over many years. The time available is not too bad, but I will not be able to respond to every point, and if I fail to respond to a specific point, I will do my best to do so to hon. Members after the debate.

I congratulate the hon. Member for Sefton Central (Bill Esterson) on securing this debate. It comes at an auspicious moment, because I understand that the National Organisation for Foetal Alcohol Syndrome UK is holding its conference today. The hon. Member for Luton North (Kelvin Hopkins) is passionate about the subject, but I take issue with his description of direct responsibility. Absenting personal responsibility for one’s body, and the life of one’s unborn child, is wrong. I am not saying that the Government do not have a huge responsibility to society at large to provide education, but to talk about direct responsibility is to miss the point that we want all adults to take responsibility for their health and that of their unborn children.

[Kelvin Hopkins]

The fact is that other countries have taken that responsibility and acted, and they are ahead of us. We have more babies being damaged than they do. There is a responsibility on the Government—not necessarily on individual Ministers, but on the Government in general. That applies to both Labour and Conservative Governments.

[Jane Ellison]

I am absolutely comfortable with the fact that Governments have responsibility, and I will try to address some of the points that have been made. My point to the hon. Gentleman is simply that encouraging personal responsibility in any individual for their own health and particularly that of their unborn child is vital throughout life, not just during pregnancy. I put it on the record that we must encourage people to take responsibility for themselves. Let me mention an example given in the debate. Everyone knows about smoking. No one would knowingly damage their own child, and the damage that smoking can do is well known, but the most recent figures I have seen show that smoking in pregnancy varies throughout the country from 0.5% in one borough to more than 26% or 27% in other places. Even when people know about the damage being done, they do not always change their behaviour. We must always put personal responsibility in the frame.

The majority of people who drink alcohol do so responsibly, but it has been amply illustrated during this debate that too many women are unaware of the health risks. More generally, too many people are unaware of the health risks associated with drinking too much. It is important to remember that throughout the debate. Understanding what is a healthy level of alcohol to consume is vital because, as has been said, not everyone knows when they are pregnant. We understand that around 50% of people do not plan their pregnancy, so encouraging a healthy intake of alcohol and understanding the harm that it may do if taken in the wrong quantity is important. There are encouraging signs among the younger generation of a dramatic drop in smoking and drinking during the past 10 years, which is encouraging.

The focus today is on foetal alcohol syndrome and foetal alcohol spectrum disorders. Some hon. Members described facial abnormalities and a range of other conditions associated with alcohol exposure by the mother. Although there is wide international agreement on the diagnostic criteria for foetal alcohol syndrome, the criteria for diagnosis of foetal alcohol spectrum disorders are less clear, although other hon. Members have cited various pieces of academic research. For both disorders, the diagnostic features may not be clear until later in childhood, so yes, we do struggle with diagnosis and with accurate prevalence data. Prevalence figures for FAS are not routinely collected or recorded by the British Paediatric Surveillance Unit, although hon. Members might be interested to know that the World Health Organisation is leading a review on agreeing common diagnostic criteria to measure prevalence better internationally in future. That would be very welcome, and we are lending expertise to that review. There are limits on some of the data, even though we hope that they can be improved.

On advice and prevention, let me talk about what Public Health England does. Its Start4Life campaign provides advice to pregnant women on establishing healthy habits to give their children the best start in life and to reduce the risk of poor health in future. One of the key behaviours covered in the campaign is focused on the consumption of alcohol and why it is best avoided in pregnancy. It promotes alternatives to alcoholic drinks during pregnancy and emphasises the negative impact that alcohol consumption can have.

In May 2012, we launched the NHS Start4Life information service for parents. That is a digital service that enables parents-to-be and new parents to sign up to receive regular free e-mails, videos and SMS messages offering high-quality NHS advice and information based on the stage of pregnancy and the age of the child. The service also signposts parents to other information about parenting, relationship support and benefits advice. Parents-to-be are encouraged to sign up to the information service for parents during their early contacts with health professionals. The take-up target was exceeded two years early, with 385,000 parents signed up to the service as of the end of last week.

Advice on alcohol consumption and other health issues during pregnancy is also routinely provided by health visitors, midwives and GPs. I think it is a fair challenge—

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

Let me respond to this point. I think it is a fair challenge to say that not everyone is administering that advice and that we can do more. A piece of work is going on to educate thousands more doctors about that, and a good question hon. Members can ask health leaders, when they meet them in their area, is “Are people routinely challenged, and is there a sense of concern in terms of talking about these issues?”, as has been voiced during the debate.

I turn to the National Institute for Health and Care Excellence, which publishes clinical guidance that includes recommendations for doctors and midwives on the advice that they should give. As we know, the NICE antenatal guidance, which was published in 2008, gives further advice. I accept the point that there may seem to be some confusion. In my understanding, the honest truth—I have done a number of debates and questions on this, and queried it quite heavily—is that the reason for the mix of guidance is that there is a mixed clinical view. There is not a settled clinical view in all these areas, but work is under way.

In 2007, the chief medical officer for England published revised guidance on alcohol consumption during pregnancy. The advice is that women who are pregnant or trying to conceive should avoid alcohol altogether—in other words, adopt the precautionary principle. The CMO is overseeing a UK-wide review of all alcohol guidelines, so that people can make better informed choices. That review is under way and I can assure hon. Members that it will take into account any relevant new evidence since the guidelines were last published. I am aware that in some cases, experts have, over recent years, started to change their view, moving from a view about a lower-alcohol intake to one about a no-alcohol intake. All that emerging evidence will be put into the review.

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

I am very conscious of time, so I give way very briefly.

[Kelvin Hopkins]

I am interested in what the Minister is saying, but what is wrong with requiring all drink containers to have a health warning, as they do in America, Canada and elsewhere? What is the problem with requiring notices in every doctor’s surgery and every antenatal clinic that say: “Do not drink alcohol for fear of causing birth defects to your baby.”?

[Jane Ellison]

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

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

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

[Bill Esterson]

Will the Minister give way?

[Jane Ellison]

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

[Bill Esterson]

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

--- Later in debate ---

[Jane Ellison]

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

[Bill Esterson]

But you are the Minister.

[Jane Ellison]

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

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

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

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

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

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