A new NICE Quality Standard on FASD is coming in England in July 2020. The NICE Quality Standard will be based on the Scottish SIGN 156 Guideline. This pamphlet summarises the diagnostic process in the SIGN guidance.
The brochure is available for download as a PDF.
For details about last year’s programme, click here. Great fun was had by all!
We had an amazing Brain Base 2019. A huge thanks to all the young people, parents/carers and speakers who joined us! And especially to the talented team that made this possible. More details will be available soon from our event.
Participants shared their ‘stay cool’ strategies. This was made into a poem and acted out in the final showcase.
This “Stay Cool Toolkit” is designed to help them remember things we covered.
A generous and exciting offer from OurBoards – OurBoards are donating a free gift for all attending the 2019 Brain Base and a 20% discount for all families connected with NOFAS-UK who order from their website with the code NOFAS2019. See www.ourboards.co.uk for their full range of visual planners.
17 May 2019 Informal Roundtable on Forthcoming NICE Quality Standard on FASD
NOFAS-UK hosted an informal roundtable on the forthcoming NICE Quality Standard on FASD in the week following the announcement. The discussion was co-chaired by Dr Raja Mukherjee and Sandra Butcher. This took place in the margins of the launch of the Greater Manchester Alcohol Exposed Pregnancies Programme.Continue reading
A Crisis of Commissioning: CCGs Are Failing Government Policy on FASD
Based on Freedom of Information requests to all Clinical Commissioning Groups and NHS Trusts and Health Boards, this report highlights the mismatch between government policy and actual practice. The vast majority of CCGs are not commissioning services for FASD prevention, diagnosis or post-diagnostic care for those with FASD.
Please click here for the media release that accompanied the launch of the report.
Policy Matters CCGs and FASD – Easy Read Version
What You Can Do
- CCGs exist in England. If you live in England, write to your MP and ask them to contact the local CCG and ask about FASD services in your area. To find the response (if any) from your local CCG, go to www.whatdotheyknow.com and search for the name of your CCG and ‘FASD’ then it should pop up. The same search will work for NHS Trusts. If you have any trouble doing this, please let us know and we will try to help.
- Ask your MP to join the APPG on FASD chaired by Bill Esterson MP. They can do so by emailing email@example.com. (NOFAS-UK now serves as the APPG secretariat.)
- Contact your CCG and ask them to meet with you and other stakeholders about FASD. Ask the CCG to encourage the Department of Health and Public Health England to provide more guidance about FASD diagnosis, support and training for professionals. Click here for more information about CCGs and to find your CCG.
- Contact your local media and explain the ‘local angle’ on this report from a national charity. “Local families unable to access services for brain-based conditions’. You can refer them to this media release which has quotes they can use from leading experts and other stakeholders.
The All-Party Parliamentary Group on Foetal Alcohol Spectrum Disorders exists to raise awareness of Foetal Alcohol Spectrum Disorders (FASD) and the potential dangers of drinking alcohol in pregnancy, in order to increase knowledge of this condition, to improve support for those living with FASD and reduce its prevalence in the UK.
“What am I asking for? I am asking for action on prevention and diagnosis, and action to cut the numbers, and for a sea change in our approach and our building of awareness among the population, including and especially among health professionals….
I am asking that the chief medical officer’s advice and guidance, which has now been accepted by the National Institute for Health and Care Excellence as well, be given much greater prominence and that we build awareness so that everyone understands it, especially, but not exclusively, health professionals. I am asking that we have a proper study of incidence so that we need not rely on the limited evidence of the Bristol University study. It was only able to make rough estimates, given the nature of its research, but if it is between 6% and 17%, it really does need that intervention and prevalence study….
We have to build greater understanding among health professionals and professionals right across the public sector. I have mentioned support as well. There needs to be greater support for those living with FASD—both those suffering from it and those caring for them— and those in education and elsewhere who are looking after them.”Bill Esterson, MP, Chair APPG on FASD, Adjournment Debate on FASD, 17 January 2019
UPCOMING MEETING DATES 2019 – 2020
(details to follow)
11 September – 2 pm (AGM business meeting)
6 November 2pm
15 January 2pm
10 March 3 pm
13 May 2pm
9 May 2019 (Report forthcoming)
In the meantime, the submission from Richard Clements is available here. Richard is father to a child with FASD and also a commissioner.
A video excerpt of Nyrene Cox’s statement is here. Nyrene has been trying for five years to get access to a diagnosis for FASD.
Report from APPG Meeting, 13 December 2018 (PDF)
From the Archives, December 2015
Please note: NOFAS-UK was asked to take over secretarial duties in late 2018. We were not provided with any records from the prior secretariat when it ceased operations.
This is not an official website of the House of Commons or the House of Lords. It has not been approved by either House or its committees. All-Party Parliamentary Groups are informal groups of Members of both Houses with a common interest in particular issues. The views expressed in these webpages are those of the group
- Martin Butcher, East Hertfordshire and Area FASD Support Network, introducing a statement on behalf of the FASD UK Alliance;
- Pip Williams, on behalf of the UK-EU Birth Mothers Network-FASD;
- Brian Roberts, a former virtual school head who discussed Looked After Children, FASD and education;
- Andy Jackson, adult with FASD
Main points raised by stakeholders included:
- There is an urgent need for Increased awareness, training, information and tracking across all NHS platforms on the full range of the FASD spectrum diagnoses and not just the 10% of those with FASD who have the facial features of Foetal Alcohol Syndrome.
- Prevention is key. Support for pregnant women should be framed in ways that help not only decrease the incidence of FASD but also support women in the post-natal by providing access to early diagnosis and support for a child who might have been affected.
- To avoid tragic consequences, it is critical to ensure those affected (including adults) have access to FASD diagnosis and related assessments. Looked after children and those who are adopted should all be assessed for FASD and particular attention should be paid to training all professionals in these fields.
- Appropriate support is required across the lifespan of those with FASD – it is a lifelong hidden disability arising from organic brain damage due to alcohol exposure in utero. Failure to provide this support can have – and is having – devastating impact. This point was poignantly underscored by contributions from adults with FASD. A strengths-based approach is needed.
- FASD should be recognised as the neurodevelopmental disability it is, so all people with FASD no matter what their IQ-level can access services and benefits that are open to others with autism and other neurodevelopmental disabilities.
- Continuing engagement with stakeholders and service users must be a part of finding the way forward.
Also available: Additional Insights from UK Adults with FASD
Topical Debate — Cheap Alcohol (Health Consequences)
Orders of the Day — Consolidated Fund Bill – in the House of Commons at 1:58 pm on 6th December 2007.
I really want to talk about alcohol and health, particularly about an issue that I have successively raised in parliamentary questions and called for us to debate—foetal alcohol syndrome and the damage caused to babies before they are born because of their mother’s drinking. There is a lot of evidence that the amount of damage caused by alcohol to babies when they are born is far and away above all the other birth defects put together. I am not talking only about serious foetal alcohol syndrome, but about rather lower levels of damage that can inhibit babies’ intelligence, perhaps leading them to perform less well at school or to have behavioural problems.
Although a great deal more research needs to be done, there is already considerable evidence that mothers’ drinking is having serious effects on babies. It seems very unfair on pregnant women—I am pleased to see the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend Claire Ward, on the Front Bench today—but it is a serious issue. Men do not suffer from the same problem, which is very unfair, but when women are seeking to become pregnant and during the early stages of pregnancy it is absolutely vital for them not to drink, because small foetuses do not have very large livers and they cannot cope with the alcohol. They are damaged by any alcohol that their mothers consume. There has been considerable obfuscation about this issue recently, perhaps deriving indirectly from the drinks industry, but the evidence is there.
I, too, believe that there is an important debate to be had about the damage caused to foetuses from alcohol. That is so important that we should have a separate debate on it. I completely agree with the hon. Gentleman that an educational process needs to take place throughout the country, not least in pre-natal classes.
Foetal Alcohol Syndrome
Children, Schools and Families written question – answered on 12th November 2007.
To ask the Secretary of State for Children, Schools and Families what steps he is taking to improve education provision for children born with foetal alcoholspectrum disorders.
Kevin BrennanParliamentary Under-Secretary (Department for Children, Schools and Families) (Children, Young People and Families)
Many children born with foetal alcohol spectrum disorders have special educational needs. Schools and local authorities must have regard to the SENCode of Practice when carrying out statutory duties to identify, assess and make provision for special educational needs—including children whose needs arise from foetal alcohol spectrum disorders. The code highlights the importance of education, social care and health services working together to meet the needs of all children with special educational needs.
– in the Scottish Parliament at 2:15 pm on 25th October 2007.
Foetal alcohol spectrum disorder covers a wide range of disorders, encompassing everything from behavioural problems to extreme physical and neurodevelopmental disabilities. There is no cure. FASD is a lifelong medical condition that can prevent children from succeeding in school, leading healthy lives and becoming productive adults. It is, by its nature, extremely difficult to diagnose. Indeed, if we compare figures from other developed countries, not least the United States of America, we can see that it is likely that the condition is seriously underdiagnosed. As a result, it is difficult to ensure that the needs of a child with FASD, and its most severe manifestation, foetal alcoholsyndrome, are met. Prevention is the key, which is why it is of some concern that six out of 10 women in Scotland drink during pregnancy.
How much is safe for a pregnant woman to drink? The chief medical officer sensibly suggests nothing at all. The BMA, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives support that view. It is vital that that position is promoted by the Scottish Government. No one really knows how much alcohol, if any, it is safe to imbibe in the womb. Each foetus develops neurologically at slightly different rates, and although the pathways are the same, it is not known when a specific development may occur and when a child may therefore be vulnerable to alcohol in the womb. So why take risks?
Down south, the National Institute for Health and Clinical Excellence suggests a maximum of no more than 1 to 2.5 units a day, which is not far short of what is suggested for an adult woman who is not pregnant. What does that mean, though? A card that I picked up in the Parliament at lunch time tells us that 25ml of gin, rum or vodka represents 0.9 units, with an alcohol level of 37.5 per cent by volume, while 175ml of wine, at 12 per cent volume, is 2.1 units. It is extremely difficult for people to get their head around that, which is why I suggest that the Parliament should promote the view that no alcohol should be drunk during pregnancy. In the USA, all bottles containing alcohol display a warning that simply states:
“According to the Surgeon General, women should not drink alcoholicbeverages during pregnancy”.
I support the BMA’s recommendation that further research into FASD be conducted. Guidance and training for health care professionals on the prevention, diagnosis and management of FASD should be implemented at the earliest possible opportunity. Public awareness of FASD and the adverse effects of alcohol in general should be raised.
The second issue that I highlight is alcohol and pregnancy. From the moment a woman becomes pregnant, she begins to influence the future child’s life chances. Her decisions on smoking, alcohol, diet and her own well-being all have implications for the future child. The lack of clarity in the recommended drinking levels and information on the potential health impacts of alcohol has made it difficult to deliver a coherent message to pregnant women. At the extreme, alcohol can cause permanent damage to embryos while they develop in the womb and can cause foetal alcohol syndrome, which permanently impairs brain and nervous system functions. However, there are increasing concerns that drinking alcohol during pregnancy can lead to a wide range of disorders and there has been a clear move towards supporting a precautionary principle.
Although it is socially acceptable for women to avoid soft cheese and peanuts during pregnancy, avoiding alcohol seems to be a different matter. The unhealthy relationship with alcohol that we have in this country seems to make abstinence from certain risky foods far easier than abstinence from alcoholduring pregnancy. However, the evidence is inconclusive and the matter must be approached in a sensitive and reasonable manner. Women must be able to make informed decisions. To enable that, the Government must work closely with the medical profession; guidance on alcohol consumption should contain specific advice on drinking and pregnancy; and any voluntary labelling initiative with alcohol producers should include information on the risks and potential consequences of drinking while pregnant.
Most disturbing was the research highlighted by Children in Scotland, which showed that one in every 100 live births suffers from foetal alcohol syndrome. The statistic suggests that, of the 55,000 Scots born last year, 550 had FAS. Kenny Gibson and Claire Baker have already highlighted the problems associated with the condition, and the emotional hardship and trauma faced by the families and children who are affected each year by this completely avoidable affliction are truly upsetting.
I urge close consideration of the gender disparities in drinking culture, but not only because of the danger of foetal alcohol syndrome that Claire Baker and Ken Gibson mentioned. I emphasise that it is important that we do not spread panic among women, who will often not know that they are pregnant until a number of weeks—in some cases, a number of months—have passed. Stress and anxiety are also harmful in pregnancy.
Third Sector Review
Business of the House – in the House of Commons at 11:32 am on 18th October 2007.
May I draw to his attention the fact that the Department for Education and Skills is planning to axe the small but effective community champions fund, which provides £3 million a year to enable individuals to tackle issues around them? It is one of the central Government funds to go to individuals. I have seen it promote initiatives that range from creating the national charity for foetal alcoholsyndrome to mums fixing things for their children here.
Health written question – answered on 8th October 2007.
Miss Kirkbride: To ask the Secretary of State for Health what research he has (a) commissioned and (b)evaluated on the effect on children’s (i) brains and (ii) development of (A) prematurity, (B) foetal alcohol spectrum disorder and (C) fragile X syndrome. 
Dawn Primarolo: The Department funds research to support policy and to provide the evidence needed to underpin quality improvement and service development in the national health service and through its Policy Research Programme supports a programme of research at the National Perinatal Epidemiology Unit (NPEU) on the health of pregnant women and their babies. This includes research relating to cerebral palsy and other early childhood impairment where prematurity is the single largest risk factor. With additional support from other funders, NPEU is also undertaking work which relates to neurodevelopmental follow-up of groups of children recruited to trials of specific interventions, where either all or the majority of the recruited children were preterm.
Implementation of the Department’s research strategy “Best Research for Best Health” has resulted in an expansion of our research programmes and in significant new funding opportunities for health research. In particular, the major focus of the neonatal medicine research group at the Hammersmith and St. Mary’s and Imperial College Biomedical Research Centre, formed this year, is the prevention and treatment of brain injury and developmental impairment in the newborn infant, both as a result of prematurity and birth asphyxia. The Department has allocated £7 million over five years to the research theme of which the Centre’s work forms a part.
The Medical Research Council (MRC) is one of the main agencies through which the Government support medical and clinical research. In 2005-06, MRC expenditure on research related to premature birth amounted to £4 million. In addition, the MRC supports a large portfolio of reproductive tract research and underpinning reproductive medicine and paediatric research.
More specifically, the MRC is currently funding a research project on Fragile X syndrome that aims to provide fundamental insights into the cellular mechanisms through which cognitive symptoms of the syndrome arise and that may be important for discovery of new therapies for mental retardation.
Business of the House
– in the House of Commons at 11:30 am on 26th July 2007.
Kelvin Hopkins (Luton, North) (Lab): Several weeks ago, I raised with my right hon. and learned Friend’s predecessor as Leader of the House Britain’s serious and growing alcohol problems. I expressed concern about the health problems, especially foetal alcohol syndrome, which is a growing problem as more young women drink a lot more. My right hon. Friend, now the Lord Chancellor, expressed some sympathy with my request for a full debate on the Floor of the House about the whole range of Britain’s alcohol problems. Will my right hon. and learned Friend confirm that it is a possibility?
Ms Harman: It certainly is a possibility. The problem concerns Members on both sides of the House, not only because of the health issues relating to alcohol—my hon. Friend mentioned foetal alcohol syndrome—but also because of crime and disorder.
Pregnant Women: Alcoholic Drinks
Health written question – answered on 26th July 2007.
Sandra Gidley: To ask the Secretary of State for Health (1) what plans he has to implement training programmes for health care professionals on the prevention, diagnosis and management of the full range of foetal alcohol spectrum disorders; and if he will make a statement; 
(3) what research he has (a) commissioned and (b) evaluated on the clinical management of individuals affected by foetal alcohol spectrum disorders; and what support systems are available to them and their carers and families. 
Ann Keen: The Department is not responsible for setting curriculums for health professional training. However, the Department does share a commitment with statutory and professional bodies to ensure that all health professionals are appropriately trained, so that they have the skills and knowledge to deliver a high-quality health service to all groups of the population, whatever their condition.
The Department has funded the production of guidance to support the effective delivery of high quality training on substance misuse, including alcohol, within undergraduate medical education in the United Kingdom. Compilation of Substance Misuse in the Undergraduate Medical Curriculum was overseen by an expert steering group and published by the International Centre for Drugs Policy in April 2007.
Business of the House
– in the House of Commons at 11:30 am on 21st June 2007.
Kelvin Hopkins (Luton, North) (Lab): I welcome the recent publication of the Home Office document on alcohol issues, but evidence suggests that alcohol problems in Britain, especially liver damage, are much
21 Jun 2007 : Column 1529
worse than we imagined. It is also highly likely that instances of foetal alcohol syndrome are rising, given the amount of alcohol that young women consume, and given that some young women are possibly getting pregnant partly as a result of drinking to excess. Will my right hon. Friend make time for a debate on the Floor of the House about all such alcohol issues, given Britain’s growing and alarmingly serious problem?
Mr. Straw: I share my hon. Friend’s concerns about what appears to be increasing alcohol abuse, especially by young people. Even when he and I were young, youngsters sometimes drank to excess, but evidence suggests that that has now gone much further. Of course, I will do my best to ascertain whether we can find time for a debate on the matter.
[Mr. Bill Olner in the Chair] — Alcohol Harm Reduction Strategy
– in Westminster Hall at 12:00 am on 15th May 2007.
Baroness Andrews spoke about that in 2004 in connection with foetal alcoholsyndrome, and said that she would work with the industry on labelling. Not much has transpired since then. Will the Minister update us on where she is with that?
Alcohol Labelling Bill [HL]
– in the House of Lords at 12:16 pm on 20th April 2007.
Lord Mitchell: My Lords, I beg to move that this Bill be now read a second time. It has a very simple objective: it seeks to compel manufacturers, distributors and retailers of alcoholic products to display a warning label on all bottles or cans that contain alcohol. The label will state the following:
In drafting the Bill, several points have been uppermost in my mind. The first is that the Bill should be tightly focused. We could have widened it much further, but we judged that for a privately introduced Bill of this nature, the wider it is, the less likely will be our chances of success.
we have ensured that the Bill is only about giving a warning and is not about forcing any member of the public to do anything that he or she does not want to do.
Finally, we have thought about the cost of labelling. It is predictable that the alcohol industry will raise this matter, but its argument looks a little thin when it already meets identical costs in other countries where labelling is compulsory.
In a nutshell, the Bill is being introduced because drinking alcohol while pregnant is dangerous. Many women are unaware of the danger. We seek to make them, their partners and the world in general aware of the risks to the unborn baby.
It does not need me to stand here today to tell your Lordships about the alcohol pandemic that plagues our country; we see it in the media, and we see it in all its harsh and revolting reality on our streets. However, we are walking a tightrope; we do not want to come across as puritans preaching against fun. Drinking is a highly pleasurable experience, and most of us enjoy it. We are not against young people drinking, even occasionally to excess—after all, which of us never did that? However, what we do want to do is to increase the awareness of the dangers of drinking while pregnant.
Since time immemorial, drunken young people have engaged in sexual encounters that when sober they might have avoided, and there is nothing much we can do about that. However, put sex and alcohol together and there is indeed a cocktail, but of a very different kind. The physiology is simple. The developing foetus in its early stages in the womb has no liver. Its formative body is unable to deal with the same toxins as the fully fledged human being. Therefore, all the poisons its mother ingests will pass through the placenta into the baby’s bloodstream.
Alcohol is a lethal poison. It has the potential to cause great harm to a foetus. It can kill brain cells that can never be replaced; it can damage the nervous system and connections within the brain itself; and it can retard the growth of vital organs, particularly the heart and lungs.
Like tobacco and lung cancer, the correlation is not perfect. People who do not smoke still get lung cancer, just as people who smoke do not get lung cancer. Nevertheless, the relationship of one to the other is now beyond dispute. So it is with drinking when pregnant. Harm is not certain, but it is more likely. It is the risk of this harm that we are trying to address.
Through no fault of their own, future children are being sentenced to lifelong brain damage. Tragically, many of their mothers have not been educated or informed about the risks of alcohol in pregnancy. That is the objective of the Bill—to inform them of the harm that their unborn babies could be exposed to. That harm is called foetal alcohol spectrum disorder. As a spectrum it has many forms. In its most benign form it can cause many types of behavioural problems. It is claimed that, for example, some forms of attention deficit disorder are caused by FASD. It is also felt that many forms of juvenile unsocial behaviour can be similarly traced back to FASD.
The cost to our society resulting from such conduct is vast. Any action taken to ameliorate this condition would be of benefit to society as a whole. It is believed that one live birth in 100 produces a baby with some form of foetal alcohol spectrum disorder. Put another way, this equals 7,500 babies per year.
At the other end of the spectrum is foetal alcohol syndrome. This takes the problem into a different and more acute dimension. It is judged that in this country between one and three children in 1,000 are born with the condition. That represents somewhere between 750 and 2,250 per year. That is more than the combined number of babies born with muscular dystrophy, spina bifida, HIV and Down’s syndrome. Foetal alcohol syndrome manifests itself in many ways. In some cases the child appears physically normal; in others the child has a series of facial deformities. Widely spaced eyes, a small head due to a smaller brain, thin lips and a flattened philtrum between the base of the nose and the upper lip are all indicators of the presence of the syndrome.
However, it is the hidden brain damage that causes maximum problems. Children with FAS are emotionally and mentally delayed. Typically, they have difficulty in telling time, they get lost, they cannot remember instructions and they are largely innumerate. Eighty per cent are not able to live independently and will always need to rely on the state or other carers.
Sadly, many children in this world are born with all sorts of physical or mental handicaps and sometimes with both. But the harsh reality of foetal alcohol syndrome is that these births are not inevitable. They are not a quirk of nature; they are the result of someone else’s actions, and that someone is the child’s mother. The fact is that foetal alcohol syndrome and the complete spectrum is preventable: it does not have to happen.
For many years I and others have been lobbying the Department of Health, the alcohol industry and anyone else we can get our hands on, to make them aware of this problem. In the beginning we received polite but cool brush-offs. They asked: where is the evidence? And when confronted with experiences elsewhere, particularly in the United States, we heard, “Just because other countries make it mandatory for alcoholic containers to have labels attached to them, doesn’t mean that we have to follow suit”. That is an odd and somewhat parochial conclusion when you think about how rampant binge drinking and alcohol abuse is in this country.
Refusing to take no for an answer is now paying dividends. We hear that the Department of Health is close to reaching an agreement with the alcohol industry. It has been reported that the industry is willing to adopt a code that will encourage labelling. I gather that the label will warn the public in general to restrict alcohol consumption to a number of units per week. I have always had a problem with units as a measure; it is too imprecise and too easily fudged. What is a unit? Is it a glass of wine? How big is that glass of wine, and how strong is that wine? Is it 14 units per week spaced over the week, or is it 14 units consumed in one boozy evening? And, “If they say 14 units, they probably
mean 20; and if they mean 20 then probably we can get away with 25”. Such is human nature.
Standing around a bar with a bunch of friends is no place to consult the alcohol unit calculator. Nevertheless it is a start. What would be even better is if the label had a warning specifically directed at the dangers of drinking while pregnant. That would be the bold decision.
When it comes to pregnancy we are dealing with an imprecise measure. We do not know how much alcohol is safe. Neither do we know when it is safe. It is a game of Russian roulette—drink at one moment and the chances are you will be safe, but pick the wrong time, without realising it is the wrong time, and the consequences can be lethal.
I therefore ask the Department of Health to reconsider its current position, which is that for pregnant women a few units per week are acceptable. The only reliable message that they should be giving is that no alcohol is safe during pregnancy, and it is to be totally avoided.
Then the question is whether a code imposed by self-regulation is sufficient. I do not think it is, and that is why I believe that this Bill, making it mandatory to include a warning label, is a better solution. I simply do not believe that all suppliers of alcoholic beverages will abide by the code all of the time. The bottle of Bacardi Breezer may have the label attached, but will the bottle of Château Lafite 1982? Perhaps the Minister will let us know the department’s thinking on that point.
Other countries have taken the lead on this issue. In the United States compulsory labelling has been in place since 1989. In France a law was passed last year. Others are following; for example, Finland, Chile and Poland. Of course this causes the alcohol industry a great dilemma. How can it possibly object to compulsory labelling in our country when it is forced to include it elsewhere? Where is the logic that requires one consignment of Scotch whisky going to New York to have an American label stuck on at the distillery, whereas a similar consignment bound for London from the same distillery will not? Is it really saying that British women are not entitled to have the same health message as American women? I sincerely hope not.
I should like to take a few moments to make a further comparison with the tobacco and cancer issue, because it is relevant and a pointer as to how matters could develop if not addressed now. The tobacco companies were well aware of the links between smoking and cancer from the early 1950s, yet they sat on the evidence and denied it in public. Labelling was eventually introduced on tobacco products, despite intensive lobbying by the very well resourced tobacco industry. Finally, the anti-smoking lobby won through. Warning labels are now printed on every pack of cigarettes, and with great success. Today, smoking in public places has become socially unacceptable. In many countries it has been banned outright, including our own with effect from 1 July of this year.
At least that is true in the developed western world. Elsewhere the tobacco companies ply their wares with ever increasing resolve. All of this is a pretty strong indicator that multinational companies, whether tobacco or alcohol, will respond to imperatives only if legally compelled to do so. The alcohol companies would do well to study what happened to the tobacco industry and the potential for legal actions against them.
In a recent article in the Lancet, Dr Raja Mukherjee of St George’s Hospital in London and Mr Nigel Eastman address some of the legal and ethical issues. Dr Mukherjee has been to the forefront in matters to do with foetal alcohol syndrome, and we should all thank him for his persistence and scholarship. He cites a case in the American state of Wisconsin where a mother was charged with attempted murder and reckless endangerment because she drank heavily during her pregnancy. It was held that she should be held accountable to her unborn child by her actions.
The Wisconsin appeals court concluded that because a foetus is not a human being the mother could not be held criminally liable. In our country, if a mother were to feed her newly born baby with neat alcohol, she could be prosecuted for doing so, but if she feeds her unborn child alcohol through her bloodstream, she has no responsibility. I find this somewhat bizarre.
Dr Mukherjee also shows in the same article that many healthcare professionals have shown difficulties in diagnosing FAS. In Canada, in a survey, 98 per cent of paediatricians and GPs had heard of FAS but fewer than half felt able to diagnose it. Dr Mukherjee states that diagnosis is key because after the birth of a single child with FAS, the risk of another child, similarly affected, being born to the same mother increases by 800 times. The ethical issues are enormous.
In getting to this point, I have been helped by many people whom I must thank. In particular, I have been ably assisted by Susan Fleisher, who heads NOFAS-UK, and Mr Ross Cranston, a former MP who helped me to draft this Bill. I owe both of them a huge debt. There are also many people who confront the consequences of foetal alcohol spectrum disorder every day of the year; that is, doctors, social workers and other carers, but most of all parents, particularly mothers. Imagine, if you can, the guilt and grief that thousands of mothers endure, realising only too well what the momentary pleasure of drinking went on to cause. It does not bear thinking about. Finally, the children themselves only want normality. There is somehow a haunting plea from all of them—“Mummy, why can’t I be normal?”.
In market research that we commissioned, 61 per cent of women admit to drinking when they are pregnant and 75 per cent are aware that it might have some effect on their unborn child. Sadly, it is still the young and less-educated women who are unaware of the dangers and it is particularly them we seek to inform. Ask a mother-to-be what she wants for her baby and, whoever she is and whatever her background, the answer will be the same: “I want my
baby to be healthy”. It is not given to us to make all babies healthy. That is beyond our power. But this Bill, by making the dangers of alcohol more widely known, will undoubtedly result in some babies being born healthy who otherwise would not be. If we can do that, we will spread joy where otherwise there would be sadness. That is why I have introduced this Bill and why I hope your Lordships will support me in taking it further.
Baroness Finlay of Llandaff: My Lords, I support the Bill introduced by the noble Lord, Lord Mitchell. Drinking alcohol to excess in pregnancy is known to harm the unborn child. As the noble Lord has said, we do not know whether there is a safe level of alcohol intake during pregnancy. Although there is overwhelming evidence of harm, there is no evidence of harm from abstinence. The Government’s policy, which is based on a precautionary principle, is eminently sensible but it could go further. Therefore, the Bill misses a potential opportunity, but I understand why it does not target the many others who are at risk from alcohol abuse. Let me be clear that it is not alcohol but excessive binge drinking which leads to some of the problems that we see in society today. It seems that in pregnancy the drip-drip of alcohol is also harmful. Therefore, the problem of foetal alcohol spectrum disorder is being addressed in this Bill.
The Bill also raises a question, and an opportunity, as to whether other health benefits could come from labelling. In the sub-committee on allergy, which I have the privilege to chair, we have heard about the allergenic potential of the sulphites found in wines and the benefit that a statement of the sulphite content would have for those allergy sufferers who can tolerate low but not high levels of sulphites. In this Bill, labelling is confined to pregnancy, although there would be benefits in extending the warnings about the dangers of excessive drinking to everyone, not just to pregnant mothers. My support is built on the evidence that we need a commitment to a broad-reaching approach. I fear that this Bill, by itself, may not prevent mothers drinking while pregnant, but it is a very important move towards prevention.
We have seen from warning labels on tobacco products about harmful effects that labels are not enough to bring about culture change. Warning labels on alcohol may act as a deterrent where alcohol is sold in sealed containers to people who are sober, but they will not deter those buying excessive alcohol in licensed premises, such as pubs and clubs, where it is dispensed in glasses, which cannot, of course, be labelled. I would like to see an amendment to require such premises to display a warning similar to that proposed for labels.
together is deeply embedded in our society and has been for thousands of years. We now have beautifully designed labels on some wine bottles, some of which are glass works of art in themselves. I am sure that some objections will come from those who find the proposed labels aesthetically unpleasant. But I do not think our intention to protect the unborn child should be inhibited by such objections and I am confident that we have such good graphic designers that the challenge posed could be easily surmounted.
The excellent report by the Academy of Medical Sciences, Calling Time: The Nation’s Drinking as a Major Health Issue, suggests that price and availability make a difference to alcohol consumption and, therefore, to alcohol-related health damage. In order to decrease excessive drinking, we need to consider measures affecting both those factors. Such measures will often be unpopular.
Alcohol has never been cheaper in real terms in living memory. The price is determined in large part by the duty on alcohol, but that is no longer linked to the strength of the drink. White cider, at up to 7.5 per cent alcohol by volume, is taxed at only half the excise duty on weaker beers. Sadly, there is a cohort of poor, stressed single mothers who find escape in alcohol. I am informed by Professor Gilmore, president of the Royal College of Physicians, that some mums with liver damage are drinking up to two litres of white cider a day because of the combination of high strength and low price, which allows them to escape from their problems. We also know that when these mums are under the influence of alcohol they are at a higher risk of unplanned pregnancy. Therefore, the unborn child is at high risk again and there is a cycle which perpetuates itself. The low price of alcohol also makes it more available to young people and puts it within the financial, if not always legal, reach of teenagers. Most pregnancies occur in young women, so it is important to ensure that they heed the warnings in order that the next generation is not damaged.
Increasing tax is never popular. In October last year, the Health Secretary asked the Chancellor to raise the tax on alcopops and other drinks favoured by teenagers, recognising the clear link between the price and availability of alcohol and its consumption. This is not just a problem for government; retailers have their part to play in supplying alcohol in a responsible way. We have to remember that many groups of young girls go to the supermarket to buy cheap alcohol, often spirits, to get tanked up before going out clubbing. When girls are sober they are more likely to read the label or get pressure from their peers. If a young girl knows that her friend is pregnant, there is a chance she might warn her not to drink that night.
In most EU countries wines and spirits are sold in separate areas in supermarkets, but in the UK they are presented as end-of-aisle offers. Let me be clear: as someone who buys wine in a local supermarket, I do not suggest that retailers should try to sell less alcohol in a way that would damage profits. However, many retailers sell alcohol as loss leaders, particularly at Christmas, with end-of aisle promotions most
visible. An end to that practice would not only demonstrate corporate responsibility, it would certainly not harm retailers’ profits and it might allow reductions on food, vegetables, toys and other products.
I hope that a broad-ranging approach would also include guidelines on the advertising of alcohol. Adverts for alcohol play a large part in fostering our culture of excessive drinking, as adverts increase positive beliefs about alcohol and reduce perceptions of risk. Advertising bans are controversial, but it is interesting to note that there is no watershed for alcohol adverts, and many of them are focused strongly towards young people. We take a remarkably liberal approach in this country. France, which is not famed for a puritanical approach to alcohol, allows no broadcast advertising for alcohol.
One further area I would like to see covered is that of drink driving. Lowering the UK maximum blood-alcohol level from 80 milligrams of alcohol in 100 millilitres of blood to 50 milligrams, as is more generally the case across the EU, would be a significant move. In Australia, lowering the drink-driving limit from 80 to 50 milligrams resulted in a lower accident rate and a fall in health-related harm.
The Bill takes an important step towards tackling the increasing problem of the effect of alcohol on the foetus, and I hope that it might have a secondary effect on drink driving and other areas of life. It is when babies’ brains are developing that they are damaged by booze abuse. Let us not forget the cost to society and the cost to the child, and I hope the Minister will remember the cost to health and social services in the care these children require, as well as the cost to education departments in meeting their specific learning needs. Such a Bill could well prove to be remarkably cost-effective in terms of its impact on our health services. I hope that the success of this Bill will come to represent the first in a series of measures to bring about a healthier, safer and happier drinking culture. I wish it well and I end by saying, “Cheers, my Lords”.
Lord Monson: My Lords, I apologise for not putting my name down on the speakers’ list, but I had a long-standing hospital appointment this morning which I feared might overrun. Luckily, I have been able to make it just in time. Courtesy dictates that this Bill should receive an unopposed Second Reading, but I hope it will not go much further, certainly not in its present form. As my noble friend Lord Walton of Detchant said only a couple of days ago when speaking in a health debate:
There is no empirical evidence that for the great majority, taking alcohol in moderation—one must stress the word—during pregnancy harms the unborn child. If it did, neither I nor my siblings would be here today to tell the tale, and nor would most of my contemporaries. The same goes, I think, for my sons’ generation. The noble Lord, Lord Mitchell, said that
a survey had revealed that 61 per cent of pregnant women admitted to drinking. I would have thought that 40, 50, 60 or 70 years ago it was probably more like 90 per cent, the difference being that pregnant women would restrict their drinking to a glass of sherry or half a pint of mild at one end of the social scale up to a dry martini or a glass of scotch at the other. Binge drinking simply did not happen, except perhaps at university after finals or something like that. It is a modern phenomenon which was then unknown, and I agree that it is a serious one. I shall come back to that issue in a moment.
Not so long ago, doctors and district nurses would urge nursing mothers to drink a pint of Guinness a day for the sake of their health and that of their baby. Medical fashions change from year to year, and indeed from month to month. We were told not long ago that butter was a deadly poison and we must all switch to margarine. The position has totally reversed and now margarine with its hydrogenated fats is the villain of the piece while butter in moderation is perfectly all right. A decade before that, antibiotics were prescribed for everything under the sun—for anything from a scratched finger to a boil on the bum. That has resulted in people becoming desensitised to antibiotics so they no longer work. A decade earlier, anyone feeling slightly down in the dumps was prescribed tranquillisers, and hundreds of thousands were prescribed to ill effect. A couple of decades before then, asbestos was considered God’s gift to mankind. You were doing a public service by lining your house or place of business with as much asbestos as possible. Now we know better. Medical and health fashions do change.
In two or three years’ time it may well be decided that on balance it is beneficial once again for pregnant women to have a single glass of red wine a day, but that would be a bit too late if this Bill goes through. Moreover, the Bill would target the wrong people. Young, university-educated women are having babies later and later, mainly for economic reasons, and are finding it harder to conceive. Once pregnant they are more prone than younger women to complications. So they will usually religiously avoid drink, and often tea and coffee as well. The Bill is not necessary for them. Women from a more feckless background—the binge drinkers to whom the noble Lord, Lord Mitchell, referred—are likely to do most of their drinking in pubs and clubs. When they buy bottles, they are unlikely to peruse the labels carefully.
That brings me, lastly, to an aesthetic objection. The noble Lord, Lord Mitchell, talked about Château Lafite 1982. Imagine how terrible it would have been if those marvellous Château Mouton Rothschilds—I have only tasted it once—with their magnificent labels designed by Dufy, Matisse, Picasso and so on, had been ruined by ugly warnings plastered all over them, especially when such warnings are not really necessary, and certainly not on the front of the bottle.
for keeping his campaign going over the years, and for introducing his excellent Bill. Let me say now that had it been possible to add a second name to a Private Member’s Bill, I would have done that, so convinced am I that this is the right way forward. I am sure that the Minister will tell us more about the voluntary labelling of alcohol that is already taking place. Scottish & Newcastle is the leader, and all credit should go to the company for doing it.
However, a voluntary labelling system, however admirable, is not enough. The Minister for Public Health in another place is on record as saying that warning labels for alcohol will be voluntary initially, but if the drinks industry ignores them, the Government will consider legislating. That is absurd. We are asking for labelling that is not punitive but informative. The industry should not be allowed to resist precisely because so many women are ignorant of the possible effects of alcohol on the unborn child, and the duty to inform on the bottle or the can should be comparable with what is done on cigarette and tobacco packets.
This is even more important because the level of ignorance in the general population is quite high. My children are what might be described as quite aged now, at 27 and 25. When I was pregnant—which sometimes I think was not all that long ago—no one thought that drinking moderate amounts of alcohol was dangerous for the foetus or the very young baby. Indeed, in my day experienced maternity nurses and health visitors advised drinking a glass of wine before the last feed at night to help the new baby sleep. I do not think they would be saying that now, and that was not so very long ago. Our knowledge of foetal alcohol spectrum disorder has increased hugely, but public awareness has not kept pace. Most young women, especially the less well educated and the very young, do not know about the risks at all. They have not heard forensic psychiatrists talking about the prevalence of foetal alcohol spectrum disorders among young people in prison, and those with the condition are not by any means all identified because of a continuing lack of clinical awareness of these conditions in many cases.
Only last night I was with Professor Sue Bailey, the registrar of the Royal College of Psychiatrists, who is a child and adolescent forensic psychiatrist at the University of Central Lancashire. She said that signs of foetal alcohol spectrum disorder are frequently missed within prisons, even by those who know about it. Young women who do not know about it have not heard prison governors talk about how prisons are becoming the last closed institutions in this country, and it is suspected that in among the sheer misery of the huge incidence of mental illness among prisoners, there is also a fair prevalence of undiagnosed learning disability within which foetal alcohol syndrome may well figure to a considerable extent. Unlike the case with cigarettes, the public do not know about the risks of alcohol in pregnancy.
state than we already have. However, I would like women to know about the risks so that they can decide whether to accept them. Few pregnant women are really willing to add consciously to the risk of having a child with a problem such as foetal alcohol spectrum disorder. All women fear the possibility of having a child with some kind of disability, much as those disabled children are usually dearly loved after their birth. But we all want the best for our children and if not drinking during pregnancy means lowering the risk of some kinds of birth and developmental defects, that is something most women would accept if they knew. So information is critical, and making it widely available—which is why I think it has to be compulsory—is also critical.
However, let us not be puritanical about this, as the noble Lord, Lord Mitchell, said. I am certainly no puritan about this: I come, on my mother’s side, from a family of small-time wine growers and wine merchants in southern Germany. My grandfather’s drinking companions—and he could certainly drink—in the prisoner-of-war camp in France during the First World War were also the people who went into my grandparents’ apartment three days before the Second World War broke out, just after my grandparents had left for this country, and packed up all their possessions which they then sent them after them.
Drinking can provide strong social bonds. This House has its bars, and most of us drink socially. The difference is this: if we knew that by drinking we were risking the development of our unborn children, most of us would stop, just as many of our own young are so much better in many cases about not drinking at all if they are going to drive. We are talking not about abstinence but about abstinence for nine months. Similarly, no one asks for total abstinence from those who are drivers, only that they do not drink when they are going to drive. Some women are fortunate enough to have their tastes change so much during pregnancy that they cannot face even a single glass of wine. But the evidence shows that just under 50 per cent of mothers visiting the teenage antenatal clinic at St George’s Hospital drank more than four units in one go, and 27 per cent occasionally got seriously drunk when pregnant.
With an increasing culture of binge drinking among young women, to which the noble Baroness, Lady Finlay, drew our attention, we should be all too aware that this will rise. The noble Baroness is right to suggest that warning notices about alcohol when pregnant should also be displayed in bars and pubs.
We do not really know the extent of harm. The estimate is that one in 100 of live births is affected with foetal alcohol spectrum disorder, making it the most common cause of learning disabilities worldwide. The acute form of foetal alcohol syndrome occurs in between one and three live births per 1,000. So Dr Raja Mukherjee, one of the UK’s foremost experts, along with Professor Nigel Eastman and Professor Sheila Hollins, the president of the Royal College of Psychiatrists, summarised the position when she said:
Unlike the noble Lord, Lord Monson, I think the case is irresistible. I hope that the Minister will agree that this is not about voluntary labelling. We need it made compulsory, because the level of knowledge is low, and, from what we can now see, the incidence of binge drinking and drinking in pregnancy is high and the conditions are preventable. We on these Benches strongly support the Bill.
Earl Howe: My Lords, I join other noble Lords in congratulating the noble Lord, Lord Mitchell, on bringing forward this Bill. It is two and a half years since he introduced his memorable debate on foetal alcohol syndrome. None of us who researched the subject at that time was left in any doubt that we were dealing with something of major importance. I felt then, and I feel now, that doing nothing is simply not an option. The noble Lord reminded us today about the devastating and lifelong consequences which can ensue for children born to mothers who have indulged in binge drinking during pregnancy or who, in some cases, have consumed a relatively modest amount of alcohol at the wrong time.
The wider issues to do with FAS present challenges in relation to prevention, as well as to the issues further down the track such as the diagnosis, education and appropriate care of children and adults afflicted with the syndrome. The Bill deals with the preventive aspect, so I shall not talk about the other ones today.
I think that the noble Lord has successfully made the case for putting warning labels on alcohol containers. Awareness of this issue is generally low—61 per cent of British women drink while pregnant. In the background, as noble Lords have emphasised, we need to be mindful of the increasing culture of heavy drinking among the young in all socio-economic groups.
It is true that the Government have spent not inconsiderable sums on public information initiatives over the past few months, such as the Know Your Limits campaign, and these are to be welcomed. But campaigns of this sort are inevitably transitory and we cannot know that the message has reached everyone who needs to hear it. As a means of raising awareness, appropriate labelling has much to recommend it.
The questions we need to settle are twofold: first, do we need a piece of legislation to do this, as opposed to a voluntary agreement with the drinks industry; and secondly, what exactly should the label say? When we debated FAS in 2004, the Minister replying, the noble Baroness, Lady Andrews, told us that the Government were taking the problem very seriously and were working with the drinks industry on developing a voluntary labelling scheme. I was more than prepared to accept those assurances at face value, but here we are, two and a half years later, and there has been no visible result from those discussions. I would much prefer a voluntary scheme as long as it could be made to work, but after this interval of time one has to wonder whether there is
actually any mileage in the idea; and I frankly am not surprised that the noble Lord has lost patience. It may be that the Minister will deliver some words of genuine comfort on the matter today, but if we carry on without agreeing on a voluntary scheme, then yes, I think the Government need to take at least back-up powers to introduce a scheme of statutory regulation.
The noble Lord has made a very good fist indeed of drawing up his Bill. One could criticise it for being too detailed: quite a lot is perhaps more suited to secondary than to primary legislation. But notwithstanding that, full marks to the noble Lord for showing us exactly what he intends Parliament to consider.
It is not only America that is pointing the way on this. If we look at what is happening in France, Finland, Canada, Australia and New Zealand, we see that public health messages on bottles and cans about not drinking alcohol during pregnancy are gaining widespread acceptance. Indeed, in 2004, a YouGov poll of more than 2,000 people found that 67 per cent of those asked would welcome labels warning of the dangers to the unborn child. I do not think we need be too fearful that warning labels may be seen as an unnecessary piece of nannying. It is, after all, only a label.
Lord Monson: My Lords, can the noble Earl tell us whether the labels which have to be displayed on the containers in the countries he mentioned are displayed on the front or the back of the cans or bottles?
The problem, in my view, is how to achieve a message that reflects the current state of scientific knowledge and does not run the risk of alarming women without due cause. The fact is that many women when pregnant can have a couple of units of alcohol once or twice a week without any apparent detriment to the health of their baby. Indeed, the current official advice from the Royal College of Obstetricians and Gynaecologists says that drinking alcohol at that level has not been shown to be harmful, even though it makes it clear that the safest approach for a pregnant woman is to choose not to drink at all. The guidelines also warn that episodic binge drinking around conception and early pregnancy is especially harmful to a woman and her baby, and this line is echoed by the Royal College of Midwives.
I do not think that anybody disputes the advice about binge drinking. The real question is whether we can justify a message as drastic and uncompromising as the one contained in Clause 1. We must be guided, surely, by the science. There is no consensus at the moment about the threshold below which consumption of alcohol causes negligible damage in the expectant mother. Nor is there consensus about the causal mechanisms which lead to foetal alcohol syndrome. We know that some populations are more prone to alcohol-related disorders; for example, those
in lower socio-economic groups and ethnic minorities. The prevalence of these disorders also seems to be a function of maternal age, poor nutrition, drug use and use of tobacco, so the picture on causation is not wholly cut and dried. There is scope for further research into these issues to enable us to explain why some babies are more affected than others.
The research that we do have suggests increasingly that if we err at all it should be on the side of caution. In the 1990s, Ann Streissguth, at the University of Washington, established that children of mothers who had drunk seven to 14 standard drinks per week in pregnancy tended to have specific problems with arithmetic and attention, as well as behavioural difficulties when older. These results have been confirmed by the work of Sandra and Joseph Jacobson at Wayne State University, Detroit. At the same time, what is important is not just the number of drinks you consume: it is when you are drinking them, whether you have eaten beforehand and how fast your body metabolises alcohol. Drinking all seven units at one session during a week would amount to a binge which potentially puts the baby at risk.
What do we know about very low levels of alcohol consumption? The Jacobsons found that children of mothers who drank fewer than seven drinks a week had no detectable mental deficits. But a study by Hepper at Queen’s University, Belfast, indicated that fewer than seven drinks a week can have a measurable effect on the developing nervous system of an unborn baby. John Olney, a neuroscientist at Washington State University, has performed studies on rats. These show that cell death in the brain can occur when developing rats are exposed to only mildly raised blood alcohol levels equivalent in humans to 50 milligrams per 100 millilitres of blood for a period of only 45 minutes. This level would be sufficient to delete 20 million neurons in the brain of a foetus—not enough to translate into a detectable effect on a child’s cognitive abilities, but nevertheless a measure of damage.
What does all that say to us? It says, rather messily, that we cannot as yet convert our current scientific knowledge into categoric blanket advice for all women about how many drinks they can have when pregnant. But we appear to know that the less alcohol she consumes, the better it is likely to be. Meanwhile, the noble Lord’s approach in this Bill is to adopt the precautionary principle. In the circumstances, it is hard to disagree with that approach. It is right that we should think carefully about the precise wording of the warning message and whether it could be improved on, but I would not wish to suggest to the noble Lord that the general tenor of the message he has proposed is misplaced.
If I have a worry at all, it is on an associated issue—the vagueness of alcoholic measures, to which the noble Lord, Lord Mitchell, referred. If we are to talk in terms of units of alcohol, people need to be aware of the true number of units they are consuming. A 125 millilitre glass of wine contains roughly one unit. But a glass of wine that you pour at home is likely to be larger. It may also have a stronger alcohol content, so a glass of wine at home may be far
more than one unit. The lack of awareness of these basic things needs to be addressed every bit as much as the matters covered by the Bill.
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I congratulate my noble friend Lord Mitchell on introducing and securing the Second Reading of his Bill. I also congratulate him on the fine quality of his speech, as I do other noble Lords who have spoken. It has been a short but highly informed and high quality debate.
This issue, I know, is close to my noble friend’s heart, reflecting his close involvement with the National Organisation on Fetal Alcohol Syndrome, to which I pay warm tribute today. The organisation is at the forefront of efforts to alert women to the potential dangers of alcohol consumption during pregnancy, and its work is well known to the Government, particularly through its regular contact with my ministerial colleagues in the Department of Health. I commend the organisation and wish it well in the future.
There is no doubt whatever that foetal alcohol syndrome is a devastating condition and the effects of foetal alcohol spectrum disorder on a child’s future life can be grave. The Prime Minister’s Strategy Unit interim analytical report on alcohol estimated that there are between 240 and 1,190 cases offoetal alcohol syndrome per year in England and Wales.Moreover, NOFAS estimates that in the UK as a whole, more than 6,000 children are born each year with the more prevalent condition of foetal alcohol spectrum disorder.
When my noble friend last spoke to the House about this subject, he painted a worrying picture of the health symptoms of the syndrome and the spectrum disorder. He did so again today and was very persuasive on that point. His remarks and those of the noble Baroness, Lady Neuberger, about the problems of misdiagnosis and non-diagnosis were also persuasive. It is clear that much more needs to be done to educate health professionals in this area.
Understandably, our debate took in a number of issues around alcohol consumption. There is no question that, particularly among young women, there has been an increase in alcohol consumption. The evidence that I have is that the proportion of 16 to 24 year-old women who had drunk more than six units on at least one day in the previous week increased from 24 per cent to 28 per cent between 1998 and 2002 but had fallen to 22 per cent in 2005.
Thirty-nine per cent of women aged 16 to 24 reported drinking more than three units on at least one day compared with 5 per cent of those aged 65 and over. Average weekly alcohol consumption in the past 12 months in England for women increased from 5.5 units in 1992 to 7.6 units in 2002. Among women, the proportion drinking more than the recommended
weekly benchmark of 14 units increased from 12 per cent in 1992 to 17 per cent in 2002. Nine per cent of women are drinking more than twice the recommended daily amount and 15 per cent of women drink at hazardous or harmful alcohol levels.
The latest figures that I have are that in the UK in 2000, 30 per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy. Those mothers who continued to drink during pregnancy reported drinking very little, and 71 per cent of those who continued to drink consumed less than one unit of alcohol a week on average. Only 3 per cent drank on average more than seven units a week.
In 2000, 87 per cent of mothers who had recently given birth reported drinking alcohol before their pregnancy and 61 per cent continued to drink while they were pregnant—a fall from 66 per cent in 1995. I understand that older mothers are more likely to drink during pregnancy—71 per cent of mothers aged 35 or over did so compared with 53 per cent of those under 20. Thirty per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy, which compares to 24 per cent in 1995. In addition to the 30 per cent of mothers who gave up drinking during their pregnancy, 65 per cent said that they reduced their alcohol intake.
Clearly, there are a lot of statistics there. They suggest that there is a general issue about an increase in alcohol consumption, but they also suggest that pregnant women have taken to heart some of the messages that have come through.
Noble Lords made a number of interesting remarks on the question of units of alcohol. Noble Lords will know that the Chief Medical Officer recommends that men should not regularly drink more than three to four units a day and that women should not regularly drink more than two to three units a day. The definition that I have of a unit is 8 grams of alcohol—typically, one small glass of wine, one half pint of beer, though not a strong variety of beer, and one measure of spirits. However, I fully accept the arguments made by noble Lords that the size of glasses can vary considerably and the use of very large glasses has become more frequent, both in pubs and restaurants but also at home. Equally, more generally, I take to heart the point that the noble Earl, Lord Howe, and my noble friend raised about the lack of awareness in that regard.
The noble Baroness, Lady Finlay, made some very telling points about the more general issues in relation to alcohol, and gave some recommendations for the Government to take on board. I listened very carefully to that. We launched the alcohol harm reduction strategy for England in 2004, with the specific aim of minimising the harm caused by alcohol through better education, prevention efforts and the improved identification and treatment of alcohol problems. We are committed this year to reviewing that strategy and to identifying what further actions we wish to take. Of course, today’s debate will be very helpful in informing officials as they advise the Government on taking the new
strategy forward. We have launched the Know Your Limits campaign—the first national campaign on alcohol, focusing on young people who binge drink, to which a number of noble Lords have referred. We are taking action to tackle underage drinking, which has led to targeted enforcement including the wider use of issuing fixed penalty notices.
Drinkaware Trust has been established as a new organisation, independent of government and the alcohol industry, and it is developing work to change behaviour and the UK national drinking culture. We have developed Models of Care for Alcohol Misuse Services, published in June 2006, and we have launched alcohol misuse interventions, which is guidance on developing local programmes of improvement. We are not complacent; we understand very clearly the importance of action in this area. As I have said, the review of this strategy in 2007 will be a very good way in which to take on board the comments that noble Lords have made today.
The noble Lord, Lord Monson, and the noble Earl, Lord Howe, referred to the evidence specifically in relation to alcohol drinking by pregnant women. In 2005, my department commissioned the National Perinatal Epidemiology Unit to undertake a review of existing evidence. The main aims were to update what we knew from existing evidence about the effects of prenatal alcohol exposure. The principal findings were that there is no consistent evidence that low to moderate consumption of alcohol during pregnancy has any adverse effects, although there is some evidence that binge drinking can affect neuro-development of the foetus. The department has commissioned a recent review from the National Perinatal Epidemiology Unit on the effects of low to moderate alcohol consumption in pregnancy. The review has broadly concluded in support of the scientific conclusions of the 1995 Sensible Drinking working group.
I have to say that this evidence base is not strong. While the current advice remains scientifically correct, there is a perception that it might be construed as too permissive. It is interpreted by some as meaning that it is safe to drink a little when pregnant, when a little can differ from person to person. Most women, as we know, stop drinking or drink very little in pregnancy, so a slightly stronger message could be aimed at those who do not reduce their consumption to appropriate levels. I echo the words of the noble Earl, Lord Howe, that action must be based on scientific evidence. His speech was a tour de force of some of the available evidence that we now have. It is clear that we do not have enough evidence—but clearly we need to do more to obtain it.
It is clearly important that labelling is used as a strong component in a preventive approach. We are committed to action on labelling, as was laid out in the Government’s alcohol harm reduction strategy, which was published in 2004. We know that the public support labelling. I refer noble Lords to the recently published Eurobarometer survey on attitudes to alcohol, which showed that almost eight out of 10 people agree with putting warning labels on
alcohol products and in adverts, in particular, to warn pregnant women of the dangers of misusing alcohol. In the UK, 75 per cent of people supported labelling.
Labelling is not a panacea and is no substitute for other actions, such as education and wider information. The evidence for the effectiveness of health warnings alone is not particularly strong, but it can be an essential component of a broader strategy to help consumers to estimate their own unit consumption and to help people to become more conscious of drinking in relation to their health.
I agree with the noble Earl, Lord Howe, and my noble friend that doing nothing is not an option. We are working in close partnership with the alcohol industry and wider stakeholders to implement the many initiatives that were set out in the 2004 alcohol harm reduction strategy. Industry has shown its willingness to help us to achieve that aim and we know that more than 75 per cent of spirit labels and 85 per cent of beer for sale in the UK market already carries information on unit content. It is much less for wine and it is clear that more needs to be done. It is also pleasing to remark that many supermarkets’ own brand beers, wines and spirits include that information on their labels—but we need to move beyond this.
Providing only unit information, important though it is, is not sufficient. We have asked the industry to go further to ensure that there is more consistency and visibility in the information that is provided and to add a short health message on drinking for adults and on pregnancy to ensure a link to the Government’s wider campaigns, and that there is an agreed timetable for intervention. We want government intervention to regulate the industry to be proportionate. We do not want to impact unfairly on responsible consumers, manufacturers and retailers, and we need to work with industry on this, but we are not opposed in principle to legislating in this area should a voluntary approach fail or prove ineffective. I can say to the noble Baroness, Lady Neuberger, that I think that that is an entirely sensible approach. If in a very short time we can pull off an agreement with industry that produces the kind of advice that we want, that is a very desirable way forward.
Baroness Neuberger: My Lords, what does the Minister make of the observation of the noble Earl, Lord Howe, that we started having this debate in this Chamber in 2004 and nothing has happened? I regard it as absurd that nothing has happened since 2004—and that is why maybe the voluntary method is not enough.
Lord Hunt of Kings Heath: My Lords, my understanding is that we hope that we can report progress on our discussions with the industry very soon. I entirely accept that if talks became protracted and it looked as if there would not be a successful outcome, noble Lords would be absolutely right to come back and say to the Government, “The time for talking is over; let’s see some action”. But I have discussed this with officials and we are confident that
we shall be able to report progress very soon. However, I reiterate that we shall not shrink from tougher measures if we do not reach a satisfactory agreement with the industry. I say to my noble friend that there is no question that there is a need for women to be alerted to the potential dangers of alcohol for the unborn child and his or her future well-being. The points made by noble Lords today were entirely persuasive. We have a responsibility to future generations to ensure that parents, and mothers in particular, are fully aware of the dangers for unborn children of drinking. This is a very serious matter.
We consider that there is great hope of partnership with the industry. It is worth spending a little more time ensuring that we reach agreement. I thank my noble friend for raising this matter so effectively and powerfully. I again reassure the House that if a voluntary approach does not work, the legislative option remains.
I say to the noble Baroness, Lady Finlay, that I thought very seriously about notices in pubs and off-licences. She made a very strong point. As I said in my opening remarks, I wanted to keep my speech very focused. I take the point that she made about the cost to society and the nation of children who are affected by this syndrome.
I say to the noble Lord, Lord Monson, that we are not saying that all pregnant women who binge drink will have foetuses with some form of foetal alcohol syndrome. Nor are we saying that the foetuses of all pregnant woman who drink will have foetal alcohol syndrome. We are talking about the minority who drink a lot or perhaps even a little, whose foetuses may be affected if the alcohol is consumed at the wrong time. We are not preventing them from drinking, we are just issuing a warning.
On the subject of labels, to the best of my knowledge the relevant labels that I have seen are on the back of bottles of wine. That is certainly the case with bottles that I have seen in the United States. In Australia, I believe that they are on the side. I have no desire for such labels to be inspired by the designs of Matisse or any other great artist.
I should have loved the noble Baroness, Lady Neuberger, to be a co-sponsor. I agreed with everything that she said. I thank the noble Earl, Lord Howe, for the support that he gave on the previous occasion the Bill was introduced and again today.
I thank the Minister for his remarks. It was good that he said there was government understanding of the issue and no complacency about the fact that something needed to be done. He gave a very strong hint about a voluntary code. If such a code were 100 per cent effective, it would be a good thing. However, he hinted strongly that if there were any wavering on this issue, the Government would
support legislative action. That is as much as we can hope for. I ask the House to give the Bill a Second Reading.
– in the House of Lords at 1:56 pm on 29th March 2007.
Lord Avebury Spokesperson in the Lords (Civil Liberties), Home Affairs, Spokesperson in the Lords (Africa), Foreign & Commonwealth Affairs 3:39 pm, 29th March 2007
If their mothers drank during pregnancy, they may already have been disadvantaged by low birth weight, which is another factor in the survey where the UK is near the bottom of the league table, as the noble Baroness, Lady Howells, said. In the worst cases—several hundred a year—alcohol misuse by a pregnant woman may lead to foetal alcohol syndrome.
Foetal Alcohol Syndrome
Health written question – answered on 19th January 2007.
Tim Loughton: To ask the Secretary of State for Health what plans she has to raise awareness of foetal alcohol syndrome. 
Caroline Flint: Raising awareness of foetal alcohol syndrome is part of the multi million pound “Know Your Limits” alcohol campaign which was launched in October 2006. We have produced a leaflet, “How much is too much when you’re having a baby?”, which is being widely distributed across the NHS, and to other frontline agencies on request. It is also available for downloading via the campaign website at www.knowyourlimits.gov.uk. We have engaged a public relations agency to take forward a media campaign to increase awareness of issues pertaining to pregnancy and alcohol.
The Government’s vision for maternity services is set out in the maternity standard of the national service framework for children, young people and maternity services. The standard highlights the need for local health promotion arrangements to include the provision of information for parents on the importance of minimising intake of alcohol. It also asks all national health service maternity care providers to ensure that all women who have a significant alcohol use problem receive their care from a multi-agency team, which will include a specialist midwife and/or obstetrician in this area.
Foetal Alcohol Syndrome
Health written question – answered on 16th January 2007.
Tim Loughton: To ask the Secretary of State for Health what estimate she has made of the number of children born in England with foetal alcohol syndrome in each of the last 10 years. 
Caroline Flint: Hospital episode statistics publications contain information on admissions to hospital together with information around the primary and secondary diagnosis of the patient being treated. However, the diagnoses of foetal alcohol syndrome (FAS) are rarely recorded in hospital systems as such a diagnosis may not be identified at birth. It requires identification of the facial or other FAS abnormality at this early stage, which can be very difficult and problems that raise the possible diagnosis may only become apparent during schooling. In addition, sensitive information about heavy drinking during pregnancy may not be revealed in that context.
Please note: we have posted here full transcripts of some debates on FASD (including labelling) – as a result this page is quite lengthy and may be slow to load.
– in the Scottish Parliament at 9:15 am on 20th November 2008.
I hope that there will be full information for all, not just adopted children; that preplanned support for their medical needs will be provided in a way that ensures continuity; that there will be prior and guaranteed access to child and adolescent mental health services, which is an issue to which the Health and Sport Committee will return in its inquiry; that there will be specialist drug and alcohol teams that will intervene in the antenatal period and at least the first year after birth and will also work with addicted children and those suffering from foetal alcohol syndrome; that there will be an end to voluntary information sharing and that it will instead be made statutory; and that there will be effective guidance on managing children in families with drug addiction problems.
Foetal Alcohol Syndrome
Health written question – answered on 14th October 2008.
Bob Russell: To ask the Secretary of State for Health (1) what recent research he has undertaken into foetal alcohol syndrome; and if he will make a statement; 
Dawn Primarolo: In May 2005 the Department’s Policy Research programme commissioned a systematic review, by the National Perinatal Epidemiology Unit (NPEU), of national and international evidence on the effects of alcohol on the developing fetus and child. The review was published on the NPEU website in May 2006 and copies have been placed in the Library.
Due to difficulties in ascertaining the mother’s alcohol intake during pregnancy, babies born with foetal alcohol syndrome (FAS) can often be misdiagnosed with a more general learning disability. It is therefore not possible to provide accurate figures on the number of babies born with FAS.
Pregnant Women: Alcoholic Drinks
Health written question – answered on 9th October 2008.
(2) if he will (a) make foetal alcohol spectrum disorder (FASD) a core subject in training for new doctors and other medical professionals and (b) design and implement a catch-up training programme on FASD for medical professionals already in practice, with particular reference to (i) general practitioners, (ii) midwives, (iii) mental health workers and (iv) those working in paediatrics; 
(4) if he will take steps to improve the awareness of foetal alcohol spectrum disorder (FASD) amongst (a) LEA members, (b) local authority members and (c) others responsible for decisions on the allocation of public funds in order to ensure appropriate future provision of funds to deal with FASD. 
Dawn Primarolo: In early 2007, the four United Kingdom Chief Medical Officers considered the need for consistent advice across the UK on pregnancy and drinking alcohol. Following this, the Department’s advice on drinking before and during pregnancy was revised and published in May 2007.
In March 2008, the National Institute for Health and Clinical Excellence (NICE) published advice for health professionals on the treatment and care of women during pregnancy. This includes advice on drinking alcohol.
The Department’s advice is that pregnant women and women trying to conceive should avoid drinking alcohol and that, if they choose to drink, to minimise risk to the baby, they should not drink more than one to two units of alcohol once or twice a week and should not get drunk.
The Department is working with the alcohol industry to include information about drinking when pregnant on alcohol labels. This voluntary agreement with the alcohol industry, announced in May 2007, is to include unit content and daily guideline information on labels. The Department expects that advice to women to avoid alcohol if they are pregnant or trying to conceive should also be included on most alcohol labels by the end of 2008.
In May 2008, we launched a campaign to raise awareness of the public’s knowledge of units of alcohol and how they relate to today’s drinks and servings—this included communication to highlight the updated pregnancy advice around alcohol consumption.
On 22 July 2008, the Department launched the Government’s alcohol consultation, asking for the views of the public and key stakeholders on what action the Government should take in response to the rising levels of alcohol health harm and crime and disorder. One of the questions that the consultation asks is whether the alcohol industry should have to include information on alcohol unit content and health on the labelling of alcohol products.
We are working with the International Centre for Drug Policy to influence the development of the undergraduate medical curriculum and embed substance misuse, including a specific module on alcohol identification and brief advice, within the curriculum. This includes working with the Deans of the 24 English Medical Schools, who are all independent and set their own curriculum. The aims for undergraduate medical students are that:
students should be able to recognise, assess and understand the management of substance misuse and associated health and social problems and contribute to the prevention of addiction;
students’ education and training should challenge the stigma and discrimination that are often experienced by people with addiction problems.
In spring 2008, we announced funding to develop the implementation of the curriculum and the training of new doctors, including, as a core priority, ensuring that future doctors will be able to recognise, assess and understand the management of alcohol misuse and its associated health and social problems, and the funding of co-ordinators in medical schools, whose roles include working with curriculum developers to ensure that the guidance is implemented and to facilitate integration of the guidance into their curricula.
Guidance, issued in April 2007, has been developed to define the aims and core learning outcomes in substance misuse, which medical students should achieve during the undergraduate stage of their basic medical education.
The guidance goes on to say specifically that on graduation students should be able to advise women on the effects of substance use, including alcohol, and the impact on foetal and maternal health. Concerning specific diseases, students should be able to describe the effects on pregnancy and on the newborn of misuse or dependence on alcohol, tobacco or illicit drugs.9 Oct 2008 : Column 764W
Foetal Alcohol Spectrum Disorder
Private Members’ Business – in the Northern Ireland Assembly at 2:00 am on 22nd September 2008. [Please note: it appears these times may be pm and not am? NOFAS-UK]
I beg to move
That this Assembly calls on the Minister of Health, Social Services and Public Safety to introduce policies to reduce the level of Foetal Alcohol Spectrum Disorder; where necessary co-operating with other agencies and Departments; and to introduce dedicated teams to assist families affected by Foetal Alcohol Spectrum Disorder.
I did not bring this subject to the House to be negative or judgemental or to scaremonger. I state categorically that I understand that no one deliberately intends to harm an unborn child. This debate is not an attack on the Minister or the professionals who deal with foetal alcohol spectrum disorder (FASD) daily. I sincerely believe that they deserve our utmost respect and admiration. I tabled the motion to raise awareness of the effects of the disorder. I want to highlight the devastating effect that alcohol or drug misuse can have on an unborn child and the need of families, who live daily with FASD, for diagnosis and a support network.
This debate is about the well-being of future generations. Some people may not fully appreciate the damage that alcohol can cause to the unborn child. Problems affecting a child with FASD include: varying degrees of facial disfigurement; brain damage, resulting in poor social skills; inability to learn simple tasks; behavioural problems; and an impact on co-ordination and motor skills. Those problems affect the entire family of a child with FASD.
As the term “spectrum disorder” implies, there is a wide variation in the severity of the condition and in the level of support required. FASD is not a well-publicised condition, but that does not mean that we, as a society, can afford to overlook the daily needs of the families and children who are affected by it. Their needs must be identified and addressed. Everyone in the Chamber must play a part in getting the ball rolling today.
The effects of alcohol on the unborn child are permanent — they do not go away. However, they are entirely avoidable. An interdepartmental co-operative approach must be adopted to achieve the objective of reducing the number of children affected by FASD. It must involve the Department of Education, the Department for Employment and Learning, the Department for Social Development, the Department of Health, Social Services and Public Safety and national organisations who can supply the knowledge on which new policy and structures can be firmly based. Such a multi-agency approach will ensure that all resources are utilised efficiently and effectively — in short, joined-up working.
The problem of drinking before and during pregnancy must be raised early with young people. I say young people, rather than young women, because research has shown that alcohol consumption during adolescence can also have a detrimental effect on the fertility of young men. It may permanently alter the DNA that they pass on to their children, increasing the risk of birth defects such as FASD.
We must examine the dual issues of whom we should target and how, operationally, that can be achieved. It can be done through the education system, youth groups, family planning clinics or anywhere that young people get together. The means of delivery must be relevant and must utilise multiple threads of communication, such as leaflets, social networking websites and the traditional media. The policy in Northern Ireland should be to prevent, rather than deal with, birth defects caused by alcohol. There is an old adage, “prevention is better than cure”.
General public awareness must be raised. Even in today’s society, parents have an important role to play. In the interests of public health, a publicity campaign should be undertaken to help to raise awareness of FASD among our citizens.
In the education sphere, some of the possible problems of FASD include: a reduced attention span; frustration; poor problem solving; the feeling of difference and exclusion from their peers; and delays or defects in speech and language development. However, every child with FASD is an individual and will have different needs.
Many children with FASD have exceptional abilities in one area, be it music, art or mathematics. Therefore, the people of Northern Ireland should be responsible for ensuring that such children achieve their maximum potential. We need better diagnosis and specialised services. At the moment, there is no accurate information on the number of children with FASD.
Some parents have told me that they have had difficulty getting an accurate diagnosis of the disorder. In fact, last week one parent told me that their child’s diagnosis of FASD had been overturned. The implications of that are huge, as the support services that have been in place, and even benefit entitlement, may also be removed from that family.
From my perspective, that is a shocking state of affairs. How can that family be expected to cope physically, emotionally or financially? I secured this debate in order to urge the Minister to put in place a comprehensive service designed for those children and families who, sadly, have to live with FASD. As with any medical condition, there must be, primarily, an accurate diagnosis so that families are not left in turmoil because of medical inconsistencies.
I can almost hear the Minister screaming in my ear, “George, what about the cost?” I ask the Minister: what is the cost of doing nothing? There is a continuing need for lifelong medical assistance, special arrangements for education and medication to treat the secondary symptoms of FASD, all of which cost, at best, millions over each generation. Many of the specialised services and personnel required to supply those services are already available in the different systems. It is not a long journey to make in order to utilise them. However, every journey begins with one step, and I ask the Minister to take that step by liaising with other Departments and support organisations in order to ensure that those communications are embedded and developed. After an accurate diagnosis, families must have barrier-free, easy access to the services that are beneficial to them.
I am fully aware that there is no quick fix for this problem, but we have to start somewhere at some time. That time and place is now. Children with FASD carry the effects for their lifetime. That is why parents need accurate diagnostic and support programmes that are obviously and desperately required in order to achieve the objectives that I have brought to the attention of the House today.
The FASAwareUK website states that FASD:
“is the biggest cause of non-genetic mental handicap in the western world and the only one that is 100% preventable.”
Let the Assembly encourage the Minister to take the first step on the journey.
“to introduce policies to reduce the level of Foetal Alcohol Spectrum Disorder … and to introduce dedicated teams to assist families affected by Foetal Alcohol Spectrum Disorder.”
Drinking during pregnancy may give rise to foetal alcohol spectrum disorder, and babies who have been subjected to alcohol while in the womb are also more at risk of sudden infant death. That is a cause of great concern, especially as we appear to have a culture of binge drinking. According to a representative of the Royal College of Midwives, many women carry a binge-drinking habit into their pregnancies.
In general, more people are aware of the dangers that are associated with smoking during pregnancy, but there is much less awareness of the effects of alcohol while pregnant. In the past few years there has been increased awareness-raising of the effects of alcohol consumption by pregnant women and those trying to conceive. However, more must be done, especially as some health professionals suggest that foetal alcohol spectrum disorder is increasing and that, due to the complexity of the disorder, many cases are not being diagnosed.
Foetal alcohol spectrum disorder is the umbrella term used to describe a range of effects that can be caused by maternal alcohol exposure. Children that are identified as having FASD show signs of behavioural, intellectual and physical difficulties, including learning difficulties, poor language and memory skills, and attention problems. Who would willingly subject their child to such problems? Who would willingly drink alcohol, knowing that those difficulties could be the outcome? We must provide targeted support and advice, so that women are made aware of the effects of the condition and can make an informed choice.
We have sought changes to the advice that is offered to women about drinking alcohol during pregnancy. The National Institute for Clinical Excellence (NICE) guidelines were revised in recent years to reflect the change in thinking. NICE now recommends that alcohol should be avoided altogether during pregnancy, but it says that those who wish to consume alcohol should minimise the risk to the baby by refraining from drinking alcohol in the first three months of pregnancy and thereafter consuming only a few units a week. Even that advice is confusing and is causing a great deal of concern. Women are asking whether they should or should not have a drink during pregnancy.
FASD is completely preventable through the elimination of drinking during pregnancy. Therefore, we have a duty to ensure that every possible effort is made to raise awareness and to bring down the level of FASD, or, if possible, to eliminate it. The dangers of drinking too much alcohol have been well documented for years. However, in recent times, healthcare professionals have made more concerted efforts to increase public awareness. I want to commend those professionals involved in the campaign, and pledge my support to help them along the way.
In order to lead an informed campaign, there is a need for more information, a good understanding of the continuum of permanent birth defects associated with FASD, and an increased awareness of the risks of pre-natal alcoholexposure among the general public, in particular among women who are pregnant, or considering pregnancy. That has been made more difficult by the fact, for which there is evidence, that FASD consists of a set of conditions that are poorly understood, not only by the general public, but by health professionals. Therefore, there is a need for more studies of the effects of those conditions, so that the best support can be provided.
It appears that the best advice for pregnant women seeking clarity on whether they can drink alcohol or not is to refrain altogether, because there is no definitive research to suggest that there is a safe level of alcohol consumption during pregnancy. If a pregnant woman consumes alcohol, it will go into her bloodstream, and, from there, straight into the baby’s bloodstream. In some cases, that alcohol can have a toxic effect on the foetus. Surely, that is enough to deter any mum-to-be. If you are drinking, your baby is drinking. I support the motion. Go raibh maith agat.
Foetal Alcohol Spectrum Disorder
Private Members’ Business – in the Northern Ireland Assembly at 4:00 am on 22nd September 2008.
Debate resumed on motion:
That this Assembly calls on the Minister of Health, Social Services and Public Safety to introduce policies to reduce the level of Foetal Alcohol Spectrum Disorder; where necessary co-operating with other agencies and Departments; and to introduce dedicated teams to assist families affected by Foetal Alcohol Spectrum Disorder. — [Mr G Robinson.]
I have gone on record many times warning of the hidden costs of alcohol for the National Health Service. Normally, those costs are associated with underage drinking and the effects that that will have on the National Health Service in the future. However, on this occasion, I am drawing attention to a disorder that is also caused by alcohol, but that is often caused unwittingly and without intent. I refer, of course, to the dangers that are posed by drinking during pregnancy and to foetal alcohol spectrum disorder (FASD), which is a lifelong condition affecting one in 100 people in this country.
(Mr Deputy Speaker [Mr McClarty] in the Chair)
That spectrum of disorder includes: foetal alcohol syndrome, the symptoms of which include a small head or body, distinctive facial characteristics and brain damage; foetal alcohol effects, including symptoms such as behavioural disorders and attention deficits; alcohol-related birth defects, which can include heart defects, sight and hearing problems and joint anomalies; and alcohol-related neurodevelopmental disorders, including attention deficits, behavioural disorders and obsessive-compulsive disorder.
It is clear that that range of disorders creates lifelong difficulties for sufferers and lifelong costs for the National Health Service. I add my voice to those who have commended the work of the National Organisation on Fetal AlcoholSyndrome-UK (NOFAS-UK), which has done so much good work in support of FASD sufferers. Our role as an Assembly must be to highlight the disorder and to tease out the issues that surround it.
For instance, some geneticists who specialise in diagnosing FASD believe that the rise in young children being diagnosed with attention deficit hyperactivity disorder (ADHD) is because they are, in fact, suffering from FASD. That misdiagnosis has a serious impact on the treatment and assistance that are available to sufferers and their families. Most of those children end up in foster care or are adopted. Often, they have behavioural problems and can sometimes end up with criminal records.
There is also a risk of recurrence of the condition in the same family. One geneticist had reported seeing a family in which three of the siblings showed symptoms of the condition. Identification of those symptoms is already included in the training of doctors and midwives.
The Minister of Health, Social Services and Public Safety has already signalled his positive intentions with regard to improving the management of FASD. He has entered into discussions with the drinks industry about the sale of alcoholat discount prices, which has helped to create the problem of expectant mothers drinking at home. We should welcome his proactive and sympathetic response.
As other Members said, foetal alcohol spectrum disorder is the term that is used to describe a range of totally avoidable mental and physical birth defects that are the result of maternal alcohol exposure during pregnancy. They are conditions for life that can have an adverse impact on the lives of the individuals concerned and their carers. The disorders can have serious consequences for infants and children, such as learning difficulties, attention disorders, physical abnormalities and physical difficulties.
The advice for women who are trying to conceive and for those who are pregnant has recently become clearer and more consistent across Ireland and the United Kingdom. The message for women is now to avoid alcoholcompletely. Indeed, for years, the message was mixed. We know that the message about drinking a little — a small glass of wine, perhaps — was very subjective. Unfortunately, many women did not know how much was too much, and that resulted in many babies being born with FASD. The National Institute for Health and Clinical Excellence guidelines are unambiguous: women should not drink at all during pregnancy, and particularly not during the first three months, which is the time when most of the baby’s organs are being formed. It is at that stage that the unborn child is most sensitive to the drugs and alcohol that can cause birth defects.
Given our binge-drinking culture, it is important that the message not to drink is presented clearly to all women. There is a real risk that women could deliver babies with FASD if they keep up their usual drinking habits during pregnancy. Even low levels of alcohol can affect a child’s development and can damage a child’s nervous system. Education and communication are vital if we are to reduce the number of women drinking while trying to have a baby or when pregnant.
It is also important to stress to women that if they have been drinking alcoholbefore their pregnancy has been confirmed, they must stop. Indeed, the area of health professionalism that diagnoses, manages, and reduces the incidence of those disorders needs to be built upon. Although the numbers affected are relatively low, there is a possibility that cases are going undiagnosed, due to the wide range of symptoms, and there is also a chance that some of the symptoms could be indicative of another disorder.
There must be a raising of the awareness and training of paediatricians, midwives and other health professionals, such as social workers, who may come across this type of disorder in children. Support must be given to women who have a problem with alcohol and who find it difficult to stop drinking when pregnant. As with all excessive alcohol use, it is important to address it before becoming pregnant. We should consider providing education in schools on alcohol abuse during pregnancy, because so many young women are becoming pregnant.
The health and well-being of babies is a very serious issue. Women want the best for their unborn children, and abstaining from alcohol is essential in preventing the unnecessary adverse effects of the disorder. We do not want to have to pick up the pieces when the damage is done. The important thing is prevention.
I welcome the motion and thank George Robinson for bringing it to the House. The effects of this very serious disorder can and should be avoided. It is essential that every effort continues to impress upon young women the consequences to their new-born babies if they continue to abuse alcohol while pregnant.
As has been said, the effects of excessive drinking during pregnancy can be horrendous. I know of a case, which is probably typical, of a mother who, unfortunately, had succumbed to the evils of alcohol and was recognised as an alcoholic in her community. Both she and her partner were long-term unemployed. The baby was born with severe learning difficulties. That family had little knowledge of foetal alcohol spectrum disorder and had little understanding of how to access services for the new-born baby and the rest of the family. It goes without saying that that new-born baby got off to a very poor start in life.
A recent study showed that some 55% of women consumed alcohol during pregnancy, against the advice of professionals, who continually advise that no alcohol should be taken during that time. It is widely recognised that heavy alcohol consumption during pregnancy leads to growth retardation, abnormality of the features, intellectual impairment, memory deficits and other defects. Surely, no mother would wish to ignore all the medical advice on the subject when she knows exactly what the outcome of her actions will be.
I know of the excellent work of the Health Promotion Agency, the Health Department and other organisations, and I hope that they will continue to appeal to women who are pregnant or who plan to have a family to avoid excessive alcohol consumption at all costs, explaining time and time again what the results may be.
The motion requests that the Minister introduce dedicated teams to assist families affected by FASD, and that must be of high priority. However, the main emphasis must be on prevention, and I concur with Carmel Hanna’s closing remarks on that issue. That is the main message that must be put across. I support the motion.
I congratulate my colleague for securing this important debate. Foetal alcoholspectrum disorder has been described by the Salvation Army as:
“the most common and preventable cause of birth defects and brain damage in children.”
It has been reported that almost one million children in the United Kingdom live with a parent who has an alcohol dependency. A survey published this morning by Tommy’s the baby charity states that one third of pregnant mothers drink alcohol during their pregnancy. Given that 70% of women in Northern Ireland drink alcohol, and that there has been a recent increase in binge drinking among younger females, there is a danger that, without education and information, pregnant young women will be unaware of the dangers of drinking alcohol and will place their unborn child — or children — at risk of FASD.
Some 6,000 children a year are born in the United Kingdom with FASD. FASD is not a diagnosis, but it describes a full spectrum of disabilities — from birth anomalies, such as low birth weight, to neurological problems that have the potential to leave lasting physiological and psychological damage. FASD has the potential to create lasting physical, cognitive and behavioural problems. I welcome the Minister’s speaking to the manufacturers of alcoholic drinks about the issue, because they, along with publicans and the Government — who do very well from the tax on alcohol — have an important role. I hope that a holistic approach is adopted to deal with the problem.
In small children, FASD leads to irregular sleep patterns; a failure to thrive through a height and weight deficiency; an inability to make and keep friends; a lack of the normal ability to distinguish friends from enemies; difficult-to-manage public behaviour; danger to the affected children, and to others, because they do not grasp the universal laws of cause and effect; deficiency in the normal sequential learning abilities of reasoning, judgement and memory; highly manipulative behaviour; and, sometimes, medical fragility. Such problems in development are likely to be amplified as a child grows older.
Research shows that if FASD is not diagnosed correctly, children and adolescents are likely to experience mental-health problems; drop out of school early; experience homelessness; engage in inappropriate sexual behaviour; develop alcohol and drug problems; have regular employment problems; and be unable to handle independent living. Some children may not experience such obvious forms of abuse and disadvantage, but they are likely to suffer from neglect or a chronic lack of the little things that are crucial to their overall well-being. Where affected children live with parents who continue to experience difficulties with alcohol, they can be exposed daily to rage, violence and abuse, which become part of the unpredictable and inconsistent environment in which they live.
The lack of a diagnosis of FASD often means the adoption of inappropriate and ineffective traditional interventions that can lead to the development of secondary disabilities. A child who receives a correct diagnosis is in a much better position to benefit from intervention than one who is not diagnosed, or one who is misdiagnosed and receives only partial treatment.
I call on the Minister to use the resources available to him to provide better education for young mothers. Young women must be better informed of the evident risks of drinking alcohol during pregnancy. Guidelines published by the National Institute for Health and Clinical Excellence recommend that women not drink alcohol during the first three months of pregnancy — my personal view is that they should not drink at all. We must do everything possible to further protect unborn children from such unnecessary abuse. FASD is preventable. I support the motion.
Members are aware that we live in a society that abuses alcohol at a level that impacts seriously and detrimentally on every aspect of the lives of individual citizens and on wider society.
Tens of thousands of households in Northern Ireland spend more money each week on alcohol than on food. Even during the current credit crisis, some alcoholic beverages are cheaper to buy than bottled water and soft drinks. Daily, newspapers are filled with reports of alcohol-related violence, mayhem and murder. Children as young as 10 years of age are admitted to hospital with alcohol poisoning. The binge-drinking mentality has become pervasive in society. Fifty per cent of weekend admissions to accident and emergency departments involve alcohol abuse. Youth is being corrupted by the availability of cheap, potent, alcoholic drinks. In many parts of the Province, the situation at weekends and holiday periods seems to be out of control and well beyond the police’s ability to deal with effectively. A sad feature of the problem is that an increasing number of valuable and scarce resources are expended on dealing with incidents and illnesses that result from alcohol abuse.
With the debate, the Assembly has turned its collective attention towards the need for the introduction and development of policies to tackle the increasing incidence of children being born with foetal alcohol spectrum disorder. It is the single biggest cause of non-genetic mental handicap in the Western World, yet the condition is 100% preventable. In young children, it causes serious growth deficiencies, major neurological damage to the brain and the central nervous system. The condition is caused when expectant mothers consume large amounts of alcohol during their pregnancy. One episode of binge drinking during pregnancy is one too many.
The National Organisation on Fetal Alcohol Syndrome-UK estimates that more than 6,000 children are born with FASD each year in the whole of the UK. Excessive alcohol can damage unborn babies at all stages of pregnancy. As mothers can often be unaware that they are pregnant for some weeks or months, those who wish to conceive and bear children should adopt a zero-tolerance attitude to alcohol. There are no safe limits.
The Assembly cannot ignore a tragedy of that dimension; it must take decisive and determined action. Children who are damaged by alcohol in the womb suffer throughout their lives from behavioural and learning difficulties, poor memory skills and attention problems. Often, they have noticeable physical deformities and are at greater risk of sudden infant death. The Assembly must acknowledge the part that is already played by primary- and community-care workers to develop selective prevention strategies that include screening and referral procedures to identify and target women who are most at risk and to minimise the risk to their unborn children. However, no child should be born to suffer in that way. Prevention has always been better than cure.
I support the call on the Health Minister to introduce well-researched and well-resourced multi-agency policies that involve various Departments in order to tackle the increase in FASD. Special emphasis must be put on assisting families who are affected by FASD. However, on a wider front, there is a pressing need for the Assembly to tackle, as a priority, the scourge of alcohol abuse in society. People must change their attitude to the dangers of alcohol. Alcohol abuse must be given the urgent and critical attention that it deserves.
I add my thanks and congratulations to Mr Robinson for securing this important debate. I also want to pass on the apologies of my party colleague Mr John McCallister, who, unfortunately, cannot be present. Mr McCallister and his staff have worked for considerable time on the issue, which he has raised in the Health Committee. He has worked with NOFAS-UK to raise awareness of the condition in Northern Ireland. He is the sponsor of a training day that will be held in Stormont on 14 October 2008. It has been organised by NOFAS-UK and is an opportunity to highlight this avoidable condition among relevant bodies. I hope that Members will support that event.
Foetal alcohol spectrum disorder is an umbrella term that describes the range of disabilities that are caused entirely by a woman’s drinking alcohol at any time during her pregnancy.
Disabilities can often occur even before she knows that she is pregnant. Foetal alcohol spectrum disorder symptoms include the baby’s having a small head and body, facial abnormalities and brain damage. Symptoms that are not visible may include behavioural and attention-deficit disorders. Organ dysfunction, epilepsy and learning difficulties — in addition to other conditions — can all derive from the mother’s consumption of alcohol during pregnancy. All those conditions are permanent and irreversible but, as has been said in the debate, totally avoidable.
Drinking alcohol during pregnancy is a serious problem that affects the most innocent and vulnerable even before they are born. The decision that expectant mothers take can destroy the rest of their children’s lives. We need a two-pronged approach to tackle the issue.
First, we must take steps to reduce the number of women drinking alcoholwhile pregnant. Unfortunately, there is an increase in the numbers of teenage girls who engage in sexual activity but continue to drink. However, that group does not account for all the cases of this avoidable disorder. Last year, the British Medical Association (BMA) published a paper on the syndrome as a guide to healthcare professionals. The document includes a number of recommendations that we should consider. The BMA recommends that, as part of routine clinical care, all healthcare professionals should provide ongoing advice and support to expectant mothers at every stage of pregnancy. That should include information on the risks of maternal alcohol consumption. All health promotion and advice should be supplemented with take-home printed information on the risks of consuming alcohol during pregnancy. During antenatal care, alcohol use should be monitored and recorded appropriately. Any pregnant woman who has a known history of alcohol consumption should be offered brief intervention counselling. Any expectant mother who is identified as being a high-risk case should be referred to specialist alcoholservices for appropriate treatment.
I recognise that training is in place in the Health Service in Northern Ireland. The steps outlined may not be entirely appropriate, but most reasonable people will agree that more steps should be taken to educate and support pregnant women and to help them not to drink alcohol. I am aware of the UK Chief Medical Officer’s position on the issue, and he has issued advice. An agreement between the Government and the drinks industry has ensured that alcohol units and health information will be included on labels. However, more can be done to prevent drinking during pregnancy.
Secondly, we must consider how to deal with the conditions that result from mothers drinking during pregnancy. That has already been partly touched on in the discussion on misdiagnosis. I agree with Mrs Hanna that the key to dealing with the disorder is prevention. However, that must not detract from the need to care for those children and families whom the disorder already affects. Its effects on them are devastating. One has to live through it to see how it affects them. We cannot ignore those people. Serious measures must be put in place to deal with the condition, and to support the families and children affected.
A’hm fer the motion. A houl at a wean bes a gift fae God. An ivry wean bes a wee miracle. A houl forebye at thair bes an onus oan iz tae leuk aboot the weans an’ the mither tae the bes’ o’ oor ability tae dae sae an’ thon’s fer wie A congratulate mae colleague fer bringin the matther tae public attention.
I support the motion. A baby is a gift from God, and each and every child is a little miracle. Furthermore, there is an onus on us to protect babies and mothers to the best of our ability. It is for that reason that I congratulate my colleague on bringing the matter to public attention. I was shocked when I read the reports of the damage done to babies when their mothers drink alcoholduring pregnancy. It is not necessary to repeat what my colleagues have said already on that subject. However, it is important that, although the number of births affected in the Province is some 10 a year, the number of people affected by the symptoms is much greater.
Symptoms can range from learning difficulties and ADHD to facial abnormalities. Given the number of children in the Province who suffer from behavioural issues, flags are definitely being raised.
I will not go over everything that we have already heard. However, midwives say that the mothers who admit to drinking while pregnant often fib about the amount that they actually consume. That is where the problem lies. Mothers and fathers are unaware of the severe nature of the problem and feel that a fib is enough to cover themselves, or perhaps they do not see the danger in it. They do not understand the issue, and it is little wonder.
When my colleague asked the Minister how widespread information was on the issue, the answer was that it was not very widespread. Some midwives are trained in dealing with those issues, some are not. No leaflets are given out, and no posters are posted. Although legislation concerning labelling on products is changing, the Minister said that the Department will voluntarily put information on the labels at some stage. However, it will take more than that. I ask the Minister to label alcohol in the same way as cigarette packets, which carry the easy-to-understand warning, “Smoking kills” in big, black letters.
In the United States, wording on alcohol labels advises pregnant women, or those trying to get pregnant, against drinking any alcohol. Like my colleague Iris Robinson, I want to see that approach employed here. It is all well and good to tell pregnant women to limit their drinking, but to do so allows certain people to think that they can drink just a little bit more without doing any harm. The fact is this: it can and does make a difference to the life of child. I urge the Minister to make the right, and clear, statement about that.
The last survey on this issue that was carried out by the Department of Health, Social Services and Public Safety found that 6,000 children a year are born with FASD and that some 9% of pregnant women are still drinking more than is recommended. Those statistics are based on the women who are not telling fibs, so who knows what the real figures are. More than 50% of women admit to drinking during pregnancy. I am sure that the Department wants to lessen that number. The answer should be to tell women that no alcohol should be consumed during pregnancy — full stop.
All pregnancy-related appointments with GPs, midwives and in hospital must be supplemented with take-home information highlighting the risks of drinking while pregnant and advising a no-alcohol policy. That is also the recommendation of those involved in highlighting the disorder. If a child is born with problems, his or her mother always wonders what she could have done differently. Some of those problems may be preventable, because the disorder is completely preventable, so let us help to prevent it today.
There must be wide understanding of the difficulties associated with alcohol. Mothers must understand that their children’s bodies do not have the ability to process alcohol in the way that their bodies do. Alcohol immediately affects a child in the womb. Some ideas have been proposed, and a complete ban on alcohol during pregnancy has been advocated. Can we, in good conscience, do any less? The health and social life of a mother is not adversely affected by not drinking, whereas the life of a child can be affected through his or her mother’s drinking, so let us make clear — through widespread labelling of alcohol — that mothers-to-be must not drink. Let us have posters on the walls of health centres, leaflets distributed at anti-natal classes, and a publicised campaign to let prospective parents realise the dangers —
I thank the Member for giving way. Does he agree that education in schools is one of the most important ways in which to highlight the dangers of drinking while pregnant? Does he also agree the Department of Education should adopt the role of providing such information?
I thank the Member for her intervention and for her comments.
I fully support the motion, and I ask that Members do the same. We must protect the family unit and the health of unborn children in the Province.
The Member’s time is up.
Alcohol misuse is a major public-health issue in Northern Ireland. The Department estimates that the total cost of alcohol misuse is more than £700 million a year and that the cost to the Health Service of treating addiction alone is some £12 million a year. A wide range of physical and mental harm is associated with the misuse of alcohol, including sclerosis of the liver, several cancers, increased blood pressure, stroke and heart disease. It is also associated with harm to the community in the form of antisocial behaviour. It is linked with accidents in and outside the home; and we are becoming increasingly aware of alcohol’s association with suicide.
Alcohol is clearly an issue that we need to address. Today’s motion concerns one impact of alcohol misuse — the effect that it has on the unborn child.
The term “foetal alcohol spectrum disorder” is used to describe the many problems that are associated with exposure to alcohol before birth. The most severe of these disorders is foetal alcohol syndrome, a combination of physical and mental birth defects. These defects occur when babies are exposed to maternal drinking during pregnancy. Only a minority of pregnant women with alcohol problems have babies with the more severe foetal alcohol syndrome. The severity appears to relate to the frequency of high doses of alcohol during pregnancy.
One of the difficulties of FASD is that it is sometimes a hidden issue. Diagnosis is complex and open to interpretation. It is, therefore, difficult to state confidently the prevalence of the condition in Northern Ireland. Based on international estimates, it is likely that between seven and 10 births a year here could be described as exhibiting foetal alcohol syndrome.
The latest figures available show that, over the past six years, there have been 20 hospital admissions involving 11 patients requiring treatment because of foetal alcohol syndrome. It is likely that more people did not have the condition diagnosed or did not require hospital care. It is also important to note that the condition does not affect the individual only as a baby or as a child; it is a lifelong condition. Although the number of recorded cases in Northern Ireland is small, each case concerns a unique individual who has real needs that must be met.
The first part of the motion states that we should reduce the level of foetal alcohol spectrum disorder. That means that we should address the entire issue of alcohol and the full range of problems that its misuse causes in our society. Although the focus for this debate is FASD, I am sure that Members will agree that alcohol misuse causes other significant health and social problems. As I have stated previously, excessive use of alcohol can increase the risk of liver damage, heart disease and cancer, including breast cancer. The emotional and mental health consequences of alcohol misuse are also considerable.
Alcohol is involved in one third of all suicides and too often is a factor in antisocial behaviour and violence. Domestic violence is often fuelled by alcohol, and, shockingly, one third of all domestic violence incidents occur when a woman is pregnant. Tragically, alcohol is too often the common link for physical, emotional and mental-health problems.
In Northern Ireland, the main problem with alcohol is our unhealthy attitude towards its use. That attitude is deeply embedded in our culture and is difficult to change. I am determined to continue the work in addressing the issue.
In May 2006, the Department launched its ‘New Strategic Direction for Alcoholand Drugs 2006-11’. The aim of the strategy is to reduce the amount of alcohol– and drug-related harm in Northern Ireland. There is a clear focus on the need to reduce the level of excessive binge drinking and increase public awareness of the real harms associated with alcohol misuse.
The strategy is supported by a range of Departments, including those of Education, Social Development, Culture, Arts and Leisure, and Employment and Learning. It contains regional and local outcomes that depend on cross-sectoral co-operation in order to achieve them.
I am encouraged by the wide support for our efforts to combat alcohol misuse. I have had discussions with each of the major supermarkets, representatives from the alcohol and drinks industry, and the PSNI on the availability of alcohol, especially to our children and young people.
The debate also presents an opportunity to highlight our growing concern about the level and pattern of female drinking in Northern Ireland, where 67% of women choose to drink. Of those, one third are binge drinkers; in the 18 to 20 age range, 50% of drinkers binge drink.
The occurrence of foetal alcohol syndrome is associated with the frequency of binge drinking. Over the past 20 years, Northern Ireland, in common with the rest of the UK and other countries, has seen a rise in the proportion of women — especially young women — who drink, and hidden within that increase is a growing trend towards excessive drinking.
All our campaigns, literature and websites ensure that the risks to women from alcohol misuse are made clear. That will be further strengthened by a specific leaflet — which I have instructed the Health Promotion Agency to publish — in support of the next phase of the binge-drinking campaign. Education work is ongoing in schools and youth clubs across Northern Ireland, and we will continue to support such work.
We have a clear message for women about the effects of alcohol consumption during pregnancy and its relation to foetal alcohol spectrum disorder. The current advice, which is common across the UK, is that alcohol can damage an unborn baby, so women who are pregnant should avoid alcohol or at least cut down to a couple of drinks a week. Couples who are trying to get pregnant should also cut down as alcohol can affect both the egg and the cells that produce the sperm. Many of us feel that that message could be toughened up.
Excessive alcohol consumption can not only harm an unborn child but it may result in couples having difficulty conceiving. That advice will be found in all our literature on alcohol. It will also be found in the recently revised copy of ‘The Pregnancy Book’, which is available to first-time expectant mothers through antenatal clinics, GPs or health visitors. I assure Members that the real risks of alcohol to the unborn child are made clear to expectant mothers by health and social care professionals.
Just as we have seen improvements in the screening of pregnant women when cases of domestic violence are suspected, so too there are clear procedures in place when it is thought that a particular risk has been identified in relation to alcohol misuse. That involves liaison between health and social care colleagues to advise and monitor the health and well-being of the expectant woman and the unborn child. Members should be reassured that this issue is one that all health and social care professionals receive training on. The ‘Hidden Harm’ action plan, which my Department will issue later in the autumn, places particular emphasis on inter-agency collaboration and training in addressing the needs of those young people who are problem alcohol and drug users and who are being cared for by parents or carers.
That leads me on to the other point of the motion — the introduction of dedicated teams to assist families affected by foetal alcohol spectrum disorder. I fully understand and appreciate the issues and challenges for those families, however, the consistent view of health and social care professionals who work in that area is that dedicated services are not always appropriate and, in fact, may not be beneficial. That is because children with the disorder require access to a wide and often different range of services. The complex nature and broad range of diagnosed conditions associated with FASD means that the management of individuals diagnosed as having that disorder should be tailored to their individual needs, circumstances, the severity of their condition and their responsiveness to interventions.
For example, the specific needs of children who have suffered a learning disability as a result of the disorder are met through a range of services funded by my Department. Those services are provided for all children with a learning disability and will vary to meet the specific needs of the individual child. Services for children include allied health professional provision such as occupational therapy, physiotherapy, speech and language therapy, respite provision and day-care provision.
Respite care is an important part of the wide range of health and social care services provided. Such care takes many different forms and is delivered in care settings that range from people’s homes to day facilities or residential care homes. I have secured extra funding for respite care amounting to a total of 400 additional packages, which will be available to those people diagnosed as having FASD. I have secured £4 million to provide a total of nine early-intervention support teams across the five health trusts. Those teams, which operate in early-years settings, comprise speech and language therapists, community and paediatric nurses, paediatricians, occupational therapists and physiotherapists. These multidisciplinary teams focus on diagnosis, assessment and early intervention.
Improving and safeguarding the well-being of all children and young people in Northern Ireland are primary aims of Government policy. Improving the assessment process is essential, which is why my Department has developed a new assessment framework for understanding the needs of children in Northern Ireland (UNOCINI). The framework is in the process of being introduced in all health and social care trusts.
I mentioned my meetings with the alcohol and drinks industry. An agreement was reached with the industry to introduce health information on drinks labels, including information about alcohol and pregnancy. That was a voluntary arrangement. However, consultation is taking place in order to see whether health messages on such labels should be made mandatory. I am determined to pursue as a matter of urgency, at all levels, the clear labelling of alcoholicdrinks with health messages, including responsible drinking in pregnancy.
The drinks industry has a clear, corporate, social responsibility in respect of the products that it manufactures, sells and markets. That is just one element of the new strategic direction for alcohol and drugs which is aimed at tackling alcohol misuse across Northern Ireland. As part of the strategy, there will be further phases of the binge drinking public information campaign next year, and the young people and alcohol action plan will be published later this year.
I am, and will be, taking measures in order to prevent or reduce the level of foetal alcohol spectrum disorder by targeting the level of alcohol consumption in Northern Ireland, obviously including among women. There are a range of services for children with special needs, including FASD.
It is important that individuals can be treated based on their unique individual needs and circumstances. However, we do not necessarily have a total picture of the scale of FASD in Northern Ireland, and that is an issue that I am discussing with my departmental officials in order to get a more complete picture, which would enable better planning of services.
In the meantime, we will all take responsibility for helping to reduce the levels of alcohol misuse in society. Tackling drinking habits that are almost culturally ingrained is a major challenge. My Department will continue to target the level and pattern of drinking by young women, and continue to address the issue of alcohol and pregnancy, and to provide information and appropriate advice. To those women who drink excessively during pregnancy, the message is simple: alcohol and pregnancy do not mix. The stark fact is that every case of foetal alcohol spectrum disorder is preventable, and I will ensure that all efforts are made in order to achieve that.
Alcohol misuse and problem drinking can severely affect the well-being of families through its association with child abuse and neglect, domestic violence and sudden infant deaths. I was shocked to learn that there are no accurate figures available for the number of people in families with FASD. That, surely, must be the basic starting point for the Minister in order to begin to resolve the problem.
How can this Assembly improve the situation of those affected by FASD, whether individuals or families, when there is no accurate database from which to work? In order to establish such a database, we must, first, have accurate diagnosis of cases of FASD. That is the foundation stone for everything that this motion seeks to achieve.
My colleague George Robinson listed some of the characteristics associated with FASD, and I will not repeat them. However, Members must recognise that FASD is entirely preventable and we must remain focused on establishing the services that we seek to provide. A concentrated and targeted approach is required, not only to assist those families who are living with FASD, but to reduce the number of future cases.
It makes no sense, morally or economically, not to tackle the problem head-on. The prevention of the adverse impact of alcohol consumption during pregnancy remains a significant challenge, not least because of the poor levels of awareness and understanding of FASD among healthcare professionals and the public.
Health promotion and educational programmes have been shown to be ineffective in altering drinking behaviour, and therefore FASD must be considered as part of a wider strategy to reduce the harm caused by alcohol. Primary and community care settings provide the ideal opportunity to deliver active prevention strategies, including screening for maternal alcoholconsumption. It is essential that young people are given the starkest possible message about the effects that alcohol or drugs can have on them years ahead when they wish to start a family.
Not every child who is born with FASD will need a great amount of care and support, but it must be available to those who do. Every child in Northern Ireland should have the opportunity to develop his or her skills and abilities to their full potential. For some, that means that a care package must be easily accessible, and the Assembly must ensure that that is exactly what is provided.
Today’s debate highlights the need for packages of specialist services to be available to those affected by FASD, whether for individuals, families, or a combination of the two. The need for young people to be aware of the dangers to the next generation from alcohol consumption is abundantly clear. The only effective way to achieve such awareness is through co-operation between Departments and specialist outside bodies. Some people might think that the Minister of Health, Social Services and Public Safety is unfortunate in having to take the lead departmental role. However, the crucial issue is the achievement of accurate diagnostics of FASD, and the services and benefits that other Departments will subsequently provide depend on that. Only an inter-agency approach can provide the support that the families concerned need. I repeat that the achievement of accurate diagnostics is the foundation stone of what the motion aims to achieve.
“Excessive alcohol consumption in pregnant women has led to 50 babies being born with serious mental and physical birth defects in the last five years … A consultant with Belfast City Hospital has warned that the amount of babies with Foetal Alcohol Syndrome (FAS) is likely to be much higher, as many are not diagnosed until pre-school age. FAS causes disfiguring facial abnormalities, small body weight, mental development delays and other behavioural problems. Many children born with this syndrome require lifelong care.”
Today, I urge the Minister to ensure that the services required by FASD-affected families and individuals will be available as soon as possible. If the Assembly lays the proper foundation stone, all that is built on top of it will provide the safety and security that is so desperately required. I apologise for not being present when George Robinson started today’s debate; I was chairing an all-party Assembly group meeting on cancer. However, as I listened to the rest of the debate, three or four key issues emerged: awareness, prevention, education, and support. That really sums up the content of the motion.
Mr Gardiner spoke of the hidden cost to the Department of Health, Social Services and Public Safety on account of those who consume too much alcohol. The Minister’s comments about the amount of money that is spent on treating alcoholics and those who misuse alcohol illustrate the fact that a staggering amount of money comes out of the Department’s budget to tackle the misuse of alcohol. That issue must be urgently tackled head on.
Carmel Hanna said that people must be made aware of the problem, and she mentioned the awareness campaign. The clear message must go out that, as the Minister said, alcohol and pregnancy do not mix. It would be wrong to send out a message that it is OK to have a few drinks a week. There must be no ambiguity on the matter; we must be clear and concise in saying that alcoholand pregnancy do not mix. No alcohol should be consumed during pregnancy.
Kieran McCarthy spoke about the horrendous effects that the syndrome can have on children after they are born, such as lack of growth, and other disabilities. My colleague Iris Robinson spoke about the educational needs of young mothers and the need for early intervention, which is essential for children who, through no fault of their own, may be affected by the condition. It is vital that the correct procedures be put in place to ensure early intervention.
Alex Easton spoke about the need for prevention, and the misuse of alcoholamong young women. That issue must be tackled. Tom Elliott spoke about the measures that must be taken on prevention, and he said that those who are already suffering as a result of the disease must not be forgotten. Along with a focus on prevention, that point must be taken on board so that measures are also in place to help people who are already afflicted.
Jim Shannon said that life is precious, and we must remember that life is a gift from God. Therefore, it is important that the proper facilities are in place to treat anyone who is affected by such a terrible disease.
I commend the Minister on the strategies that are already in place, and on the action plans that he proposes to put in place. I hope that the necessary measures will be introduced, and I support the motion.
Question put and agreed to.
That this Assembly calls on the Minister of Health, Social Services and Public Safety to introduce policies to reduce the level of Foetal Alcohol Spectrum Disorder; where necessary co-operating with other agencies and Departments; and to introduce dedicated teams to assist families affected by Foetal AlcoholSpectrum Disorder.
Adjourned at 4.59 pm.
Foetal Alcohol Spectrum Disorder
Private Members’ Business – in the Northern Ireland Assembly at 3:15 am on 16th September 2008.
The following motion stood in the Order Paper:
That this Assembly calls on the Minister of Health, Social Services and Public Safety to introduce policies to reduce the level of Foetal Alcohol Spectrum Disorder; where necessary co-operating with other agencies and Departments; and to introduce dedicated teams to assist families affected by Foetal Alcohol Spectrum Disorder. — [Mr G Robinson.]
Motion not moved.
– in the Scottish Parliament at 2:04 pm on 25th June 2008.
I welcome the survey of the incidence of foetal alcohol syndrome, but we have to be clear about the matter. Some will think, “If people are saying one or two units once or twice a week for nine months, well, that’s probably the minimum. I can probably take a bit more.” I ask the minister, in developing the strategy, to look at the websites and the advice that is given.
I welcome the survey of the incidence of foetal alcohol syndrome. The chief medical officer has made it plain that we must start with the state of our children in the womb.
There are fundamental issues to do with tackling alcohol misuse. I represent an area that is well up there in statistical terms with respect to foetal alcohol syndrome problems, underage teenagers consuming alcohol and violent incidents resulting from that consumption.
The minister and other members will also be aware—Mary Scanlon mentioned this—of the problems that are associated with misuse of alcohol by pregnant women. The most extreme resulting problem is foetal alcohol syndrome, but foetal alcohol spectrum disorder can also be debilitating for the child. It would be helpful for the Scottish Government to collect data on the incidence of FAS and FASD. The Government should co-ordinate a strong message and ensure that training is available so that health professionals and others can identify problems. Perhaps the minister will say a little about how the Government will do that.
Specific groups of people have been referred to in the paper and in members’ speeches, including pregnant women in connection with foetal alcohol syndrome. How children are affected by alcohol has been raised, as has adolescent and young adult alcohol misuse. Ian McKee mentioned hazardous, harmful and dependent consumption and the question of how we tackle it, and there are issues around offenders…
There are two areas in which the report is weak, and we should revisit them. First, as Mary Mulligan mentioned, the only reference to children affected by alcohol misuse is to a survey on foetal alcohol spectrum disorder—and I am not sure how that will work. There is a need to spell out more specifically and widely the effects of alcohol misuse on children. That may be done in other areas, but we need clarity.
We must address several matters. Mary Scanlon was correct to say that we must be clear about the problem of alcohol and pregnancy. The chief medical officer’s advice is that alcohol should be avoided by women who are pregnant or who are trying to conceive and the advice is the same throughout the UK.
The chief medical officer’s advice might be not to drink alcohol during pregnancy, but I quoted advice from the NHS Health Scotland website that was given to those of us who attended a briefing by Children in Scotland earlier this week.
I am grateful for that point. We will ensure that the message is consistent, but the guiding principle that we will follow must come from the CMO.
Health: Obesity During Pregnancy
– in the House of Lords at 7:41 pm on 9th June 2008.
We have before us the Health and Social Care Bill, which features the grant in pregnancy. It is a unique opportunity to engage women in education on health issues, on issues around breastfeeding and on parenting. There is another aspect that we must not ignore. Quite a few morbidly obese women who present are like that because they are desperately unhappy and have been abused. We should use this opportunity to screen for abuse women and other members of their family. There is also the potential problem of substance abuse—particularly of alcohol, but of other substances as well.
Alcohol Labelling Bill [HL]
– in the House of Lords at 4:35 pm on 1st May 2008.
The noble Baroness said: I should like first to thank the noble Lord, Lord Mitchell, for being kind enough to rearrange the Committee stage of the Bill so that I could be present to speak to my amendments following an absence of several weeks after an accident. I am most grateful.
Before tackling the amendment I should declare various interests. Noble Lords should know that until September 2006 I was the chief executive of the Portman Group, an organisation funded by major alcoholic drinks producers to promote sensible drinking by consumers and responsible marketing by producers. I was also a member of the Alcohol Education and Research Council. I am a paid non-executive adviser to a global wines and spirits company, Brown-Forman, and I have undertaken various projects for other drinks producers in my capacity as an independent consultant. In my earlier career in the voluntary sector I worked and campaigned for several organisations concerned with maternity and infant welfare issues.
I also acknowledge the valuable assistance that I have received from the Wine and Spirit Trade Association and the British Beer and Pub Association in preparing the amendments to which I wish to speak. The WSTA represents about 90 per cent of wine sales by volume in the UK market, 80 per cent of imported spirits and
all of the major multiple alcohol retailers. The BBPA represents 98 per cent of all beer sold in the UK market. The amendments in my name are also supported by the Scotch Whisky Association, the Gin and Vodka Association and the National Association of Cider Makers. I make that roll call not just to thank those organisations but to demonstrate the willingness of the industry to act effectively on the issue covered by the Bill and to demonstrate their willingness to make it workable in practice.
Legislation making it mandatory for labels to carry pregnancy advice is somewhat premature, if I may use that expression, at a time when the voluntary labelling agreement negotiated between government and industry is getting off the ground and attracting significant positive compliance. Nevertheless, my main concern has been to work as constructively as possible with the noble Lord, Lord Mitchell, to make sure that if and when his Bill becomes law, it will be as workable and non-contentious as possible in practice. I appreciate that his overriding concern is to see pregnancy advice on labels and that how it gets there is of secondary importance. I am therefore very glad that he has added his name to most of my amendments, which are designed only to acknowledge and honour the voluntary scheme and to keep any statutory provisions as a failsafe mechanism or back-stop.
- “so far as is practicable”,
after “ensure” in line 2. It is a shame that we have to start with one of the amendments to which the noble Lord, Lord Mitchell, has not added his name. I wish to make it clear from the outset that my intention is absolutely not to provide a device that lets companies off the hook.
As I said, in general I believe that the Bill’s measures should kick in wherever the voluntary scheme is not complied with. However, some types of package, container or label formats would make it very difficult to comply with the Bill’s requirements. Miniatures are the obvious example. There is a requirement in the United States for pregnancy advice on labels, but I have seen writing on some bottles so miniscule that I question the value of such a format to the consumer. Surely it is a tenet of all UK and EU labelling requirements that the information concerned should be meaningful to the consumer and proportionate to the goal. We certainly should not go for a measure that includes miniatures just because we know that they do that in the United States. After all, there are some very strange rules in the US relating to miniatures that I do not think we would go for here at all. I understand that in Washington DC, for example, it is illegal to sell miniatures singly. They have to be sold in six-packs because it is thought that selling them singly somehow encourages misuse. I should have thought that the opposite would apply, but that is a bit of an aside.
The noble Lord, Lord Mitchell, introduced the Bill some time ago and has since changed the wording of the text of the advice to bring it into line with the wording now advocated by the Department of Health and which is in the voluntary agreement. I still hope
that I may be able to change his mind and that he will accept this amendment, which would bring the Bill into line with other aspects of, and assumptions behind, the voluntary agreement.
There is also the question of disproportion, which I touched on at Second Reading. There are certain packages and label formats where disproportionate cost, even to the point of threatening commercial viability, would be an issue for certain companies if this provision became a mandatory requirement for every single label on every single brand. That would apply, in particular, to small businesses, especially in the wine sector, where thousands of brands are tested each year in the UK market using hundreds of UK agent companies. We are talking about a very small fraction of the market. If this had been government legislation, it would have needed a regulatory impact assessment. However, just because it is a Private Member’s Bill, I do not think we should forget that there are regulatory impact issues for small businesses and, indeed, for consumer choice. As I said, hundreds of companies would be faced with the choice either to comply at cost or simply not to supply the UK market at all. I would not be concerned about these small businesses and their predicament—even if it were a cost predicament—if I thought that, by making the requirement mandatory for 100 per cent of labels on 100 per cent of brands, we would be doing women a favour, but the shortfall that would occur as a result of the kind of exemptions that I have in mind would make no difference at all to women’s awareness of the advice. We do not need 100 per cent of labels to carry this message. Labels are only part of the information stream bringing this vital message to women. The voluntary agreement between industry and government acknowledges that the labelling regime will play,
- “a part in supporting a wider government-led campaign”.
The word “practicable” could also deal with another situation that I have in mind to make the requirement more practical—that is, to acknowledge that it is not reasonable to expect all brands to comply all at the same time with a single enactment date. In practice, I think that it would be reasonable to allow the gradual phasing-in of a labelling requirement for some niche brands with a very small market share but a long shelf life. Many of these brands will be owned by large global companies and so cost is obviously not ultimately a barrier, but the logistics of label production mean that it might be practical to deal with these brands later rather than sooner—for example, within two years rather than two months. Again, the voluntary agreement envisages that those considerations should be taken into account. It says that the Government understand that these labelling changes will happen as part of normal industry cycles for making changes to labels.
I did a small amount of research on the way in which the word “practicable” has been interpreted by the courts. I was relieved to see that it seems to have been interpreted in a fairly tight way. It is certainly regarded as much stricter than the phrase “reasonably practicable”. It is regarded as meaning feasible rather than “if you feel like doing it”. I stress that this is not meant to be a device to let anyone off the hook. If I am unable to persuade the Minister to accept the
phrase in my amendment, I would ask him at the very least to consider bringing back an amendment on Report or at Third Reading with a new clause or schedule for the specific exclusion of things, such as miniatures, which it seems reasonable to exclude from the requirements of the Bill. I beg to move.
Lord Monson: I am very glad to be able to support my noble friend Lady Coussins. She has moved the amendment with great skill and most comprehensively, for which I am grateful. I have had no chance to discuss any of these amendments with her before today’s debate, but quite independently I arrived at the same conclusions concerning miniature bottles.
Miniatures contain either five centilitres or, occasionally, only three centilitres—usually when the bottle contains cognac. It is almost impossible to get any meaningful warning on a bottle that size. If there were lettering a millimetre high it would swamp the rest of the bottle. I do not think anyone would willingly buy a miniature, not least because they are terribly bad value. If you multiply a miniature by 15 to get the price of a bottle, it would be enormously expensive. Mostly, you get given them free on British Airways flights, no doubt to compensate for your delayed luggage. British Airways are very good at that: I have a collection of empty miniature bottles which are useful for various things.
This is an unanswerable point. I suppose that there may be other containers which are difficult to label, but the miniature bottle is certainly one. I urge the noble Lord, Lord Mitchell, to think very carefully about it.
Baroness Harris of Richmond: I was slightly horrified when I learnt that I had to deal with this Bill, not having been involved with it previously. However, when I looked at it closely, I came to some conclusions, which are mine and not necessarily the policy of my party. I shall oppose all the amendments before us today because I believe that the Bill’s proposals are right, so I shall speak only once. I have heard the noble Baroness, Lady Coussins’s, explanation of this amendment, with the insertion of the words “so far as is practicable”, but I still find it very difficult to understand. Those words must be open to all sorts of interpretations, so I cannot accept this amendment and nor can I accept any of the others.
We, in this Committee, all know the dire consequences of drinking to excess but many young women do not. Alcohol-related deaths have almost doubled since 1991 and continue to rise. The costs to the NHS are huge. Alcohol-related injuries and disease cost around £1.7 billion a year and about 353,000 people were taken to hospital in England in 2006 as a direct result of alcohol abuse. Clearly and unambiguously, labelling is now necessary, especially for pregnant women or those hoping to conceive. The Government’s labelling of every cigarette packet has certainly got the message across about smoking being dangerous to health. Now that message must be followed through to the labelling of alcoholic drinks. A toned-down warning, something that says, “We hope that you abide by this”, is absolutely no use whatever, and these amendments suggest that. I am sorry, but I will not be supporting them, and I support the Bill in its entirety.
Lord Monson: The noble Baroness talks about alcohol abuse. Does she not concede that the greatest alcohol abuse occurs in clubs and pubs, but there will be no need to have labels put on the glasses served to the mainly young people concerned? That is the problem. It has little to do with whether there are labels on the bottle or cans.
Baroness Finlay of Llandaff: I in large part echo the words of the noble Baroness, Lady Harris. Reading through the amendments, I have particularly concerns about the first. I am rather disappointed that, in moving the amendment, there was no suggestion that the label on the bottle should be clearly displayed at the point of sale, when somebody is purchasing it. That creates a loophole within the Bill. People will perhaps then argue through various bits of case law that their bottle or label is too special, precious or different in shape to warrant carrying the relevant warning.
My other concern is that there is no requirement for the warning to be legible. We all know and have seen times when, for example, the sell-by or the shelf date of a product is stamped in such an illegible way that we need two pairs of glasses and a strong light to see which year it was, let alone which day or month. I am concerned that exactly the same method could be used to print pale grey on a light background, or a shade of green on green or whatever, so that the label would not be clearly legible. In that spirit—and I use the word advisedly—I have grave concerns about the amendment.
The Earl of Listowel: Briefly, I warmly welcome this Bill in Committee, the co-operation and work undertaken between many of the interests involved, and the work of my noble friends and the noble Lord, Lord Mitchell, in bringing this forward. I do not intend to speak any further in Committee, but am grateful for the work that has been done.
I share the disappointment expressed about the amendments. It should be as strong as possible. After all, we were recently reminded by a report from Alcohol Concern that 1 million children have an alcohol-dependent parent. Of course, we are particularly concerned about the foetus at this point. This is an opportunity to break some women and mothers from their use of alcohol when their child is at an early stage, so that the children do not experience their parent with that dependency.
“Large warnings on cigarette packets in the UK have had a dramatic effect. 12 per cent of quit attempts in 2004 were prompted by packet warnings. Packet warnings are the second largest source of callers to the NHS Stop Smoking Helpline. As the warnings have grown bigger, the number of people who said that the warnings had stopped them from having a cigarette doubled, and the number of people saying they have led them to consider quitting has gone from 25 per cent to 40 per cent”.
1 May 2008 : Column 408
These warnings are clearly important. I know that we are talking about the size, and the small warnings. I look forward to listening to the Minister’s response on this. In general and on principle, however, I welcome the Bill and the work done on it. I regret that it is not stronger, but recognise that compromises have to be made.
Lord Monson: Would my noble friend not agree that you cannot go into a pub or club and buy one or two individual cigarettes, having no sight of the packet? If you want a cigarette, you have to buy or have access to a packet and therefore you will see the warning. The analogy with alcohol is imperfect because you can drink an awful lot in a year without buying a bottle or can of beer, or whatever.
Baroness Falkner of Margravine: The noble Lord, Lord Monson, made a valid point that many young people who overindulge do so in a social setting where they would not be buying the entire bottle, and therefore would not see the label. But the point of the Bill is to create a culture whereby people are educated about the damage that alcohol can do to them. Irrespective of whether on a particular Saturday night they had a couple of drinks too many and did themselves harm, they would be more aware in general of the damage of alcohol through the labelling process.
Secondly, we know from recent research figures that since the smoking ban, the consumption of alcohol in social domestic settings has increased considerably. That is where people would be privy to the warnings on bottles and so on.
Baroness Thornton: Perhaps I may say to my noble friend Lord Mitchell that the first amendment always takes time, so don’t worry. It is of course up to him to decide what he wishes to do with this amendment, but I thought it might be useful if I placed the Government’s position on the record. Thereafter, unless asked specifically, I shall not take part in the debate. I shall sit here and smile.
I congratulate my noble friend on his perseverance and his success in bringing his Private Member’s Bill to Committee stage. I am very pleased to see the noble Baroness, Lady Coussins, again in her place and on her feet.
As we have said on both occasions that my noble friend has sought to introduce his Bill, the Government support fully the ethos and motivation behind it, and are determined to tackle alcohol-related harm in whatever form it may take. As Members of the Committee will recall, last year we reached a voluntary agreement on labelling with the alcohol industry which will provide people with information about how much they are drinking and what it means for their own health. We also expect that the industry should include information on what drinking alcohol during pregnancy means for the health of the child. On Amendment No. 1, the Government’s agreement with industry contains an exemption similar to the proposal put forward by the
noble Baroness, Lady Coussins, because it is aimed at providing flexibility to a minority of small producers in cases where the logistics of production and distribution would have disproportionate costs.
My noble friend’s excellent Bill proposes a warning on drinking alcohol during pregnancy. We commend this entirely. We have been clear with the industry that it should include pregnancy advice on labels. Our strong preference is for industry to use government wording, but labels may also use the French pregnancy advice logo. However, we hope that the voluntary agreement will accomplish even more than my noble friend’s Bill, incorporating additional information on units and relating these to daily recommended alcohol consumption guidelines.
My noble friend’s Bill rightly proposes that, should it be enacted, it will come into force by no later than 1 January 2010. We agree that swift action is needed. Our voluntary agreement with industry is clear that we expect to see the majority of alcohol product labels carrying the health information by the end of 2008, which is soon and well within the timeframe that my noble friend proposes.
It is fair to give industry, which has shown willing thus far, the opportunity to improve labelling without new regulation. And we have given the industry a reasonable period of time within which to meet the terms of the agreement announced last May. We shall be monitoring the industry to ensure that this has taken place, and have appointed CCFRA Technology Limited to carry out an initial collection and analysis of data from a sample of alcoholic drinks labels throughout the UK. A second sample will be taken towards the end of 2008.
I remind noble Lords of the Government’s position. While our voluntary agreement is not so prescriptive on placement, size and other things, we expect the industry to produce labels that consumers can easily read and take in. Visibility, legibility and intelligibility will be the key measures of effectiveness. It is clear that we must await the results of the monitoring, but I sincerely hope that the outcome is as positive as the Government and my noble friend would like. However, if it becomes evident that progress on implementing the agreement is insufficient and that the industry has not delivered, Ministers have made clear that they are willing to legislate following public consultation.
The Bill has given the Government the opportunity to consider what further action might look like. We are satisfied that primary legislation to require the industry to comply with the voluntary agreement would not be required since the Secretary of State for Health already possesses adequate regulation-making powers under the Food Safety Act 1990. That means that, should it prove necessary, and I sincerely hope it will not, the Government could make labelling mandatory through secondary legislation.
In summary, we support my noble friend’s aims, but we do not agree that his Bill will provide the public with information as swiftly or as effectively as we expect our voluntary agreement with the industry should do. Under the agreement, we expect positive changes to the majority of labels by the end of 2008. They should provide unambiguous, clearly presented information about units and guidelines on sensible drinking. We expect that labels should include information on drinking and pregnancy.
My noble friend’s Bill also has implications for the devolved Administrations. This is particularly true for Scotland where food labelling is a devolved matter and a Sewel motion would be required. Noble Lords must also be satisfied that details such as enforcement are properly provided for in each part of the United Kingdom. I am pleased to say that our voluntary agreement is UK-wide and does not present these difficulties.
Our preferred approach, for now, is a voluntary approach, but we are serious about labelling and have powers to extend regulation. If we are not satisfied that the industry has delivered, we will not hesitate to move to a mandatory scheme.
Lord Mitchell: The Minister has given me a lot to think about. I will consider very seriously what she said. I am delighted that the noble Baroness, Lady Coussins, is in her place. It was the right decision to postpone the Committee stage of the Bill. She has been very helpful. She was in hospital, and we are glad to see her on her feet. I am pleased that she is making a contribution to this. In the beginning, I was not absolutely convinced that she was on the side of the angels, but we have spent quite a bit of time trying to find a practical solution to these issues, and she brings a wealth of knowledge from her experience in the drinks industry. There are two areas where we do not agree, and I am certainly less strident than the noble Baroness, Lady Harris, on this issue. It will be interesting to see how the Committee proceeds.
Since Second Reading, there have been a number of developments that are well worth mentioning. First, the National Institute for Clinical Excellence, which had in some ways equivocated on this issue, came up with a strong position regarding alcohol and pregnancy. That was very good for all of us who have supported this position. Secondly, the BMA has been consistent in its support for what we are trying to do and supports compulsory labelling.
However, the most interesting thing that has happened relates to Diageo, which is a major drinks manufacturing company. It manufactures Guinness and lots of spirits, and is a leader in the industry. Its position on this is quite clear: it does not like a voluntary agreement and does not want one. It wants legislation. I went to see Diageo, and it issued a press release. I shall read what the managing director of Diageo Great Britain wrote; it is worth listening to:
“We believe that this is crucial if we are to avoid confusion among women. If a pregnant woman walks into a shop and sees two bottles of wine, one with a pregnancy message on it and another without, we want to avoid her thinking that one is better for her than the other. A voluntary labelling agreement would carry this risk”.
“We have been waiting for NICE to confirm its position. We believe that all alcohol producers should include the new guidance on their products. Now is the time for Government to make it a mandatory requirement. We should remember that information on labels is only one way to communicate a pregnancy message. Labelling will only be effective if part of a wider package of responsible drinking communication including programmes, interventions, websites and other resources”.
When it comes to it—when the independent survey to which my noble friend referred takes place—Diageo may well not have complied, because I do not think that it wants to. It is absolute: it wants in black and white what it should and should not do.
I listened to what noble Lords said about the amendment. I have thought a lot about the issue of miniatures. Clearly, you cannot have a label bigger than the bottle. That is not practicable. The American example is good. You may not be able to read it, you may need good eyesight to be able to read something on a small bottle, but it is there. It is part of a method of thinking; it is part of where we stand on the issue. I see no reason for any exception, even for miniatures.
In any other area, you do not get an exception just because you are a small business. It is absolute: if you have to do certain things, you have to. I cannot see the issue. Just as the rules on tobacco were a 100 per cent requirement that had to be complied with, exactly the same should be true of alcohol, without exclusions.
There are always issues about phasing in but, as my noble friend said, the Government will look seriously at what is the situation at the end of 2008. It is now May, and there are eight months ago, which is not long. By then, we will know exactly where we stand.
On the issue of pubs and clubs, which the noble Lord, Lord Monson, mentioned, I was in a bar in New York a few weeks ago with some friends. There in the bar—not on the glasses but with the bottles—was a clear message that stated that drinking when pregnant can affect the unborn child. There are various ways in which the message can be put across. Even in the club and pub culture, we can do that, as we did in the case of tobacco.
Baroness Coussins: Is the noble Lord aware that the Diageo commitment to mandatory labelling for pregnancy does not extend to miniatures? It has said that it would be happy to do it only on containers above that size. Because the noble Lord is so delighted with Diageo’s position, which I can understand, I wonder if that alone might persuade him to think twice about a specific exemption for miniatures. I shall not go to the wall on any of the other aspects, but that seems to me a logical thing to do.
The noble Baroness said: The amendment would remove the obligation to put the pregnancy advice on the brand label or the most visible surface. Amendment No. 29 is consequential on that. Amendment No. 28 concerns a related issue, which I will deal with at the same time. Amendment No. 6, in the name of the noble Lord, Lord Monson, to which I am sure he will speak, would do the same thing in relation to the pictogram or logo. I support that; I am sorry that I was not quick enough off the mark to add my name to the amendment.
Under the clause, the advice in the text would have to be put on the front label of the bottle. That is what “brand label” is understood to mean. I suggest that this would be overrestrictive and possibly counterproductive. The assumption in the voluntary labelling scheme is that producers have flexibility, as we heard from the Minister, over where the information and advice go. The phrase “the most visible surface” in any case is arguably subjective. What is it in the case of a can, a soft tube or a foil pouch, all of which are containers of alcoholic drinks that are currently on the market? Producers need the flexibility to incorporate this pregnancy advice in the most practical way, subject of course to legibility criteria, which we will come to later.
Another point that is worth making is that there is no case for separating the different elements of the sensible drinking message, which will be the case if the amendment is not accepted. The voluntary agreement deals with the five elements of the sensible drinking message, which go together en bloc on whichever place is the most suitable on the label. There is no case for separating out one aspect of the sensible drinking message. Placing them all together would have much more impact.
Insisting on the front label creates a rather unfair, and certainly unscientific, parallel between alcohol and tobacco. The voluntary agreement, as I said, includes the pregnancy advice as part of the overall sensible drinking message. There is no sensible smoking message. It may well have been necessary—I am sure that it was—to have strong legislation in the face of the intransigence of the tobacco industry to change, but this is patently not the case with the alcohol industry, which is willing to engage in a partnership with the Government to try to achieve a culture change. In this way, it is absolutely different from the tobacco industry.
Amendment No. 28, which applies to Clause 14 and is on a related point, would insert “primary” after “sealed” on containers. This is simply a pragmatic measure that would ensure that the advice appeared on the main consumer unit—in other words, the bottle, can, pouch or tube—and not on any outer or additional packaging such as the cardboard wrapper or the box of a multipack. It would be unreasonable to expect it to be incorporated on both, partly because of cost but mainly because it would be of little or no use to the consumer if it appeared on packaging other than the primary packaging. I beg to move.
Lord Monson: The noble Lord, Lord Mitchell, has gone a considerable way—although not quite far enough—towards meeting the concerns of those who have misgivings about the Bill. We thank him for that. I also thank him for tacitly accepting my recommendation that drinks containing less than 0.5 per cent alcohol should be exempt. I tabled an amendment to that effect when the previous Bill was in this House. It lapsed because the Bill proceeded no further, but I am glad that he has picked up on it.
I shall focus on my Amendment No. 6, to which I was glad to hear that the noble Baroness, Lady Coussins, lends her strong support. Most of the amendments of the noble Lord, Lord Mitchell, would convert the Bill into an enabling Bill, leaving this or a future Government to decide on precise details such as the size of the lettering, the colour of the labels and so on and so forth.
- “brand label, or on the most visible surface”.
A future Government could require the lettering to be six inches high and printed in fluorescent ink, or half a millimetre high and printed in pale grey. They would have no choice over the siting of such advice. That these words should remain in the subsection would be inconsistent with Amendment No. 29, to which the noble Lord, Lord Mitchell, has put his name, which deletes exactly the same wording from Clause 14. That reinforces my supposition that his failure to put his name to the deletion of these words was inadvertent.
The noble Baroness said: Amendment No. 3 and those identical to it deal with replacing the word “warning” with the word “advice”. Again, the parallel with smoking is an issue. For tobacco products, the word “warning” is justified. The messages on packets of cigarettes, such as “Smoking kills” or “Smoking causes serious damage to your health”, are warnings. But in the case of alcohol, this Bill is seeking the promotion not of a warning but of advice. It cannot be a warning, partly because we do not know enough for it to be as bold as with smoking. Private Members’ Bills should of course be evidence-based even if they are not obliged to come up with a regulatory impact assessment.
“Determining the incidence of FASD is complicated by a lack of reliable and consistent data collection, and the difficulty in diagnosing the range of disorders. Consequently, the incidence of FASD in the UK and internationally is not accurately known. The relationship between maternal alcohol consumption and the development of the range of disorders is not fully understood”.
“As a general rule pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to protect the baby they should not drink more than one to two units of alcohol once or twice a week and should not get drunk”.
The second part of that advice is extremely important. It is not just about the dangers of damaging the foetus, but also about excessive alcohol consumption having an adverse impact on fecundability or the chances of conceiving in the first place. I believe that the Department of Health knows from recent qualitative research that this aspect of its pregnancy advice is less well known and less well understood by the target audience, so it is particularly important to include. I am very supportive of the text proposed in this Bill, apart from the words “GOVERNMENT WARNING”.
We also know from research over several years that people’s responses to so-called health warnings are not positive and can even be counterproductive. It is much more sensible to position this in terms of advice. I propose to delete the words “GOVERNMENT WARNING” from the beginning of the prescribed text because we must start from the consumer and what we know about how they would respond to public health messages. Having what is called a warning would be bad enough, but I am afraid that something calling itself a government warning is doubly bad for the chances of its being taken seriously. There is simply no need for it; let us concentrate on advice. In any case, all labels will carry the Drinkaware website address, which has detailed information about alcohol and pregnancy. I beg to move.
Lord Monson: It is hard to add anything to the excellent argument made by my noble friend Lady Coussins. Before we leave Clause 1, I want just to refer to something that I do not think has been mentioned, although I was not able to be here for the Second Reading debate—it was held on a Friday, which as noble Lords know is not the easiest day to be in the House.
The noble Lord, Lord Mitchell, will correct me if I am wrong, but I do not think that any mention of pictograms was made in his earlier Bill, which had to be withdrawn. It is an interesting idea and in many ways a pictogram may be better than a written warning. However, while one can visualise easily a pictogram of a pregnant woman, one of a woman trying to conceive is rather more interesting. All sorts of images come to mind, some of which might fall foul of the censorship lobby. Has any thought been given to this? Perhaps there is an American example that could be copied. It may sound frivolous, but it is an interesting point mainly because, as the noble Lord, Lord Mitchell, told us on the last occasion, it is when a woman is trying to conceive or has just done so that the foetus is in the most danger.
Lord Mitchell: I shall deal first with the questions raised by the noble Baroness, Lady Coussins. I agree that “advice” is a better word than “warning”. Having thought about it and discussed it, I think that we are giving advice rather than issuing warnings. I feel quite
comfortable with the changes and I accept the point that a government warning is for most people a red rag to a bull. It is good that the word will be removed.
To answer the point raised by the noble Lord, Lord Monson, I should tell him that in France a very effective pictogram is used. It shows the outline of a woman who is clearly pregnant and holding a glass of champagne, as they would in France, surrounded by a clear circle with a cross through it. It makes the point that, whether you are pregnant or thinking about becoming pregnant, alcohol should be avoided. I do not think that any more graphic an example is necessary.
The noble Lord said: I have already spoken to this amendment, but the noble Lord, Lord Mitchell, chose not to respond to it when replying to Amendment No. 2. However, it is an important amendment because the wording here is anomalous and does not chime well with Amendment No. 29, which deletes precisely the same words in Clause 14. I wonder whether he might give his view on whether he mistakenly left these words in and would be prepared to remove them, if not at this stage, at the next one. I beg to move.
“(4) No advice as required by subsections (1) and (2) shall be required on any container if the producer of that container is in compliance with the voluntary labelling agreement between the alcoholic drinks industry and the Department of Health as expressed in the Memorandum of Understanding dated 24th May 2007.”
The noble Baroness said: This additional subsection would prevent the most responsible producer companies in the industry being penalised for their leadership by having to go to the trouble and expense of changing
their labels yet again, in line with the Bill’s requirements, when they have already complied with the voluntary scheme which is nearly but not quite the same. The option of the wording or the logo is the same apart from the words “Government Warning”. There is flexibility within the voluntary scheme to put the advice on the back label as part of a block of text which also includes the key aspects of the sensible drinking message; namely, the daily unit benchmarks for men and women, the unit content for the particular container, the Drinkaware website address and a responsibility message.
The memorandum of understanding setting out the voluntary scheme deals with pregnancy advice as an important integrated aspect of the sensible drinking message and there is no good reason to separate it out, as the Bill requires. It would be a crying shame for the Bill to undermine the voluntary agreement which has been reached following detailed negotiations between the Government and the industry. It would risk sending out a negative message to the industry about how worth while it may or may not be in the future to work in partnership with the Government and, indeed, with other stakeholders in this way.
As we heard from the Minister, the Government intend to review progress on implementation of the scheme towards the end of 2008 and they hope that the majority of product labels will be suitably amended by then. Compliance levels, or commitments to introducing the new production cycles required to achieve compliance, are already respectably high across the industry; I referred to some figures in the Second Reading debate which I shall not repeat here. I am glad that the noble Lord, Lord Mitchell, by adding his name to the amendment, seems happy to accept that it would be fair and just to expect the provisions of his Bill to apply only to those who have not complied already with the voluntary scheme. I beg to move.
Lord Mitchell: I accept what the noble Baroness, Lady Coussins, says on this. The way the wind is blowing is clear from what my noble friend the Minister said. We already have a memorandum of understanding. If that is not complied with, it is clear that the Government will come down like a ton of hot bricks—or at least I hope they will. People in the industry will read this debate and be well aware of what is behind it all. I am happy to go along with the amendment and to lend my name to it.
Baroness Coussins: Thank you. It would be sensible to lose Clauses 2, 3 and 4, and it would not damage or reduce the overall impact of the Bill to do so. As they stand, the clauses are over-restrictive, inflexible and not helpful.
Clause 2 is superfluous given that the food labelling regulations, which also cover alcoholic drinks, already prescribe for clarity and legibility. The relevant parts of the Food Labelling Regulations 1996 state that any information on labels,
- “shall be easy to understand, clearly legible and indelible and, when a food”—
- “is sold to the ultimate consumer, the said particulars shall be marked in a conspicuous place in such a way as to be easily visible … Such particulars shall not in any way be hidden, obscured or interrupted by any other written or pictorial matter”.
I cannot see any reason to go any further than that, in the interests of consistency—which, after all, is one of the five principles of better regulation, an agenda enthusiastically endorsed by the Government. I shall read a couple of sentences from the guidance on the consistency principle produced by the former Better Regulation Commission, on which body I used to sit:
It is really not in producers’ interests to put consumer information on labels that is illegible. Retailers would reject it, and so would consumers. The value and importance of reputational risk should not be underestimated.
Many of the same arguments apply to Clause 3, where the over-prescriptiveness could end up being counterproductive, partly because of the design of labels—if the label were black and/or red, the impact of the requirement here could be completely lost—but partly because if pregnancy advice is being included as part of the wider sensible drinking message, as in the voluntary agreement, the design and positioning of the package as a whole needs to be addressed by the producer companies. It is too restrictive and illogical to compel them to observe particular requirements for one aspect only out of the five-point plan.
Industry needs flexibility to research and introduce improved logos or pictograms as well. We have been talking about the French logo and heard a description of it, but producers need the freedom to investigate consumer insights so that they could possibly offer improved variations on that in future. I am aware of consumer research recently done in Japan that showed
that consumers on the whole assumed that that particular logo meant that alcoholic drinks had contraceptive properties, and it would be a bit of a disaster if that happened here. We cannot assume that logos will be set in stone or that the prescriptive way in which the clause is currently framed is the best way to do it.
There is a short and simple reason for Clause 4 not to stand part: it is not necessary. It is already a legal requirement under food safety legislation, which covers alcoholic drinks, that manageable product recalls should be facilitated. The Food (Lot Marking) Regulations 1996 require containers to be marked in order to identify the batch to which the container belongs. Many of those markings are actually minute codes, providing precise information on the time of packaging and the line number on which the product was packaged. I simply cannot see what additional reasons relating to alcohol and pregnancy would require anything further, or for the existing law to be restated.
Lord Monson: Once again, the noble Baroness, Lady Coussins, has made her case so well that there is no need for me to embellish it. We are pushing against an open door, in that the noble Lord, Lord Mitchell, has been kind enough to accept the deletion of these clauses. I must express some peripheral regret at the disappearance of Clause 2, which demonstrates—if demonstration were needed—the way in which imperial and metric measurements can coexist in perfect harmony in a potential Act of Parliament. There is no need for heavy-handed bureaucracy or the heavy hand of the law to outlaw one form of measurement. I suppose I should declare an interest as a patron of the British Weights and Measures Association, as was the late Gwyneth Dunwoody, whom we shall all miss.
Lord McColl of Dulwich: I am always in favour of simplifying things and getting rid of bureaucracy. On the size of the print, however, I have studied quite a few wine bottles, and I have noted that when the warning is about 1 millimetre high, it is very difficult to read. As the noble Baroness, Lady Coussins, said, it also depends on the colour of the label. Black print on a red background is extremely difficult to read.
Lord Monson: I wonder whether the noble Lord, Lord McColl, has understood that it will be up to the Government of the day to decide on the size of the lettering and the colouring. It is not in the Bill, but it has been turned into an enabling Bill. I think that that answers his concerns on that point.
Lord Monson: I see the point of Clause 5, but if somebody buys a can of beer at an alcoholic strength of 3 per cent, it is half as dangerous as a can of a rival beer which has 6 per cent alcohol. It seems rather draconian to say that this should not be pointed out. I suppose that the purveyor of the weaker beer should not say, “This is much safer for pregnant women than my rivals”. I suppose it would be acceptable in that case. The stronger the alcoholic beverage, the more dangerous it is.
The noble Baroness said: The purpose of this amendment is to ensure that we do not leave any enforcement loopholes. The best way of doing that is to go for simplicity. It may seem at first sight that to delete every paragraph and replace them just with the words “local authority” is a little imprecise, but I have proposed this catch-all wording because of advice that I have received from LACORS, the local authority co-ordinating body for regulatory services. Taking the remit of the food labelling regulations, which also cover the labelling of alcoholic drinks, LACORS states that the enforcement authority would be,
- “a combination of TSOs in County Councils and Unitary Authorities in England and Wales; EHOs in London Boroughs, Metropolitan Authorities in England and in Scotland and Northern Ireland. In other words, enforcement by ‘Local Authorities’ would cover all eventualities”.
The noble Baroness said: I propose through this amendment to downgrade the potential penalties for breaches of the labelling requirements under the Bill. I do so for reasons of consistency and proportionality—two of the better regulation principles. I have already read out a bit of the advice on the principle of consistency; on proportionality, the advice is as follows:
The first comparison that I would make is, again, with the Food Labelling Regulations 1996, under which any person found guilty of an offence is liable on summary conviction to a fine not exceeding level 5 on the standard scale, which is currently up to £5,000. The kind of offences that we are talking about under the food labelling regulations would be misleading nutritional information, selling food after the use-by date or not marking or labelling the product in compliance with the regulations. We are looking at a comparable type of message or advice in the Bill. No term of imprisonment is mentioned in the food labelling regulations and no reference is made to conviction on indictment.
There is another comparison, which I suspect the noble Lord, Lord Mitchell, would rather make—the penalty under the Tobacco Products (Manufacture, Presentation and Sale) (Safety) Regulations 2002, under which an offence would attract a penalty harsher than the one that I propose in that it specifies on summary conviction a term of imprisonment not exceeding three months or a fine not exceeding level 5—but please note the either/or. So even here there is no additional mention of a penalty on conviction on indictment of up to two years’ imprisonment, as is currently in this Bill. The penalty is also clearly either three months or the fine, whereas in the Bill it could be both—although I see that the noble Lord intends to try to change that himself. Would he consider going further still and support my amendment, taking the view that the parallel with the food labelling regulations and not the tobacco regulations is the fairer and more consistent approach?
As I argued earlier, we are not in a tobacco situation here: we are talking about advice, not a warning. Smoking kills, whereas alcohol in moderation can be beneficial to some groups in the population. Even in the very specific and special circumstance of pregnancy, it is important to keep things in a proper perspective. I would hate us to fall into the trap of sending out disproportionately alarmist messages and thereby cause problems, not alleviate them, as happened in the USA and Canada in the 1980s, for example, when completely unfounded misinformation about foetal alcohol syndrome reportedly led to unprecedented distress, anxiety and even requests for abortion on the part of healthy women who had been light drinkers, but were scared by the way in which the media and others had distorted research findings that were applicable only to women who were clearly problem drinkers and consuming very high levels of alcohol.
We are not dealing with a potential offence that should be capable of putting someone behind bars for two years or at all. A fine at level 5, which is the most severe level, is adequate. Anything more than that could be counterproductive, as it could be seen as so disproportionate that convictions would be unlikely. That would, in turn, defeat the whole object of creating an offence. I beg to move.
Lord Monson: Once again, the noble Baroness has put the case extremely well and I cannot really add to it. The key word is “proportionate”. For the reasons that she mentioned and the comparison that she has drawn, this suggestion would be disproportionate. There is also a practical aspect. As I said at Third Reading of the Criminal Justice and Immigration Bill, our prisons are full to bursting. Unfortunately, the Government are creating more offences for which people can be sent to prison, but this is crazy for practical reasons let alone moral ones. I would have thought that a fine—possibly an unlimited fine—and not imprisonment is the right penalty for such an offence.
Lord Mitchell: This is another clause on which we disagree. On the fears that women might have in this country, given the amount of media publicity on foetal alcohol syndrome and the dangers of drinking when pregnant or thinking of becoming pregnant, I think that most people have begun to get the message by now. I am not sure that that is particular.
I have a real problem with this amendment. I cannot see that there is any difference between a label on a packet of cigarettes and a label on a bottle of alcohol. A label is a label. There would be a legal requirement and if somebody chooses not to comply, they should face the same penalty as for tobacco labelling. As far as I am concerned, the clause should stay as it is in the Bill. As far as a fine is concerned, who would be the transgressors? They would be supermarkets, manufacturers and whoever. If they are fined, they are fined and they will just get on with life. There should be real teeth to this provision and the wording in the Bill should stand.
Lord Monson: Could we hear from the Government? This is an important matter. The Government are rightly concerned that our prisons are full to bursting point. They must have a view on whether it is wise to provide for the possibility of imprisonment for such an offence.
Baroness Thornton: The Government’s position is that, should we legislate, we will consider what penalties are most appropriate, using as a starting point the penalties in similar legislation such as for food labelling.
Clause 14, page 7, line 38, leave out from “any” to end of line 40 and insert “pre-packaged alcoholic drink above 0.5% alcohol by volume, including any product developed or marketed primarily as an alcoholic drink notwithstanding that the product—
(a) is classified as a foodstuff for the purposes of licensing or customs and excise legislation, or(b) appears to be solid or heavily textured (or can be made to be, for example, by freezing or shaking).”
The noble Baroness said: This amendment proposes a more comprehensive definition of “alcoholic beverage” that takes into account innovation over recent years in the drinks industry, and without which some products that are particularly popular with young adults may find themselves in a loophole and able to escape the Bill’s obligations.
It is too restrictive to define “alcoholic beverage” only as something in liquid form. When I worked at the Portman Group and we were strengthening the code on the naming, packaging and promotion of alcoholic drinks, we realised that some products might avoid the code’s remit unless we updated the definition to take account of products which looked more like solid or semi-solid crushed ice, gel, jelly, thickened cream or had some such texture. Sometimes these products are not even classified as alcoholic drinks for licensing purposes. The Portman Group upheld a complaint against one of these products that appeared on shelves next to sweets and baking products. It had a very high alcoholic content and was attractive to children. The code got rid of it by ruling against its packaging and getting the retailers to destock it.
The definition proposed in my amendment is taken from the definition used in the Portman Group’s code. I am happy to note that the noble Lord, Lord Mitchell, supports this amendment, which would ensure that the alcoholic products that would be captured by this
definition would be covered by his Bill, or any other requirements concerning pregnancy advice on labels. I beg to move.
Lord Monson: I did not add my name to this amendment because, frankly, I did not understand entirely what it was getting at. However, now that it has been explained I do understand and it makes perfect sense and I support it. However, I raise liqueur chocolates in this regard. This is not frivolous. In the days when I used to ski—they are, alas, long since gone—I used to enjoy stopping off at Geneva on the way out and on the way home and picking up a few bars of something quite delicious at the airport or railway station called Gouttes de Kirsch. It was a chocolate bar containing full strength kirsch. A woman suffering cravings during pregnancy could easily demolish a bar or two of these. I reckon they contain as much alcohol as a miniature, perhaps more. I wonder whether consideration has been given to that. Liqueur chocolates are not very fashionable in this country nowadays but if you had a craving for them and ate a bar a day you could presumably do yourself harm.
Lord McColl of Dulwich: I draw attention to a very small point regarding alcoholic drink above 0.5 per cent alcohol by volume—0.5 per cent means 0.5 of a gram per 100 ml, so one does not need to include “by volume”.
Lord Mitchell: The amendment is a very useful contribution by the noble Baroness, Lady Coussins. It was suggested by her and it deals with an area which, frankly, I had not anticipated. In response to the noble Lord, Lord Monson, surely chocolates containing alcohol are covered by paragraph (a) of the amendment which states, “classified as a foodstuff”. I would think that his delicious chocolates are probably covered as a foodstuff. I am also pleased that the 0.5 per cent mentioned by the noble Lord, Lord McColl, is a threshold requirement.
Foetal Alcohol Syndrome
Health written question – answered on 20th March 2008.
Norman Lamb: To ask the Secretary of State for Health how many children were born with (a) foetal alcohol spectrum disorder and (b) foetal alcohol syndrome in each of the last five years, broken down by region. 
Foetal Alcohol Syndrome
Health written question – answered on 20th February 2008.
Special Educational Needs (Information) Bill
Orders of the Day – in the House of Commons at 9:33 am on 1st February 2008.
Lynda Waltho PPS (Rt Hon David Hanson, Minister of State), Ministry of Justice 11:38 am, 1st February 2008
Information that will be gleaned as a result of the Bill’s introduction will help to encourage wider training in this area, or at least make it easier to make the point to the agency. The profile of children’s disability is changing. Many children are born pre-term, giving rise to complex SEN problems that we have not previously encountered. The profession does not always have adequate teaching and learning strategies to hand to provide effective education for those pupils, let alone register their attainment. I am particularly concerned about pupils with foetal alcohol syndrome, which is estimated to affect between one and three of every 1,000 live births. That means that 28 babies are born each week in the UK with FAS. That is a conservative estimate, because the syndrome is not always recognised, and there is a lack of diagnostic expertise. Some 7,500 babies a year are born with FAS.
I applaud my hon. Friend for raising the issue of foetal alcohol syndrome, which is something in which I have considerable interest. She mentioned the number of babies born with FAS, but there is evidence, too, of a wide spectrum of problems. The total number of children damaged by alcohol in the womb may be higher than that for all the other birth defects put together.
My hon. Friend is absolutely right. We know about the cases that are diagnosed: children born with FAS constitute the largest group of children with non-inherited disabilities, and their number is growing in the UK. At least with the Bill in place, we will be better able to plan, train and develop, and ultimately improve the outcomes for those children.
Health and Social Care Bill – in a Public Bill Committee on 24th January 2008.
I thank the hon. Lady for her intervention. She used the words “working classes”, I did not. I am saying that there is no denying the fact that there is a hard-to-reach group. They might be in the middle classes; they might be those members of the middle classes who are alcoholics sitting at home drinking themselves stupid, and whose babies will be born with foetal alcoholsyndrome. We have to use generalities; there is a hard-to-reach group. They are not necessarily working-class, but the hon. Lady might pay more attention to inequalities in health than making comments about language. It is absolutely vital that we reach those women.
Health and Social Care Bill – in a Public Bill Committee on 24th January 2008.
Paragraph 5.4.1.ii of the review examines in depth the role of nutrition. The hon. Member for Luton, North might be particularly interested in it, considering his line of questioning at the oral evidence sessions. He was pursuing with clear determination the point about foetal alcohol damage. That paragraph states:
“Although it has been argued that maternal nutrition during pregnancy has an important effect on fetal growth (Barker 1992) evidence of a relationship in generally well nourished populations like that of the UK is inconclusive (Haste 1991, Godfrey et al 1996; Matthews et al 1999). Smoking and high alcohol intake are probably more important environmental causes of fetal growth constraint in such circumstances…the relationship between dietary factors during pregnancy, outcome and birth weight are not strong.”
Alcohol Labelling Bill [HL]
– in the House of Lords at 10:06 am on 18th January 2008
Lord Griffiths of Burry Port: My Lords, on behalf of my noble friend Lord Mitchell, and with the permission of the House, I rise to speak at this point in the debate and to move that the Bill be now read a second time. Some have greatness thrust upon them.
I am glad that the Bill is of such a length that I could read it properly and prepare myself in a way that allows me to speak first on this issue. I was drawn to it as a subject when I believed that its field of application would be more widely drawn than has turned out to be the case. However, even this discrete area of proposed legislation allows me to consider the points that would have been perhaps more germane had there been a wider field of reference.
I begin with both a disclaimer and an expression of interest. The disclaimer is that I speak, of course, as a Methodist—but a Methodist with a very nice wine cellar. In case there might be some misapprehension, I am proud of my church’s teaching on questions of social importance across the generations, but life is too short to go without the pleasures of life and we must find a proper way of enjoying them and, at the same time, safeguarding the vulnerable and the weak. I believe that the Bill makes one such proposal along those lines.
The expression of interest is that our daughter will, within three or four weeks’ time, produce her first child. Our daughter loved the social life, which involved the consumption of alcohol and the smoking of cigarettes, prior to her pregnancy. My wife and I have watched with personal interest my daughter’s stance on those pleasures as she began, with her husband, to think of starting a family. With great pride we can say that her readiness and her ability to give up both habits have raised her considerably in our already rather aggrandised view of her qualities.
As she is to give birth to her first child, our first grandchild, in Cambodia, I think that the misspelling of my title on the Order Paper suggests some kind of Freudian slip on someone’s part, but I am very grateful for the great care and attention that has been given to making me feel very much at home.
give the right kind of warning and to display that warning in the proper place—visibly—to make its own point. I do not think the debate will involve noble Lords putting forward an opposing point of view.
The reason I felt drawn to the debate is largely that I want us to remind ourselves that we should not imagine that by putting such a Bill on the statute book we will cure or solve the problem we are envisaging. In other areas of life in recent times, we can see where similar animadversions have been brought to bear on our social mores and have brought short-term benefits. For example, the safe sex campaign made a great impact when it was launched with all the advertising that went with it—some of it negative advertising showing the danger of HIV/AIDS—but more recent reports have shown that unsafe sex and sexually transmitted diseases are on the rise again. So there may well be a partial and immediate benefit to be gained from the Bill—I certainly want it to happen—but we should not imagine or delude ourselves that it will solve the problem once and for all.
A similar thing has happened in the area of smoking, where health warnings abound. It is one of the ironies of life to see people clutching a packet of cigarettes that has a health warning which is visible to those looking at the smoker; whether it is visible to the smoker is another matter altogether. When one realises the recidivism and the dependency that are built into some of these pleasures, we should never imagine that what we are considering today will once and for all deal with the problem.
How do we effect a change of culture? How do we create an ethos within which people recognise the choices available to them and choose sensibly? How do we avoid the repression of the culture I grew up in, which was so condemnatory of anything that purported to carry pleasurable connotations? How do we avoid the obvious negative aspects of that without just moving into a free-for-all ethos in which it seems that anything goes? In a post modern culture where we make up our own ethics as we go along, nothing can be supposed to be bad. How do we avoid those two extremes? It is a Scylla and Charybdis situation. Those of us who are associated with bodies that, in the public mind and common perception, are negative, condemnatory and judgmental institutions find it very difficult to persuade others that there might be proper and objective grounds for some of the restrictions and that the desire to rein back the licence is reasonable.
I commend the Bill on behalf of my noble friend. I thank the House for giving me the delusion that I am a Front-Bench spokesman and I hope that the Bill will be warmly endorsed—with the caveats that I have described.
Baroness Coussins: My Lords, I agree absolutely that it is vital for women who are pregnant, or who are planning to be, to know about the effects of alcohol on the developing foetus so they can decide
whether they should modify their drinking in the interests of the baby’s health. I also agree that putting information or advice on the labels of alcoholic drinks is one important way to promote awareness of that message. The question for me is only whether imposing a statutory duty is the most effective way to achieve that.
I hope I might convince the noble Lord, Lord Mitchell, when he reads this speech, that he would see his underlying objective amply fulfilled by placing his confidence in the voluntary labelling agreement announced last May by the Government and the industry. Legislation at this point would have a disproportionately adverse impact on the industry without achieving any significant increase in women’s awareness of the impact of alcohol on pregnancy and would almost certainly produce no change in their behaviour. Indeed, some evidence suggests that if consumers are presented with information cast as a warning, as proposed in the Bill, they are likely to react unfavourably, especially if the warning comes from the Government.
If I thought that labelling was the only or the most effective way to inform women about alcohol and pregnancy, then I would have no reservations about supporting the Bill. If I thought that pregnancy labelling could be achieved only by forcing the industry to do it with legislation, I would again have no reservations. The fact is, however, that the industry has moved significantly on this issue since the noble Lord, Lord Mitchell, last introduced his Bill a year ago. I know from my 10 years as chief executive of the Portman Group that the drinks industry can often be spurred into redoubling its efforts and speeding up its actions on social responsibility if there is the threat of legislation as a backstop. However, the situation on this issue is that voluntary commitment to pregnancy labelling, if I can call it that for short, is now so widespread that the disadvantages of legislation simply outweigh the benefits of having the threat of it waiting in the wings in case voluntary labelling fails.
I want to develop my argument a little bit more. Your Lordships should know that although I no longer work for the Portman Group, I have an interest as a non-executive adviser on social responsibility to Brown-Forman, a global wines and spirits company. In my earlier career in the voluntary sector, I worked and campaigned with a number of organisations concerned with maternity and infants’ rights and welfare.
First, there is the question of timing. The Government and the industry have agreed a five-point voluntary labelling scheme, one element of which is pregnancy information that is broadly in line with what the Bill proposes. The Department of Health will monitor compliance throughout 2008 and has said that it will decide at the end of the year whether legislation is justified. The noble Lord, Lord Mitchell, knows that when his Bill comes to Committee I shall be as helpful as possible, but in the light of this timetable for the voluntary agreement I am hoping he might agree that it is putting the cart before the horse to deal with the Bill now.
wine sector first, 23 per cent of the UK market is supermarkets’ own-label brands, and all these retailer chains have already begun the production process to include the pregnancy advice on the label. Some are in the shops already. The largest wine company in Europe, Constellation, has a further 22 per cent of the UK market. It already has the French logo on some brands and will include it on 80 per cent of its brands on the UK market by this autumn. Half a dozen other global companies have between about 1 per cent and about 8 per cent each of the wine market, and several of those have also already agreed that they will adopt the pregnancy labelling point within the voluntary agreement. Most of the remaining 35 per cent or so of wine here comes from French companies and is already labelled accordingly.
In the spirits sector, the retailers’ own brands are over one-third of the UK market, and again are already carrying the pregnancy advice or will certainly do so shortly. Of the five or six major producer companies which, between them, account for virtually all the rest of the UK’s spirits market, half are already committed to including the pregnancy advice on the label, including, I am pleased to say, the company I advise.
In the beer sector, supermarkets’ own brands are a very small part of the market, although all these now carry the pregnancy advice or have a production timetable in place to do so. It is the same with the two major producers whose brands between them make up 40 per cent of our beer market. Another two are actively considering it and others which are currently unwilling might well change their mind if there were consistent medical advice, a point I shall return to in a moment.
I hope noble Lords will agree that this represents genuine progress. I believe that by the end of the year, when the department evaluates the scheme, a significant majority of total product in the UK market will carry the pregnancy advice. Ironically, if the Bill proceeds, progress is likely to dry up because companies will no longer be sure what is expected of them. They will not want to invest this year in one new label design only to face a new statutory scheme next year. Those already complying with the voluntary scheme would effectively be penalised by having to fund two changes. It is unfair to penalise the industry’s most responsible companies in this way.
A key milestone which could trigger further compliance will be when we know the outcome of the review by the National Institute for Health and Clinical Excellence. At least two of the very largest drinks producers are currently holding back from pregnancy labelling because they are, quite defensibly, reluctant to put their reputation on the line and even risk legal action by carrying misleading or inaccurate information. In the past year we have seen conflicting advice from the Department of Health, NICE and the Royal College of Obstetricians and Gynaecologists. Although the chief medical officers are agreed, this really must be underpinned by a solid consensus among the scientists and practitioners, otherwise the reluctance of some drinks companies will remain with good reason, despite their genuine wish to play a part.
Noble Lords might say that if the majority of the industry is so sympathetic to pregnancy labelling and so many are already doing it, why would it be so dreadful to make it mandatory? Legislation would not ask the good guys to do anything they are not doing already, so what is the problem? The problem is that the price of mandatory labelling for all brands of all alcoholic drinks would be a disproportionate cost and serious threat to the viability of many small businesses, with a consequent impact on consumer choice. This would apply particularly in the wine sector, where thousands of small producers from all over the world, using hundreds of UK agents, use the UK market to test thousands of new wines every year. We are talking about a very small percentage of the market in volume terms, but the cost to these companies of labelling for just one market would be prohibitive and might even raise questions about fair practice within the EU’s competition regime. It would also mean that choice for the vast majority of UK consumers—who are not pregnant—would be diminished. A regulatory impact assessment is needed to calculate the effects of what may seem like a modest labelling requirement but which could have much wider ramifications.
I would happily argue that all this would be a price worth paying, and well worth paying, if it were the case that only by labelling could we inform women about the effects of alcohol on pregnancy, or even if it were the case that there was a vast knowledge gap that needed to be plugged. But neither of these things is true. In June, the Government published the revised National Alcohol Harm Reduction Strategy, which revealed that the proportion of mothers who drink during pregnancy fell in the five years between 2000 and 2005. Some 46 per cent said that they did not drink anything at all and 92 per cent of the rest drank two units or less a week. This is absolutely in line with the advice endorsed by the chief medical officers; that is not surprising, as nearly three-quarters of mothers who drank said that they had received information about drinking in pregnancy, mainly from their midwives. The others may just have been following the message from their own body which, in my experience, stops you drinking the minute you are pregnant by making you feel nauseous at the very thought.
The Government also said that they would be launching a new campaign in April this year to ensure that women are aware of the revised advice. Labelling is a sensible way of reinforcing this advice, but is by no means the primary source of information for women. Indeed, were it down to labelling alone, we should almost certainly not have such a positive story to tell. Research in the US and Denmark suggests that pregnant women’s attitudes are largely independent of the advice they get on health warning labels.
So my conclusion is that the price of forcing every producer to label every brand is not justified either by the information gap among women or by the role played by labelling within the whole range of sources of advice available. The department seems to accept this point, because it stated in the voluntary agreement that,
- “it may not be practicable or may be disproportionately costly for labels of some products to carry all or any aspects of the sensible drinking message”.
There is one other argument against legislation, to do with the principles of better regulation. If a policy objective can be achieved through voluntary action or self-regulation, it is surely a waste of public expenditure and an unwise use of parliamentary time to create, administer and police a system that the industry is demonstrably able to produce and pay for itself.
I also think that there are ways in which the Bill could be more proportionate and consistent, and I will mention them in passing, leaving more detailed discussion for the Committee stage. For example, I should have thought that the guidance on legibility of labels from the Food Standards Agency would be perfectly adequate for drinks containers, without having to go further and be as prescriptive as the Bill. The penalties also seem excessively harsh, given the existing penalties.
A lot of emphasis has been placed on action taken on labelling in other countries, particularly within the EU. But I think that the UK is leading, not catching up. France is currently the only other member state with a statutory requirement for pregnancy labelling. Finland and Sweden will follow suit, and there are discussions in a small number of other countries. But in this context, the UK’s voluntary scheme and its likely impact of a very high percentage of market volume being labelled by the end of this year looks pretty impressive to me. What would be unhelpful would be 27 different statutory schemes, each requiring a different format and different message. Already quite different labelling protocols are emerging in France, Finland and Poland. The Bill would add to the variety and the confusion. If there has to be legislation, it would be far better from the point of view of the industry and, I think, the consumer, for it to be a single piece of EU legislation prescribing a common and consistent approach across all markets.
I think that the voluntary agreement on labelling will achieve the step change in information which the noble Lord, Lord Mitchell, seeks through the Bill, but without the unintended consequences and disadvantages that I have outlined. As for improvements in behaviour in the light of that information, in the end that is down to women themselves.
The Earl of Listowel: My Lords, I support the Bill, as vice-chair of the Associate Parliamentary Group for Children and Young People In and Leaving Care and treasurer of the All-Party Group on Children. The noble Lord, Lord Mitchell, does a great service to the public by bringing this Bill forward and by his consistent pressure in this area. I listened with interest to my noble friend Lady Coussins. It is of great benefit to the House to have her expertise in this area brought to bear on this matter. I disagree with much of what she said, but I hope that the dynamic between support for the measure and a strong opposing voice will add value to the Bill as it goes through the House.
I have been put in mind of the seductive commercials for advertising alcohol at Christmas. It is hard to reconcile the impetus from business to sell its product with the need to protect certain people from the harm that can arise. I am reminded of the work that Her Majesty’s Government have already done in introducing welcome measures to protect the public from the harms of cigarette smoking. I remember being horrified when I heard about the impact of tobacco smoking during pregnancy. I read about the likelihood of low birth rate, with all its associated risks. I learnt how exposure of the foetus to toxins from tobacco could lead to reduced intelligence and to the individual being of a smaller stature when he is fully grown. If the Government are to be consistent, they should accept this Bill, which should provide similar benefits for children.
We are all aware of the increase in binge drinking and particularly of young women becoming less prudent in managing alcohol. I was grateful for the encouraging statistics from my noble friend on the number of women who have been listening to medical advice and reducing alcohol consumption while pregnant. I have a particular concern about those women who become dependent on alcohol; they need the strongest and most explicit message to ensure that they desist during pregnancy. Will the Minister say what the estimated level is of women who are alcohol dependent and what the trend has been in recent years with regard to those women?
A year ago I had the opportunity to speak to some alcoholics and I was struck by two things. The first was the capacity of alcoholics to delude themselves. They would attempt to remain sober, but when they saw the opportunity for a drink they told themselves that to have one would not hurt—and then they would find themselves waking up in a park two days later. Secondly, I was struck when a woman said that when she was carrying her baby she reduced her alcohol intake, moving from spirits to wine and stout. She could see that in retrospect she had deluded herself and failed to protect her baby.
I welcome the chance that this Bill offers to reinforce to women who are alcoholic or on the verge of being so the message that by drinking they are harming their baby. The more explicit one is about the risks to their child, the greater the chance that they may seek to desist from drinking. They may even approach an organisation such as Alcoholics Anonymous for help; it may even be the opportunity for them to stop drinking for good and spare their child the risks associated with being reared by an alcoholic mother. I would read to your Lordships some comments made during a conference on women and alcohol, led by Alcohol Concern—comments that were made by children on ChildLine—but I cannot find them in my notes at the moment. A significant number of those calls were associated with children talking about their parents’ alcohol problems.
I look forward to the Minister’s response. I hope that she will lay out the timescale expected for the industry to implement what is proposed and that she will assure the House that the warnings coming from the industry will be as explicit and strong as possible.
Lord Mitchell: My Lords, here was I thinking that I was 45 minutes early. I thank my noble friend Lord Griffiths for moving the Motion on Second Reading of this Bill and for the generosity of the House in allowing me to speak at this point.
This Alcohol Labelling Bill is almost identical to the Bill that I introduced into your Lordships’ House last year. It differs in one respect only, which I will come to later. Last year’s Bill hit the buffers when an amendment was introduced by one noble Lord, which effectively killed it off; the usual channels told me that no time would be made available later in the parliamentary Session. This time around, I have reintroduced the Bill much earlier in the Session. Private Members’ Bills always have to battle against the constraints of parliamentary time both here and in the other place.
Noble Lords will be delighted to hear that I am not going to repeat the speech that I gave at the previous Second Reading. The list of speakers today is relatively small, but noble Lords who are speaking have great expertise in this area and I am sure that all the issues will be addressed. What I will do is repeat in summary the background to the Bill, highlight how it differs from the previous one and go through the important developments that have taken place in the past year. Finally, I shall address the fair question of why am I introducing this Bill when the industry has already voluntarily agreed to a code to include labelling at the end of this year.
We barely need reminding just how dire alcohol abuse is in our country. One comment that I made last time seems to have found a wider audience: that if at the upcoming Olympic Games in Beijing binge drinking were to be an official event, our country would walk away not only with the gold medal, but also with the silver and bronze. It is not much to be proud of. In London just 18 days ago, during the first hours of 2008, calls to the ambulance service on drink-related incidents rose 16 per cent over the same period in 2007 and by 30 per cent over 2006. The epidemic continues. This epidemic is not just a male problem; more and more young women seem to regard each weekend as an opportunity to go out on the lash. We do not need to look too far to see how true that is.
Foetal alcohol spectrum disorder occurs when alcohol passes from the mother’s bloodstream into the bloodstream of the foetus. Because the foetus has no functioning liver and because organ and neurological development proceeds throughout the pregnancy, extensive damage can be done to the unborn baby. FASD is the wider disorder affecting one in 100 babies. Sometimes its effect is mild; sometimes it is severe. Foetal alcohol syndrome is a severe disorder affecting one in 1,000 babies. Its effect is catastrophic. It causes brain damage and often organ malfunction resulting in a baby being born severely handicapped, mentally and sometimes physically.
pregnant. The Bill would make it compulsory for all containers of alcohol-related beverages to have a label printed on them with the wording, “Avoid alcohol if pregnant or trying to conceive”. That wording was agreed to by the Department of Health last year and I have included it in this Bill to replace alternative wording in the previous Bill. It is an unambiguous statement allowing no scope for misinterpretation.
Why is it important to put this message across so starkly? The evidence now is strong that mothers who drink at any stage of their pregnancy run the risk that their baby can be damaged. This damage can be slight or severe and in its worse form can cause terrible damage. What is undeniable is that it is preventable. If a mother refrains from drinking during pregnancy, foetal alcohol spectrum disorder will not happen. That seems a pretty open and shut case, yet there are many who are against labelling, who say that it is one more instance of the nanny state interfering in our ancient liberties. They fail to appreciate that what is planned to be mandatory is labelling, not not drinking while pregnant. If a woman chooses to drink in these circumstances, that is her choice. I believe passionately that we as a Parliament have the duty to inform the public of the risks and how they might affect an unborn baby.
Sadly, many women today are confused about the quantity that they can drink while pregnant. Sometimes the messages that are sent out by the authorities and the media are conflicting. This Bill seeks to remedy this confusion. It is not about more nannying; it is about more information. Many women believe that some alcohol consumption while pregnant is fine. Some say that a few units now and then are harmless. The medical profession itself sends out mixed messages. We measure alcohol consumption in units, as if members of the public have any idea what a unit is. Is it a glass of wine? Well, what is a glass of wine? Today a large glass of wine in a pub or bar can be as much as one-quarter of a litre. Moreover, are we talking about the kind of wine with which we are familiar, which has an alcohol content of 12 per cent, or is it some newer concoction that reaches 15 per cent? How about alcopops? How many units are there in a Bacardi Breezer? I must admit that I have no clue.
I suspect that it is only human, when we use the number of units as a guide, to regard such advice with scepticism. If 14 units per week is the limit, what harm is 16? While we are at it, let us go for a round 20. Sometimes I have a vision of endless meetings at the Department of Health discussing the importance of units. I bet that officials get very worked up on the subject. Everything they do is reduced to the number of units. But I wonder just how many people in the King of Prussia on a Friday night have a clue what a unit is. When I have asked my friends, I have received blank stares.
Since the Bill was previously introduced, there have been many developments. First, the Department of Health published its position that women who are pregnant or thinking of becoming pregnant should avoid all alcohol. “Avoid” is the key word. That was good news. It received massive publicity and, as a result, many more women have become aware of the issue and the dangers. But memories fade fast.
Then, in June 2007, the British Medical Association’s board of science published a report entitled, Fetal Alcohol Spectrum Disorder—AGuide for Healthcare Professionals. It made many recommendations but recommended in particular that women who are pregnant, or who are considering a pregnancy, should be advised not to consume any alcohol and that consistent and clear advice be given to healthcare professionals and the general public regarding the sensible drinking message and the risks of alcohol consumption during pregnancy.
There have been significant developments in other countries. In the United States, labelling has been compulsory since the passing of the Alcoholic Beverage Labeling Act in 1988. In France, labelling is compulsory. In South Africa, the Government plan to have compulsory labelling. In Finland, labelling is compulsory, as it is in Sweden on all products containing more than 2.25 per cent alcohol. Many other countries are moving in that direction.
I remain sceptical about a voluntary code for labelling. I am no fan of self-regulation. I know that it is the preferred route of the Department of Health and I know that the industry, to its credit, is moving in that direction. But I simply do not believe that it is good enough; those who choose to ignore it will be able to do so. When we introduced labelling on tobacco products, we did not ask the tobacco manufacturers to volunteer to a labelling code, perhaps because we knew what the answer would be. We told them what they had to do, as did legislators in most other countries, and they did it. Surely the same should apply to this form of labelling.
I fail to understand why the alcoholic beverage industry, which is compelled by law to include labelling of the type that we are suggesting in other countries, is kicking up such a fuss. I simply do not understand the logic that says that one consignment of Johnnie Walker Black Label whisky bound for New York has a label while the next consignment of an identical bottle of whisky bound for London does not.
I see confusion everywhere. I see confusion on what constitutes a unit. How big is the glass and how potent is the brew? Also, as I have asked, what is a unit? I see confusion when the Government say, “Avoid all alcohol when pregnant”, but some commentators in the media say, “Drink sensibly”. I see confusion when, in October 2007, the National Institute for Health and Clinical Excellence produced guidelines that stated that pregnant women can consume 1.5 units of alcohol per day after the first three months of pregnancy, whereas the BMA says, “Avoid all alcohol”. I see confusion when the Portman Group, the industry’s mouthpiece on social responsibility, says that it is holding back from labelling due to the uncertainties about the dangers of drinking when pregnant. If all the experts are confused, how about the young woman going out on a Friday night to enjoy herself? What is she supposed to make of it? What about the babies who in the mean time are being born with FASD and FAS, disorders that are totally preventable? It is simply not good enough for us to allow this confusion to continue.
- “if talks became protracted and it looked as if there would not be a successful outcome, noble Lords would be absolutely right to come back and say to the Government, ‘The time for talking is over; let’s see some action’”.—[
- , 20/4/07; col. 479.]
Well, here we are, nine months later. The voluntary code is less than certain and, when and if it comes into effect, it is clear that adherence will be less than 100 per cent. I end by saying to my noble friend the Minister, “The time for talking is over; let’s see some action”.
Lord Addington: My Lords, the Bill before us is based on the concept that one has to do something to address a problem. The noble Lord has made a good job of describing the problem, but the question is: what is the correct action to be taken? An argument between self-regulation and compulsory regulation is going on. What will self-regulation do? How will the Government monitor it to see whether it is successful?
About the confusion of information, the Government can do something: they can make sure that one message is coming out. That would help. Let us remember what we would achieve by having labelling on a bottle. It would be part of a drip-drip process to reinforce other messages at other points in the process. It will not be a cure-all.
The ban on cigarette advertising took a long time to get anywhere. You build consensus; you then achieve something. I was recently in Brussels, where there is a smoking ban. Everybody lit up in a restaurant because it was not being enforced. How we address that and how we get into people’s minds is something that the Minister can start to tell us about in a few minutes. What is the process?
The noble Lord, Lord Mitchell, did a good job in describing the problem. He said that it causes damage. He asked where we were going and said there was no absolutely safe limit in all cases. I am afraid that the answer is that most people will be able to get away with a little, but are we prepared to take the risk? That muddle might be addressed in a better campaign, of which it would be a small part. Without clarification on that, our arguments about self-regulation, when it will be reviewed and updated, about what is going on, about the Government’s current position and the message that must absolutely be enforced will go round in circles. Clarification will help us.
We are all worried about alcohol, because it is misused and being consumed by people of younger ages, and because we have managed—I do not know how—to create a culture of binge drinking, which is blamed on 24-hour drinking, despite the fact that it existed long before that was introduced. Binge drinking was helped to be created by the “get your round in before the pub shuts early” culture. Anybody who has not seen that was not in a pub when it shut at 11 pm. And if you wanted something to encourage you to be wrecked in the afternoon, it was lunchtime drinking.
How do we get the message across to society? If we are going to deal with excessive alcohol consumption, we have to address one of the big players in society; that is, supermarkets and retailers, which often use alcohol as loss leaders. We all saw it on television during the Christmas period: “Buy X cans at X price, and come in and do the rest of your shopping as well”. If the drinks industry really wants to address the drinking culture, I would take it much more seriously if it did something in that area. That might be a more constructive approach to the problem as a whole. I do not underestimate this element of the problem, but I am afraid that it must be seen as part of a whole at certain points.
As the Bill progresses, I hope that the drinks industry and retailers will give me some idea of what they are going to do to address the problem. If you have a pile of cans at home, and your 14 year-old son or daughter grabs them to go out with their friends, somebody who is very young will be drinking out on the streets without any supervision. Many of the horror stories which the press delights in giving us may relate to those situations.
The alcopop industry—or, to use the correct name, the pre-mix cocktail industry—initially aimed its products at people whose palates liked them. I have tried alcopops a couple of times and they suggest to me petrol mixed with syrup. Young palates apparently like them. The advertising goes along the lines of, “Are you a KWV moment?”, which means, “Are you prepared to wreck somebody else’s evening for a laugh?”. That sort of advertising and culture must be addressed at some point.
Can the Government give us an idea about their overall strategy? They are doing something. They have good adverts which demonstrate what happens if you drink too much and what you look like. A friend of mine pointed out that these are great adverts, designed to be shown when people come in from the pub. Showing them slightly earlier might be better.
Do the Government think that the industry has moved fast enough to achieve greater warnings in key areas? What is their monitoring process of that voluntary code, and how successful is it? At what point are they prepared to take action if it is not good enough? That would be very helpful to the debate.
Lord McColl of Dulwich: My Lords, I too add my congratulations to the noble Lord, Lord Mitchell, for introducing this Bill and recognise his dogged determination and his splendid work with the National Organisation on Foetal Alcohol Syndrome.
This Bill is about protecting the vulnerable because it is generally accepted that alcohol is a poison, although it is not included in the Poisons Act 1972. The mechanism by which it damages is not fully understood, but it probably disrupts the synthesis of protein. It may be related to poor diet, especially a deficiency of vitamin B. It depresses the functions of the body and it stimulates conversation by depressing our inhibitions. Lest your Lordships should think that I am about to recommend prohibition, I quote from the good book:
These comments simply emphasise the importance of the dosage of alcohol and its dangers during pregnancy. As it is not certain whether small doses are harmful, the advice of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives seems the most sensible: avoid alcohol in pregnancy altogether—a matter mentioned by the noble Lord, Lord Mitchell.
Binge drinking is especially harmful to both mother and baby, particularly around conception. As women are not aware of precisely when they are actually conceiving, all women of child-bearing age should avoid binge drinking like the plague.
While we are dealing with the subject of dosage, I have noticed that there are many ex cathedra statements about how much alcohol one can drink, quite apart from pregnancy. We are told that women can have 14 units and men can have 21 units a week. What that completely fails to point out is that these figures refer only to those who weigh 11 stone or 70 kilos. A little old lady of 7 stone or 45 kilos should have only nine units per week and a man of 7 stone only 13 units a week. Would the Minister undertake to look into the anomaly of why there is no emphasis on the dose of alcohol?
As far as concerns the actual labelling, have noble Lords noticed that many bottles of wine display a notice stating: “Contains sulphites”? The printing is usually 1 millimetre high. One bottle of Chianti had this notice in 17 different languages. Two points arise from that. If it is considered essential to put a notice about sulphites on bottles of wine, surely it must be much more important to indicate the more serious dangers of alcohol, especially in pregnancy. I have advised the Minister that I would like to know the history of the sulphites notice. Sulphites are added as a preservative. Some people believe that sulphites provoke an adverse respiratory effect in sensitive people, but this kind of reaction is complex and multifactorial and may be quite unrelated to the sulphites.
When it becomes common practice to label bottles of alcohol, I hope that the size of the print can be at least 2 millimetres. Having gone to all this trouble it seems a shame if people cannot read the notice that has been put on there.
Last weekend I scrutinised a number of wine bottles. My host was a little apprehensive as I went through his wine cellar. He thought that I had designs on it, but I was really scrutinising the labels. I was surprised at how much information is already displayed on bottles. On some French wine bottled in Manchester there is quite a large notice which reads:
The French have designed a wine bottle label with an unusual warning. It consists of a traffic “no entry” sign containing a silhouette of a pregnant lady with a glass of wine in her hand. I am not sure how well that will be received by the British wine industry, but one never knows.
Some wine companies already indicate the number of units in a bottle. For instance, the Co-op in Manchester has on the back of its bottles of French wine a 3×4-inch notice entitled “Customer information”, which not only lists the ingredients but states the maximum safe number of units. It states:
It goes on further to list the number of units in each bottle, namely 10 units in a 750-millilitre bottle of wine, the calorie content and number of glasses. Many people are unaware of how many calories can be consumed by alcoholic drinks. Three Mai Tai cocktails contain 1,000 calories.
Perhaps stimulated by this Bill, the wine industry has reached agreement with the Government, as has been said already, that by the end of the year all alcoholic drink labels will include information about the number of units. Recent surveys suggest that 75 per cent of the population agree with labelling and that 69 per cent know the maximum number of units which should be consumed. The problem is that only 13 per cent actually keep an eye on how much they drink. By displaying the number of units on the labels, together with the safe levels of consumption, we hope this will encourage people to avoid dangerous levels of drinking.
Unfortunately, many people still think that a glass of wine is just one unit—a matter mentioned already. I have been unable to find a single glass in the Palace of Westminster that contains one unit. The standard glass in the Bishops’ Bar holds 175 millilitres, which is over two units if the wine is the usual 13.5 per cent strength. Of course 13.5 per cent means 13.5 grams per 100 millilitres. The largest glass is 250 millilitres, which is over three units. As there is little appreciation of how many units people are drinking, even in your Lordships’ House, perhaps it is not surprising that more than 7 million people in this country drink in a harmful way.
In conclusion, the efforts of the noble Lord, Lord Mitchell, have already been partially rewarded and by the end of the year most bottles will be labelled, but we still need to persuade the wine industry to include warnings about pregnancy. As far as mandatory labelling is concerned, I am very much inclined to agree with the views expressed by the noble Baroness, Lady Coussins, in her excellent speech. The Bill seems to have been overtaken by events, making it unnecessary.
Baroness Royall of Blaisdon: My Lords, I congratulate my noble friend Lord Mitchell on introducing his Bill. I well understand that he must be extremely frustrated to have missed the first part of the debate. We well understand why that was the case. It is not a criticism but our noble friend Lord Griffiths did an excellent job with his reference to a minister with a wine cellar. He is absolutely right that no one can be against the important ethos behind this Bill. We wish his daughter well. My noble friend Lord Mitchell is a formidable standard bearer for the National Organisation for Foetal Alcohol Syndrome. We all admire his great and growing expertise. I commend him especially on his tenacity and commitment in seeking to place a legal obligation on alcohol producers to provide information on product labels warning women of the potential risks to the unborn child of alcohol misuse.
As he mentioned, this is the second occasion within a year that he has presented such a Bill to this House. As he will know from his recent discussions with my right honourable friend the Minister of State for Public Health, the Government have considerable sympathy with the motivation behind his Bill. He will also know that the Government are seeking to encourage the alcohol industry to implement a more wide-ranging alcohol labelling regime, the details of which were set out by my noble friend Lord Hunt last April.
In May 2007, the Government announced that we have reached an agreement with the industry to include health and other information on alcohol product labels. This will include: the drink’s unit content and the recommended government sensible drinking guidelines; UK health departments recommend men do not regularly exceed three to four units daily and women two to three units daily; and the Drinkaware website address, detailing sensible drinking messages from the charity Drinkaware. For wines and spirits, unit information will normally be given per glass and per bottle, but I recognise the difficulties raised by the noble Lord, Lord McColl. We did not, unfortunately, reach full agreement with the trade associations to include the Government’s wording, or an alternative logo, on alcohol and pregnancy. We know that some trade associations are encouraging this, and a number of major producers and most supermarkets are willing to do this. We expect most of the industry to approach this positively. We are strongly encouraging all the others to do so as far as possible, and hope to see widespread implementation.
We are very shortly to commission independent monitoring of the progress that is being made by the industry in fulfilling the terms of the agreement. I am aware that my noble friend is somewhat sceptical about the industry’s full commitment to fulfilling the agreement, and the likelihood of implementation of our wording on alcohol and pregnancy. For the Government’s part, I hope that this scepticism is unfounded and that the noble Baroness, Lady Coussins, is correct. Certainly, from our dealings with them, there does seem to be a genuine desire by most sections of the alcohol and retail industries to
promote more responsible drinking, and I welcome the generally constructive approach that the industry has taken. However, we have made clear in the Government’s renewed alcohol strategy, Safe. Sensible. Social. The next steps in theNational Alcohol Strategy, and we have made the industry very well aware that we will not hesitate to introduce legislation if we are not satisfied with the industry’s efforts in ensuring that the majority of drinks labels are carrying the information required. The Government have indicated that they expect to see by the end of this year the majority of labels carrying health and other information. And, although it is not formally part of the agreement, we expect implementation to include information on alcohol and pregnancy. This will be part of our benchmark, as we have made clear to industry. A benchmark survey will be taken in February and a further survey in late winter. If it is considered that insufficient labels carry information, the Government will go ahead with their consultation on legislation before introducing that legislation.
My noble friend Lord Mitchell and the noble Baroness, Lady Coussins, referred to confusion about guidance to pregnant women. The new UK advice to women is that as a general rule pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to protect the baby they should not drink more than one to two units of alcohol once or twice a week and they should not get drunk. A short version of the revised message on pregnancy for inclusion on labels also agreed by the four UK chief medical officers was included in our February 2007 proposals to the alcohol industry for labelling. The message is, avoid alcohol if pregnant or trying to conceive. To date, NICE has consulted about its final guidance but I am confident that as both NICE and the four chief medical officers all base their evidence on the same scientific evidence, it is unlikely that there will be conflicting advice. I do not think that we can allow there to be conflicting advice.
The noble Earl, Lord Listowel, rightly has strong concern about pregnant women who are dependent on alcohol and asked how many there are. In 2005, one in five—20 per cent—of women in the UK drank more than the recommended guidance and it is estimated that more than 6,000 children are born each year with foetal alcohol spectrum disorder. That is about 1 per cent of live births. This reflects the amount of alcohol consumed by pregnant women; that is, drinking at harmful levels, which includes those dependent on alcohol. However, an increasing number of women give up alcohol completely, as has the daughter of my noble friend.
The noble Lord, Lord McColl, spoke of dosage and the link between a person’s weight and their tolerance—if I might put it like that—of alcohol. I shall give the noble Lord further details on that in writing, but I have to confess that, like his wife, I become talkative after one glass. He gave me advance warning, as he mentioned, about sulphites. The European Union, as part of its allergens labelling regulation for food and beverages, stipulated that all wine sold in the EU must include a statement that wine contains sulphites if there is any detectable
presence of sulphites in the final product. Sulphite is one of 14 food allergens in the EU which have to be identified on the labelling of prepacked food. In the case of alcoholic drinks which do not have an ingredients list the rules require the presence of the allergen to be indicated with the prefix “contains” followed by the specific allergen, for example sulphites. I shall give the noble Lord further details on that.
Much has been said about the need to examine the relationship between alcohol price, promotion, consumption and harm. Safe. Sensible. Social does, of course, include a commitment to carry out an independent review into this relationship. I am pleased to report to the House that a research team from the University of Sheffield has been selected to carry out this important work. The review will seek to establish, through a systematic review of the evidence, to what extent and in what circumstances price—including discounting, advertising and other forms of promotion—drives consumption of alcohol and all forms of alcohol-related harm. As part of this, the review team is asked to look at evidence on whether the current advertising restrictions are sufficient to protect children and young people, taking into account the work undertaken by Ofcom and the Advertising Standards Authority.
The Government will use the review’s findings, which they expect to receive in July 2008, to assess whether particular types of discounting, linked to purchasing of bigger quantities, and promotional activities contribute to alcohol-related harm; and will, if necessary, consider the need for regulatory change in the future, following public consultation.
Responsibility for the Alcohol Education and Research Council passed to the Department of Health at the beginning last year. For the past six years, it has been ably led by Dr Noel Olsen, during which time he oversaw an independent review of the council’s work and organisation and its transfer to the Department of Health. It is a testament to his chairmanship that the transfer of the council from the Department for Culture, Media and Sport to the Department of Health passed off so smoothly. Unfortunately, his term of office comes to an end on 31 January. I am pleased to announce that Professor Robin Davidson has been appointed to succeed him as chairman of the Alcohol Education and Research Council for a period of three years effective from 1 February. The council has a strong reputation for delivering high quality, evidence-based research, and we look forward to working with him as we work to tackle the harms that are caused by alcohol misuse.
Noble Lords will recall that we have debated issues surrounding misuse of alcohol on a number of occasions recently. I do not propose to rehearse those arguments, but I emphasise the Government’s commitment and determination to reducing the long-term harms caused by alcohol, both in dealing with specific harms such as foetal alcohol syndrome, as well as more generally seeking actively to encourage a culture that accepts sensible drinking as the norm and frowns on the excesses brought about by binge drinking. We see labelling as part of a wider programme of action by the Government and the
alcohol industry to raise awareness of how much people drink and to encourage a sensible drinking culture, but labelling is not an answer of itself.
The noble Lord, Lord Addington, asked about advertising. We will shortly be embarking on a sustained national £10 million communication campaign to challenge public tolerance of drunkenness and drinking that causes harm to health and to raise the public’s knowledge about units of alcohol and ensure that everyone has the information that they need to estimate how much they really drink.
This has been an excellent debate, and I am grateful to my noble friend for his persistence in raising these important issues. It is clear that both the Government and this House want to ensure that information about pregnancy and alcohol consumption is on bottles. We differ slightly on the method of getting there, but get there we will.
I am very grateful to all noble Lords who participated in the debate. It was predictable beforehand and was true in reality that the quality was of the very highest order. I believe that the noble Baroness, Lady Finlay, did not speak, but no doubt she has a speech that she will let me read, which would be useful. I missed the contribution made by my noble friend Lord Griffiths. I heard only half of what the noble Baroness, Lady Coussins, said. She has tremendous experience in the industry; I think she was chief executive of the Portman Group at some point. She really understands the industry perspective, so I am very grateful for her contribution. I will read all the speeches in Hansard with great interest.
At the end of the day, this Bill is about whether one believes that a voluntary code will work 100 per cent. As the Minister said, I am somewhat sceptical that it will work 100 per cent. In the case of tobacco, it was mandatory. All that I will say in summary is that it was a good debate.
Further written evidence to be reported to the House
Health and Social Care Bill – in a Public Bill Committee on 10th January 2008.
No, I agree, but in terms of this particular grant, are you satisfied that the information exercise for the mothers will go hand in hand with the handing over of the money? Because if it does not—let us put to one side extreme cases such as women who, when pregnant, actually decide not to give up cigarettes or alcohol consumption; there will also be a small group of women who are drug dependent—one has to look at these groups and say, how are you going to ensure foetal health through additional resources?
Rosemary Dodds: That is why it needs to go hand in hand with advice from their health professional, which we are hoping will be improved through better training, and there are people who are willing and able to do that. Also, the NICE maternal and child nutrition programme development group is about to come out with its recommendations for reaching the most disadvantaged women with information on improvements in diet. We need to find the mechanisms to make that work.
To ask the Scottish Executive how many and what percentage of babies in each deprivation quintile were discharged in each year since 2001 with a diagnosis of foetal alcohol syndrome, broken down by NHS board.
National data on babies born with congenital anomalies are collected centrally in Scotland using a range of administrative NHS and GRO databases. Data are published routinely on a number of individual anomalies such as Neural Tube Defects and Down’s syndrome, with recording considered to be sufficiently robust for reporting statistics comparable to those produced by other UK and European Congenital Anomaly Registries.
Foetal alcohol syndrome, although recorded as a condition on the central databases, does not form a category that is routinely reported in Scotland. There will be an unknown level of under-reporting on the current system as, although foetal alcohol syndrome is present at birth, it may not be ascertained until later and may not be recorded unless the baby requires admission to hospital subsequent to the birth episode.
Available information on singleton babies born in Scotland with foetal alcoholsyndrome for the years 2001 to 2006 (most recent available) is shown in the following table. It has not been possible to provide a breakdown by deprivation quintile and NHS board due to the very small numbers. Further background information is also attached.
Singletons Born in Scotland and Detected1,2,3 with Foetal Alcohol Syndrome4,5 at Birth or During Infancy: Numbers and Rates per 1,000 Births by Year of Birth: 2001-06
CCCCCC” cellpadding=”2″ cellspacing=”0″ width=”75%”>
|Rate per 1,000||0.09||0.07||0.03||0.17||0.05||0.09|
P. The data for 2006 should be considered provisional at this time.
2. Anomalies have been located from the diagnostic summaries contained within the linked source data comprising profiles of neonatal and inpatient hospital discharge records, stillbirth notifications and death registrations.
3. All infants followed up from birth for a period of one year to allow detection of anomalies from hospital inpatient records or General Register Office death registrations.
4. Using diagnosis code Q86.0 from the International Statistical Classification of Diseases and Related Health Problems – Tenth Revision (ICD-10)
To ask the Scottish Executive at what points in a child’s development foetal alcohol syndrome may be diagnosed and what the statistics are for each such point in each deprivation quintile in each year since 2001, broken down by NHS board.
The research base for diagnosing foetal alcohol syndrome is still being developed but current evidence indicated a number of different points in a child’s development at which foetal alcohol syndrome (FAS) can be diagnosed, up to the age of 12. Although FAS diagnosis can be made at birth, it can be easily missed if the clinical team is not alerted to look out for the diagnosis of alcohol exposed pregnancies.
National data on babies born with congenital anomalies are collected centrally in Scotland using a range of administrative NHS and GRO databases. Data are published routinely on a number of individual anomalies such as Neural Tube Defects and Down’s syndrome, with recording considered to be sufficiently robust for reporting statistics comparable to those produced by other UK and European Congenital Anomaly Registries.
Foetal alcohol syndrome, although recorded as a condition on the central databases, does not form a category that is routinely reported in Scotland. There will be an unknown level of under-reporting on the current system as, although foetal alcohol syndrome is present at birth, it may not be ascertained until later and may not be recorded unless the baby requires admission to hospital subsequent to the birth episode.
Available information on singleton babies born in Scotland with foetal alcoholsyndrome for the years 2001 to 2006 (most recent available) is shown in the following table. It has not been possible to provide a breakdown by deprivation quintile and NHS board due to the very small numbers. Further background information is also attached.
Singletons born in Scotland and detected1,2,3 with foetal alcohol syndrome4,5 at birth or during infancy: numbers and rates per 1,000 births by year of birth: 2001-06
CCCCCC” cellpadding=”2″ cellspacing=”0″ width=”75%”>
|Rate per 1000||0.09||0.07||0.03||0.17||0.05||0.09|
The data for 2006 should be considered provisional at this time.
2. Anomalies have been located from the diagnostic summaries contained within the linked source data comprising profiles of neonatal and inpatient hospital discharge records, stillbirth notifications and death registrations.
3. All infants followed up from birth for a period of one year to allow detection of anomalies from hospital inpatient records or General Register Office death registrations.
4. Using diagnosis code Q86.0 from the International Statistical Classification of Diseases and Related Health Problems – Tenth Revision (ICD-10).
Foetal Alcohol Syndrome
Health written question – answered on 3rd July 2009.
To ask the Secretary of State for Health how many babies have been diagnosed as having foetal alcohol syndrome in each year since 1997.
Analysis of Hospital Episodes Statistics (HES) data on the number of babies ‘diagnosed’ with Foetal Alcohol Syndrome (FAS) at birth shows that there are approximately 20 such babies diagnosed each year. This is not the number of babies actually born with FAS: it is widely recognised that many cases of FAS are only diagnosed later in childhood, and hence will not be identified through the national HES database, or may remain undiagnosed as children with learning or behavioural difficulty of unknown cause.
Special Educational Needs and Disability (Support) Bill
Prayers – in the House of Commons at 9:30 am on 15th May 2009.
Another group of at-risk mothers are those who do not realise that they are pregnant, turn up at the hospital believing that they have appendicitis, and then discover that they are having a baby. I have met one such mother. These women do not alter their social behaviour as women tend to when they know that a baby is on the way, and are not able to take care of the child while it is in the womb. We are seeing an increase in the number of cases of foetal alcohol syndrome, which, in extreme cases, damages children’s facial characteristics. It may also be very difficult to spot that a child is carrying a learning disability alongside the physical damage that it suffered in utero.
What the hon. Lady is saying is very interesting. I recently visited a home for foetal alcohol-damaged children in Copenhagen, and I think that the condition could well be responsible for many more disabilities than has been acknowledged—some of which may have been attributed to autism, which displays similar characteristics. I feel that it merits a great deal more investigation.
I agree that we are dealing with a massive hidden problem. It is, in fact, the problem of maternal shame. We all want to do the best we can for our children. We all love our children. The possibility that something we did during pregnancy may have damaged our beautiful child, either at birth or at a later stage, is not something that most mothers—and fathers—I know would willingly contemplate.
I have dealt with the nature and scale of the birth-related problems. Let me now turn to the business of tracking a child’s subsequent development. There has been a huge increase in the number of children’s centres that can work sensitively and supportively with mother and baby in terms of early diagnosis and intervention. It is not a case of a child’s arriving at school at the age of five and there being “something wrong” with it, so that the situation becomes school versus mother. It is a case of a health visitor’s saying “Hmm. He is not sitting up quite as early as he should be”—or not walking, speaking or listening as early as he should be—and working with parents to help them to understand the nature of the damage that may have been caused.
Many people who are active in the foetal alcohol syndrome charity are adoptive parents. In the most extreme cases, the natural parents are alcoholics, their alcoholism has continued, and their children will go into care. It is the adoptive parents who are the champions and campaigners, and I fully understand the reasons for that.
– in the Scottish Parliament at 5:01 pm on 6th May 2009.
The other problem is alcohol. Foetal alcohol syndrome was first diagnosed by Dr Peter Whatmore, a colleague with whom I worked in Cornton Vale prison. We discovered that a number of the babies who were born to women in the prison had unusual features. Foetal alcohol syndrome is now well recognised. As I am sure the minister will tell us, research is to be commissioned to determine the number of babies who are born with foetal alcohol syndrome, because we still do not know the numbers involved.
I reassure members—specifically Mary Scanlon and Richard Simpson—that the programme has the support of all stakeholders, including the National Childbirth Trust. It plays well into risk assessment early in pregnancy, which enables early intervention for those who require additional medical or social support that is—crucially—tailored to their needs and delivered by the most appropriate professional. The evidence tells us that that is the way to proceed, whether we are dealing with foetal alcohol syndrome or the low birth-weight issues that Angela Constance identified. I reassure members that women who wish to continue to have their GP as first point of contact will be able to do so; there is no question about that. It is important to recognise that, and I hope that I have reassured members. The programme is positive, and it would be unfortunate to present it as anything other than that.
Drug and Alcohol Misuse
– Scottish Parliament written question – answered on 27th March 2009.
To ask the Scottish Executive, in relation to the recommendations in Hidden Harm – Next Steps: Supporting Children Working with Parents , what action is being taken to highlight the consequences of alcohol use in pregnancy and the possibility of foetal alcohol syndrome.
The Scottish Government has introduced a new NHS target on screening for alcohol misuse and delivering brief interventions to patients whose drinking may be putting their short and/or long-term health at risk. We have specified antenatal care as one of the priority settings for implementation.
We significantly increased funding to NHS boards for specialist alcoholtreatment and support services from £10 million in 2007-08 to almost £25 million in 2009-10, with further increases to follow. First call on these resources is to deliver the brief interventions target.
The number of cases of fetal alcohol syndrome diagnosed each year is low, but it is thought that a greater number go undiagnosed. We have therefore given a commitment to arrange a survey of the incidence of Fetal Alcohol Syndrome in Scotland. We are currently taking forward plans to bring together key stakeholders to discuss the scope and scale of the project.
I refer the member to the answer to question S3W-21978 on 27 March 2009. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.scottish.parliament.uk/Apps2/Business/PQA/Default.aspx.
– in the Scottish Parliament at 10:21 am on 26th March 2009.
One problem that we have not addressed is that some of our young Scots suffer from alcohol even though they have had no part in taking it. I am speaking of foetal alcohol syndrome, which was raised with the chief medical officer when he briefed the Health and Sport Committee. It is a great tragedy, not only for the mother but for the staff who deliver a baby who already has alcoholwithdrawal symptoms. It is trite but true to say that the healthy mothers who have healthy and responsible pregnancies give children the best start, which continues throughout life. I welcome the survey on foetal alcohol syndrome that is proposed in the framework because it will be a wake-up call to society. Nobody can sit back and say that society should sustain a situation in which babies are born with alcohol withdrawal symptoms.