Calling all young people with FASD in the UK

Please help us create 2 new songs about FASD!

Please watch this video ↑ where Flis explains how you can help.

Send us your ideas!!

We are creating two new songs by and for young people with FASD in the UK.

This is the first part of the project. We are asking young people with FASD to please send us some lyrics:

• What makes you special?

• What are your favourite coping strategies?

• What do you want people to know about living with FASD?

Please email them to info@nofas-uk.org.

You can send them to us any way that you like – a video, audio, a drawing, a poem, etc. Flis will collect all these ideas and use them to write the songs. Next, after we have all the lyrics, Flis will be back in touch for more help singing and performing the music and the songs.

This project is funded by the Department of Health grant to the Seashell Trust/NOFAS-UK and the songs will be part of a new “Me and My FASD” toolkit that will be made available to all in the UK free of charge. By emailing us you are providing NOFAS-UK (The National Organisation for FASD) permission to use these entries in its materials and social media. Responsible adults/parents/carers – please include your young person’s first name and age if you would like that listed in the credits.

We are SO excited about this project and can’t wait to hear what the young people have to say!!We’re thrilled to be teamed up with the Seashell Trust for this project!


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. [Note: The APPG was suspended during the 2019 election, it will be reconstituted soon…]

“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

9 May 2019

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

2007 FASD Statements from Government, MPs and Peers

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.

Kelvin Hopkins Labour, Luton North 3:07 pm, 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.

Mike Penning Shadow Minister (Health) 3:13 pm, 6th December 2007

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.

Lynda Waltho PPS (Rt Hon David Hanson, Minister of State), Ministry of Justice

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.

Kenneth Gibson Scottish National Party 3:40 pm, 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.

Claire Baker Labour 3:46 pm, 25th October 2007

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.

Dave Thompson Scottish National Party 4:21 pm, 25th October 2007

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.

Marlyn Glen Labour 4:27 pm, 25th October 2007

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.

Fiona Mactaggart Labour, Slough

 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.


Congenital Abnormalities

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. [154614]

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; [148556]

(2) what assessment he has made of the training, guidance and resources available in the NHS for routine screening of alcohol consumption by pregnant women; [148557]

(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. [148558]

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
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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.

Andrew Murrison Shadow Minister (Health) 10:38 am, 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.

12.16 pm

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:

“GOVERNMENT WARNING: drinking alcoholic beverages during pregnancy, even in small quantities, can have serious consequences for the health of the baby”.

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 also thought long and hard about the inevitable objections that will be raised. The words “nanny state” have already been raised in some quarters, so

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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.

20 Apr 2007 : Column 464

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

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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.

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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

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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.

Moved, That the Bill be now read a second time.—(Lord Mitchell.)

12.32 pm

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.

Drinking in moderation produces health benefits in those who are not pregnant and is an enjoyable social interaction, but excessive drinking harms individuals and society. The social role of drinking

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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

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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”.

2.41 pm

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:

“My Lords, we are in serious danger of living in a grossly over-regulated society”.—[Official Report, 18/4/07; col. 289.]

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

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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.

12.46 pm

Baroness Neuberger: My Lords, first I pay tribute to the noble Lord, Lord Mitchell, for his persistence in highlighting foetal alcohol spectrum disorder and

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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.

I am not of the view that we should forbid drinking alcohol in pregnancy or that we should regard the pregnant woman who drinks alcohol as a criminal because I do not want even more of a nanny

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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:

“The uncertain level of individual risk to the developing fetus, together with the possibility of misinterpreting a health promotion message, mean the only safe message in pregnancy is abstinence”.

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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.

12.53 pm

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

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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?

Earl Howe: I am afraid I cannot, my Lords. Perhaps the noble Lord, Lord Mitchell, can enlighten us when he winds up.

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

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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

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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.

Naturally, I hope that the Minister will look at the Bill in a positive light. I wish the noble Lord, Lord Mitchell, well with its future progress.


1.04 pm

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

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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

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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

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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

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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.

1.21 pm

Lord Mitchell: My Lords, it was almost predictable that we would have a good Second Reading debate today given the list of speakers. I thank all noble Lords for their contributions.

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

20 Apr 2007 : Column 481

support legislative action. That is as much as we can hope for. I ask the House to give the Bill a Second Reading.

On Question, Bill read a second time, and committed to a Committee of the Whole House.



– 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. [105632]

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. [105631]

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.



2008 FASD Statements from Government, MPs and Peers

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.

Looked-after Children

– in the Scottish Parliament at 9:15 am on 20th November 2008.

Richard Simpson Labour

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; [225636]

(2) how many babies were born with foetal alcohol syndrome in each of the last 10 years for which figures are available; and if he will make a statement. [225637]

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.

Mr. Cameron: To ask the Secretary of State for Health (1) what steps his Department plans to take to improve public awareness of foetal alcohol spectrum disorder; [224697]

(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; [224698]

(3) if he will list the steps his Department plans to take to increase awareness of the dangers of drinking during pregnancy; [224699]

(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. [224700]

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.

9 Oct 2008 : Column 763W

The NICE guidelines emphasise the importance of avoiding alcohol completely during the first three months of pregnancy, the key time for organ and nervous system development.

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 should be aware of the effects of substance misuse on their own behaviour and health and on their professional practice and conduct; and 

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

Currently, there are no plans to design a “catch-up training programme” on foetal alcohol spectrum disorder for those medical professionals already in practice.


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]

George Robinson DUP

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.

Michelle O’Neill Sinn Féin 2:15 am, 22nd September 2008

Go raibh maith agat, a Cheann Comhairle. I support the motion and welcome the opportunity to speak on it. The motion calls on the Minister of Health, Social Services and Public Safety:

“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.

William Hay Speaker


As Question Time commences at 2.30 pm, I propose that Members take their ease until that time. This debate will resume after Question Time, when the first Member called to speak will be Mr Gardiner.

The debate stood suspended.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

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.]

Samuel Gardiner UUP

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.

Carmel Hanna Social Democratic and Labour Party

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.

Kieran McCarthy Alliance

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.

Iris Robinson DUP

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.

Alex Easton DUP 4:15 am, 22nd September 2008

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.

Tom Elliott UUP

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.

Jim Shannon DUP

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 —

Mary Bradley Social Democratic and Labour Party 4:30 am, 22nd September 2008

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?

Jim Shannon DUP

I thank the Member for her intervention and for her comments.

That is certainly one of the issues that we must address. There is a role not only for the Minister of Health, but for the Minister of Education also.

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.

David McClarty UUP

The Member’s time is up.

Michael McGimpsey UUP

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.

Photo of Thomas BuchananThomas Buchanan DUP 4:45 am, 22nd September 2008

I support this motion in the name of my colleague Mr George Robinson. It is not a motion to judge, but to produce a positive debate on the way forward for those suffering from and affected by FASD.

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.

I recently read an article that appeared in ‘The Irish News’ on 25 May 2006:

“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.


Alcohol Misuse

– in the Scottish Parliament at 2:04 pm on 25th June 2008.

Mary Scanlon Conservative 3:24 pm, 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.

Christine Grahame Scottish National Party 3:37 pm, 25th June 2008

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.

Frank McAveety Labour 3:43 pm, 25th June 2008

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.

Mary Mulligan Labour 3:55 pm, 25th June 2008

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.

Richard Simpson Labour 4:42 pm, 25th June 2008

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.

Kenny MacAskill Scottish National Party 4:51 pm, 25th June 2008

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.

Mary Scanlon Conservative

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.

Kenny MacAskill Scottish National Party

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.

Lord Patel Crossbench 7:59 pm, 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.

4.35 pm

Lord Mitchell: My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved accordingly, and, on Question, Motion agreed to.

House in Committee accordingly.

[The DEPUTY CHAIRMAN OF COMMITTEES (Lord Faulkner of Worcester) in the Chair.]

Clause 1 [Warnings on alcoholic beverages]:

Baroness Coussins moved Amendment No. 1:

Clause 1, page 1, line 2, after “ensure” insert “so far as is practicable”

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

1 May 2008 : Column 404

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.

Amendment No. 1 proposes to insert,

    “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

1 May 2008 : Column 405

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

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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.

4.45 pm

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.

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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 Harris of Richmond: That is missing the point. The consumption of alcohol, wherever it is, is what is important.

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.

I want to quote briefly from a report from the mental health charity Rethink. Referring to what we have learnt from advertising on cigarette packets, it states:

“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”.

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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.

The Earl of Listowel: I recognise the point my noble friend makes.

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

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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.

We will be looking at the presentation. My noble friend’s original Bill contained some detailed provisions, but there are also amendments tabled that would lighten its requirements.

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.

5 pm

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.

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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”.

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It continues:

“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.

I want to keep the provision as it is; I think that it is correct; I do not think that practicability should be an issue. That is where I stand.

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.

Lord Mitchell: Diageo’s exports of miniatures of Johnnie Walker Black Label to the United States have labels on them. I see no reason why that should not be the case here.

Baroness Coussins: I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Baroness Coussins moved Amendment No. 2:

Clause 1, page 1, line 2, leave out from “carries” to second “the” in line 3

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.

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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.

However, an anomalous requirement in Clause 1(2) remains, perhaps inadvertently. It stipulates that a future Government must insist on the warning appearing on the,

    “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.

Lord Mitchell: I have no additions to make.

On Question, amendment agreed to.

5.15 pm

Baroness Coussins moved Amendment No. 3:

Clause 1, page 1, line 3, leave out “warning” and insert “advice”

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.

In June 2007, the British Medical Association said:

“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”.

However, we know enough to understand that there is some kind of relationship to worry about, which is why the current Department of Health guidance is framed as it is. It states:

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“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”.

For labelling purposes, this is abbreviated to:

“Avoid alcohol if pregnant or trying to conceive”.

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

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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.

On Question, amendment agreed to.

Baroness Coussins moved Amendments Nos. 4 and 5:

Clause 1, page 1, line 4, leave out “GOVERNMENT WARNING:”

Clause 1, page 1, line 6, leave out “warning” and insert “advice”

On Question, amendments agreed to.

Lord Monson moved Amendment No. 6:

Clause 1, page 1, line 8, leave out from “carries” to “a” in line 9

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.

Lord Mitchell: I am not quite sure how to answer the point, but I think that there is an inconsistency and I accept the point made by the noble Lord, Lord Monson.

On Question, amendment agreed to.

Baroness Coussins moved Amendments Nos. 7 and 8:

Clause 1, page 1, line 9, leave out “warning”

Clause 1, page 1, line 10, leave out “warning” and insert “advice”

On Question, amendments agreed to.

Baroness Coussins moved Amendment No. 9:

Clause 1, page 1, line 12, at end insert—

“(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

1 May 2008 : Column 416

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.

On Question, amendment agreed to.

Clause 1, as amended, agreed to.

Clause 2 [Size of warnings]:

Baroness Coussins moved Amendments Nos. 10 to 13:

Clause 2, page 1, line 14, leave out “warning” and insert “advice”

Clause 2, page 1, line 20, leave out “warning” and insert “advice”

Clause 2, page 2, line 2, leave out “warning” and insert “advice”

Clause 2, page 2, line 6, leave out “warning” and insert “advice”

On Question, amendments agreed to.

1 May 2008 : Column 417

On Question, Whether Clause 2 shall stand part of the Bill?

Baroness Coussins: Is it in order for me to speak at the same time on whether Clauses 3 and 4 should stand part of the Bill? They are all grouped together and the arguments interrelate.

The Lord Speaker: It might assist the Committee if the noble Baroness did so, although I shall call the amendments as they appear in the individual clauses.

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”—

or, in this case, a drink—

    “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:

“Regulators should be consistent with each other, and work together in a joined-up way … New regulations should take account of other existing or proposed regulations”.

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.

5.30 pm

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

1 May 2008 : Column 418

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.

Clause 2, as amended, negatived.

Clause 3 [Appearance of warnings]:

Baroness Coussins moved Amendments Nos. 14 to 20:

Clause 3, page 2, line 10, leave out “warning” and insert “advice”

Clause 3, page 2, line 11, leave out “warning” and insert “advice”

Clause 3, page 2, line 12, leave out “warning” and insert “advice”

Clause 3, page 2, line 17, leave out from “type” to “; and” in line 18

Clause 3, page 2, line 20, leave out “warning” and insert “advice”

1 May 2008 : Column 419

Clause 3, page 2, line 27, leave out “warning” and insert “advice”

Clause 3, page 2, line 29, leave out “warning” and insert “advice”

On Question, amendments agreed to.

Clause 3, as amended, negatived.

Clause 4 negatived.

Clause 5 [Product description]:

Baroness Coussins moved Amendment No. 21:

Clause 5, page 3, line 7, leave out “warning” and insert “advice”

On Question, amendment agreed to.

On Question, Whether Clause 5, as amended, shall stand part of the Bill?

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.

Clause 5, as amended, agreed to.

Clauses 6 and 7 agreed to.

Clause 8 [Enforcement]:

Baroness Coussins moved Amendment No. 22:

Clause 8, page 3, line 29, leave out paragraphs (a) to (c) and insert “a local authority”

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”.

So, for simplicity’s sake, the experts suggest that “local authorities” would catch everybody and not expose us to the risk of possibly leaving somebody out. I beg to move.

On Question, amendment agreed to.

Clause 8, as amended, agreed to.

Clauses 9 and 10 agreed to.

Clause 11 [Penalties]:

The Lord Speaker (Baroness Hayman): I have to tell the Committee that if Amendment No. 23 is agreed to, I cannot call Amendments Nos. 24 and 25 by reason of pre-emption.

1 May 2008 : Column 420

Baroness Coussins moved Amendment No. 23:

Clause 11, page 6, line 27, leave out paragraphs (a) and (b) and insert “to a fine not exceeding level 5 on the standard scale”

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:

“Policy solutions must be proportionate to the perceived problem or risk and justify the compliance costs imposed—don’t use a sledgehammer to crack a nut”.

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.

1 May 2008 : Column 421

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.

5.45 pm

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.

Baroness Coussins: Does that mean that the noble Lord will not move Amendments Nos. 24 and 25?

Lord Mitchell: I am intending to move Amendments Nos. 24 and 25.

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.

1 May 2008 : Column 422

Lord Mitchell: In that case, I will support the noble Baroness on this.

The Lord Speaker: I can put the Question on Amendment No. 23, but if I do so, I will not be able to call Amendments Nos. 24 and 25.

Lord Mitchell: I am very conscious of the conflict on this. Is there any way that we can defer it for further consideration before we take a position on it?

The Lord Speaker: It may assist the Committee if the noble Baroness withdraws her amendment for the moment and considers the issue on Report.

Baroness Coussins: In those circumstances I am happy to beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 24 and 25 not moved.]

Clause 11 agreed to.

Clauses 12 and 13 agreed to.

Clause 14 [Interpretation]:

Baroness Coussins moved Amendment No. 26:

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

1 May 2008 : Column 423

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.

On Question, amendment agreed to.

Baroness Coussins moved Amendments Nos. 27 to 29:

Clause 14, page 8, leave out lines 2 to 4

Clause 14, page 8, line 5, after “sealed” insert “primary”

Clause 14, page 8, leave out lines 8 to 12

On Question, amendments agreed to.

Clause 14, as amended, agreed to.

Clauses 15 and 16 agreed to.

House resumed: Bill reported with amendments.


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. [195453]

Dawn Primarolo: I refer the hon. Member to the answer given to the hon. Member for Romsey (Sandra Gidley) on 20 February 2008, Official Report, column 807W.


Foetal Alcohol Syndrome

Health written question – answered on 20th February 2008.

Sandra Gidley: To ask the Secretary of State for Health how many cases of foetal alcohol syndrome were diagnosed in (a) England and (b) each English region in each of the last five years. [186444]

Dawn Primarolo: This information is not collected centrally.


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.

Kelvin Hopkins Labour, Luton North

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.

Lynda Waltho PPS (Rt Hon David Hanson, Minister of State), Ministry of Justice

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.


Clause 121

Health and Social Care Bill – in a Public Bill Committee on 24th January 2008.

Anne Milton Shadow Minister (Health)

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.


Clause 121

Health and Social Care Bill – in a Public Bill Committee on 24th January 2008.

Stephen O’Brien Shadow Minister (Health)

 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

10.06 am

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.

Who can be against the proposal at the heart of the Bill? No one, I would have thought. It is sensible to

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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.

Moved, That the Bill be now read a second time.—(Lord Griffiths of Burry Port.)

10.14 am

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

18 Jan 2008 : Column 1547

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.

Secondly, the industry is not just paying lip service. I shall illustrate with just a few figures. Taking the

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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.

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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,

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    “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.

10.27 am

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.

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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.

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10.33 am

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.

My Bill starts from the premise that we as a legislative assembly and the Government themselves have the duty to inform women, in particular young women, of the dangers of drinking any alcohol when

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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.

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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.

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At Second Reading of the previous Bill in your Lordships’ House, the Minister, my noble friend Lord Hunt of Kings Heath, concluded his wind-up speech by saying,

    • “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’”.—[

Official Report

    , 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”.

10.44 am

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.

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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.

10.50 am

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:

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“The Lord gave wine to gladden the heart”.

When I mention another verse to my wife, which says,

“Take a little wine for your stomach’s sake”,

she says, “Yes, and it says ‘a little’”. I always knew when she was pregnant because half a glass of sherry would make her very talkative.

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:

“BEFORE/DURING PREGNANCY: Most studies show that 1-2 units of alcohol once or twice a week do not cause any harm in pregnancy”.

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That is a positive approach, but I would have preferred a more cautious wording, such as:

“Although some studies suggest that one to two units once or twice a week do not cause harm in pregnancy, the safest policy is to avoid it during the first half of pregnancy altogether”.

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:

“Use the DAILY guidelines for sensible drinking. Refraining in one day should not mean excess on another”.

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.

The notice goes on to state:

“DO NOT DRINK and drive, play sport or operate machinery”.

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.

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11 am

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

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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

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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

18 Jan 2008 : Column 1562

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.

11.12 am

Lord Mitchell: My Lords, with the leave of the House and on behalf of my noble friend Lord Griffiths, who kindly moved the Second Reading on my behalf, I will now reply to the debate.

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.

On Question, Bill read a second time, and committed to a Committee of the Whole House.

https://publications.parliament.uk/pa/ld200708/ldhansrd/text/80118-0001.htm#08011851000009 (and following pages)

Further written evidence to be reported to the House

Health and Social Care Bill – in a Public Bill Committee on 10th January 2008.

Angela Browning Deputy Chairman, The Conservative Party

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.



2009 FASD Statements from Government, MPs and Peers


Stewart Maxwell (West of Scotland) (SNP):

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.

Nicola Sturgeon Scottish National Party

Question S3W-26104

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%”>

2001 2002 2003 2004 2005 2006P
Number 5 4 2 10 3 5
Rate per 1,000 0.09 0.07 0.03 0.17 0.05 0.09

Source: Linked Maternity Catalog and SMR Linked Catalog, Ref: IR2009-01815 (data produced October 2008).

P. The data for 2006 should be considered provisional at this time.


1. The information given relates to each year of birth ending 31 December, and is based on babies born between January 1997 and December 2005.

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)

Stewart Maxwell (West of Scotland) (SNP):

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.

Nicola Sturgeon Scottish National Party

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%”>

2001 2002 2003 2004 2005 2006p
Number 5 4 2 10 3 5
Rate per 1000 0.09 0.07 0.03 0.17 0.05 0.09

Source: Linked Maternity Catalog and SMR Linked Catalog. Ref: IR2009-01815 (data produced October 2008).


1. The information given relates to each year of birth ending 31 December and is based on babies born between January 1997 and December 2005.

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.

Tim Loughton Shadow Minister (Children)

To ask the Secretary of State for Health how many babies have been diagnosed as having foetal alcohol syndrome in each year since 1997.

Gillian Merron Minister of State (Public Health), Department of Health

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.

Mary Creagh Labour, Wakefield 10:38 am, 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.

Tim Loughton Shadow Minister (Children)

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.

Mary Creagh Labour, Wakefield

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.

Richard Simpson Labour 5:11 pm, 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.

Shona Robison Scottish National Party 5:45 pm, 6th May 2009

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.

Karen Whitefield Labour

Question S3W-21957

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.

Shona Robison Scottish National Party

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.


Alcohol Strategy

– in the Scottish Parliament at 10:21 am on 26th March 2009.

Christine Grahame Scottish National Party 10:58 am, 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.



2010 FASD Statements from Government, MPs and Peers

Business of the House

– in the House of Commons at 11:31 am on 4th November 2010.

Kelvin Hopkins (Luton North) (Lab): The Leader of the House will have seen this week’s reports arguing that alcohol is by far the most damaging drug in our society. Will he make time for a long and serious debate on alcohol in which we can look at the links between alcohol and high levels of teenage pregnancy and domestic violence, the incidence of foetal alcohol syndrome, levels of addiction, the impact on the economy and every other aspect of the alcohol problem, and in which we can also examine the possibility of unit pricing for alcohol across the whole country and of raising the legal age for alcohol consumption and purchase?

Sir George Young: The hon. Gentleman raises a series of serious subjects which of course the House should debate. We will be bringing forward tough action to deal with problem drinking, such as stopping supermarkets selling alcohol below cost price. We are going to introduce a much tougher licensing regime. We are also going to review alcohol taxation and pricing. Related to that, we will publish a drugs strategy in the coming months, and we will set out a radical new approach to public health in a White Paper, which will also focus on drinking issues.


Queen’s Speech — Debate (5th Day) (continued)

– in the House of Lords at 1:10 pm on 3rd June 2010.

Lord Mitchell:

This afternoon, I want to speak about a subject that I have raised in your Lordships’ House several times, but with a new Government it is time to do it again. The subject is the labelling of bottles and containers warning of the dangers to the unborn foetus of its mother drinking alcohol. Briefly, the issue is this. Mothers-to-be who drink risk permanently damaging their babies. This occurs because alcohol in the mother’s bloodstream passes to the foetus across the placenta. The foetus, because its organs are undeveloped, is unable to process this toxin, and major damage can occur. Foetal alcohol syndrome disorder is the name given to the complete range of disorders. In its mildest form, which affects one in a 100 live births, it can cause a series of behavioural attributes, such as acute attention deficit disorder. In its most acute form, which affects one in 1,000 babies, its effects are similar to acute brain damage. Simply put, the brain and other organs do not develop. Children with the most severe learning disabilities are affected. Their mental age is retarded and their cognitive abilities are limited. Often, they cannot even tell the time or find their way home. As young adults, they become disruptive and often turn to crime. Many cannot even hold down the simplest of jobs. Whatever their degree of disorder, they become a cost to society.

If today’s mood is to cut costs, this is an easy way to do so without any downside. FASD is totally preventable and, if it is reduced, society gains. Knowledge among young women and, indeed, their partners of the damage they are running by drinking when pregnant is lamentably low. No one, least of all me, wants a nanny state; all I seek to do is to raise awareness of this danger. Just as was the case with the linkage between cigarette smoking and cancer, product labelling is a good place to start. Today, because of in-your-face labelling on tobacco products, few people can be unaware of their dangers. I am seeking to do the same with alcohol.

Three years ago, I introduced the Alcohol Labelling Bill into your Lordships’ House. It went through the usual stages and was passed. Then, as is the case with most Private Members’ Bills, it died the death when we could not persuade the Government to give it time in the other place. In summary, the Bill said that if the alcohol industry did not abide by the terms of a memorandum of understanding that it had previously signed agreeing to include prominent labelling, legislation would be introduced to make it compulsory. I cannot tell noble Lords how many well meaning Ministers I discussed this issue with. Over numerous cups of tea, they told me that they were on the case, but they needed to complete this survey and that analysis and I could be assured that there would be a successful outcome. There was not.

3 Jun 2010 : Column 430

Go into any supermarket today and examine the bottles. A few have labels prominently displayed, but more than 80 per cent do not. Others have an illustration that the French use. It shows the outlines of an elegant and obviously pregnant woman holding a champagne glass with a diagonal strike going through it. It is very cute, very chichi and very tasteful in a rue Saint-Honoré sort of way, but it has little relevance to the culture of girls on the binge buying cheap cider and vodka at the local supermarket and getting legless as quickly as possible. We see the evidence every weekend in our city centres, do we not? There is nothing very elegant about it. What is more, the illustrations on the bottles I have seen are so small that you would need a magnifying glass to see them.

The Americans have been much bolder on this issue, just as they were with tobacco. Any bottle, can or bar in the United States has a prominent label warning of the dangers to the unborn child of drinking while pregnant. They were introduced in 1989. Here is the stark truth: the alcohol industry runs circles around Governments. It lobbies hard, like the tobacco industry before it. It throws every impediment in front of the labelling proposals. No one seems to have the strength to stand up to it. This new Government have said that they intend to address our alcohol plague. We said the same but, if noble Lords will excuse the pun, I think we bottled it.

My first question to the noble Earl, Lord Howe, who has always been a tremendous supporter of what I am proposing, is will the coalition Government take on the alcohol industry? Will they make labelling prominent, unambiguous and compulsory? If the Government really want to reverse the cult of alcohol, will they consider banning alcohol adverting, just like the Labour Government banned tobacco advertising?


Earl Howe The Parliamentary Under-Secretary of State for Health 7:14 pm, 3rd June 2010

The noble Lord, Lord Mitchell, spoke about foetal alcohol syndrome, a subject about which he and I have spoken many times in the past. We want to improve labelling so that people are more aware of the amount of alcohol in drinks as well as of guideline limits. We want to see the necessary improvement in labelling information through a voluntary approach if we can, but we will consider all responses from the consultation that closed very recently-I think on 31 May-before we make any decisions on that matter.



Supplementary Estimates 2009-10 — Department of Health – in the House of Commons at 12:57 pm on 10th March 2010.

Kelvin Hopkins Labour, Luton North

The hon. Gentleman is right, and I will come to that point soon.

This week, the Herald Scotland reported on research conducted by Dr. Jonathan Sher, director of research, policy and programmes for the Children in Scotland study. According to the Herald Scotland, the

“study warns that Foetal Alcohol Syndrome (FAS) and the less obvious Foetal Alcohol Spectrum Disorder (FASD)”- what I was hinting at before-

“are entirely avoidable and completely incurable.”

If it is a self-regarding action-for instance, if a middle-aged man decides to drink himself to death-it is very sad, but he does it to himself. If, in doing so, however, a child is damaged for life, the action is against someone else as well. It is, no doubt, deeply worrying for many mothers. Is it not sensible that we warn people from now on that, if they drink during pregnancy, they could and, if they drink excessively, definitely will, damage their children for life? There is much detail in the report, into which I do not need to go now, but the sheer numbers in Scotland suggest that about 10,000 children in Britain have visible FAS problems. On foetal alcohol spectrum disorder, we are talking about hundreds of thousands and, who knows, possibly even more. This a very serious problem, so we need to persuade young women not to drink when they are pregnant, but unfortunately the two are associated, because lots of young women do drink to excess, and perhaps getting pregnant when young and drinking are related-they get pregnant because they have been drunk and taken advantage of by men.

Teenage pregnancy in Britain is six times higher than in Holland. In many ways, Holland and Britain are similar countries-in terms of culture and the ethnic mix-but we have six times more teenage pregnancies than Holland. Is that associated, possibly, with teenage drinking? I suspect that a lot of it is. However, not only does that cause a problem in terms of getting pregnant in the first place, but those young women continue drinking and then damage their babies before they are born. That is deeply worrying and something that I have been concerned about for a long time.

It is time to take serious action, and I urge my hon. Friend the Minister to take my suggestions back to her colleagues in Government and to start to think seriously about action. My minimum suggestion is for a seven-point plan-it could be eight, nine, 10 or 12 points. The first is for warning labels on all alcoholic drinks stating that if a pregnant woman drinks, she might damage or, if she drinks to excess, will damage her baby for life. That should be on walls in pubs and on all alcoholic drinks. We should have public information on television, radio and other media about that. Public information should be displayed wherever appropriate to ensure that all women know that, if they drink when pregnant, they are likely to damage their baby.

Sandra Gidley Shadow Health Minister

In France, it is now compulsory to indicate on pack labelling the shape of a pregnant woman with a cross through it to get the message across literally at the point of drink. Presumably, the hon. Gentleman would support something along those lines.

Kelvin Hopkins Labour, Luton North

Absolutely. The Americans use wording that I have mentioned before to the hon. Lady-so I will not go into the details now-and I think that Lord Mitchell, in a debate in another place, referred to the American labelling too. I cannot put my hand on it at the moment, but they use specific wording that can be seen very clearly. However, a picture of a pregnant woman with a cross through it is one way of drawing the problem to people’s attention. Most women either are not aware of it or tend to pretend that it does not affect them because it is too inconvenient. That is deeply worrying, and we care more, I hope, about children than anything else. I am sure that that is true of most people.

Anne Milton Shadow Minister (Health) 3:56 pm, 10th March 2010

Kelvin Hopkins, who is not in his place, talked at length about foetal alcoholsyndrome, and about the licensing laws. Foetal alcohol syndrome has not had much of a mention, and I do not think that it was mentioned in the report, but it has been a long-standing problem and continues to be a serious one. As the hon. Gentleman said, it is about damage that women are doing to their children, perhaps unwittingly and unknowingly. They may be unaware of the impact of alcohol.


Alcohol Consumption (Pregnancy)

First Minister’s Question Time – in the Scottish Parliament at 12:00 pm on 4th March 2010.

Jamie Hepburn Scottish National Party 12:00 pm, 4th March 2010

To ask the First Minister how the Scottish Government plans to tackle the problem of alcohol consumption during pregnancy. (S3F-2251)

Alex Salmond First Minister of Scotland, Leader, Scottish National Party

The Scottish Government‘s alcohol framework outlines a package of measures to tackle alcohol misuse in Scotland. They include legislative measures that are being developed in the Alcohol etc (Scotland) Bill, particularly action on minimum pricing and on irresponsible promotions, that are supported by the National Society for the Prevention of Cruelty to Children, ChildLine, Children 1 st , the Aberlour Child Care Trust, YouthLink Scotland, Barnardo’s Scotland, Action for Children Scotland, Quarriers and Parenting across Scotland. The bill is complemented by a range of non-legislative measures that include targeted action on foetal alcohol spectrum disorder and it is backed by record investment, totalling almost £100 million over three years, in treatment and support services.

Jamie Hepburn Scottish National Party

The First Minister will be aware that Dr Harry Burns, the chief medical officer, has said that he believes that the incidence of foetal alcohol spectrum disorder in Scotland has been significantly underestimated. Given the impact that the condition can have on the unborn child and noting the report from Children in Scotland on the matter, does the First Minister agree that the problem demonstrates yet again why all parties represented in the chamber should be united on taking action on alcohol abuse?

Alex Salmond First Minister of Scotland, Leader, Scottish National Party

A team is being put in place to work on foetal alcohol spectrum disorder. Part of that work will focus on the prevention of alcohol-exposed pregnancies and on the promotion of healthy pregnancies. A pack of resources on alcoholinterventions in the antenatal setting has been developed, and it will be issued to every national health service board by the end of this month.

Jamie Hepburn has made a point about how alcohol misuse can affect unborn children in particular. As we know, and as we must accept, alcohol misuse goes through the range of society.

It has a range of dreadful effects on public order and on the public health of Scotland. In those circumstances, it behoves everyone in the Parliament to respond to the scale of the challenge by examining outwith the normal argy-bargy of party politics the measures that the Government is proposing. This issue above all is an example of what is right, as opposed to who is right.

Ross Finnie Liberal Democrat

Does the First Minister agree with Children in Scotland‘s submission on foetal alcohol syndrome and foetal alcohol spectrum disorder to the House of Commons Health Committee that accurate measurement of the incidence of the conditions can occur only after there is a critical mass of health practitioners who are able to make the diagnosis correctly? What steps is the Government taking to create such a critical mass?

Alex Salmond First Minister of Scotland, Leader, Scottish National Party

Ross Finnie‘s question is perfectly fair. I know that he recognises the specifics of the action on FASD that I have just listed. As a general proposition, his point seems reasonable; the work of the team that has been put together to undertake specific work on foetal alcohol spectrum disorder is therefore all the more important.



2011 FASD Statements by Government, MPs and Peers

Foetal Alcohol Syndrome

Health written question – answered on 12th December 2011.

James Wharton: To ask the Secretary of State for Health what information his Department holds on the number of children with foetal alcohol spectrum disorders. [85486]

12 Dec 2011 : Column 550W

Anne Milton: The actual United Kingdom prevalence for either foetal alcohol syndrome or foetal alcohol spectrum disorder is unknown and there is no mechanism currently for national data collection.


Business of the House

– in the House of Commons at 11:32 am on 24th November 2011.

Kelvin Hopkins (Luton North) (Lab): Research reported last week has found that 10,000 babies are born each year damaged by smoking and the consumption of alcohol and drugs during pregnancy. Some 6,000 of those babies are affected by foetal alcohol spectrum disorders. Is it not time for the Government to make a statement on and bring forward proposals to deal with this tragic situation?

Sir George Young: The Government are very anxious to drive down perinatal and antenatal mortality and we have taken a number of measures already to promote public health. The Health and Social Care Bill, which is now going through the House, will, I hope, make some progress in that direction. I will bring the hon. Gentleman’s suggestion to the attention of my right hon. Friend the Secretary of State for Health and ask whether there is more we can do to diminish the number of babies who are born damaged or, sadly, die because of excess alcohol consumption by their mother.



– Scottish Parliament written question – answered on 14th March 2011.

Richard Simpson Labour

Question S3W-39720

To ask the Scottish Executive what progress it has made in carrying out epidemiological research on foetal alcohol spectrum disorders.

Shona Robison Scottish National Party

A four-year surveillance research project of the epidemiology of Foetal AlcoholSyndrome in Scotland, for which the Scottish Government is providing funding, began on 1 April 2010. The findings and analysis of the results will be published in a scientific paper at the end of the project in 2014. We would anticipate that the results will also be presented to the Scottish Paediatric Society, the British Association of Perinatal Medicine, the Neonatal Society, and the British Association for Community Child Health, the Royal College of Paediatrics Research and the European Society of Paediatric Research.

“Report on preventative spending”

– in the Scottish Parliament on 9th March 2011.

Derek Brownlee Conservative

 In the health service, some good examples were given of preventative spending around pregnancy, such as the importance of preventing foetal alcohol syndrome by ensuring that women who may get pregnant understood the risks, and the importance of taking folic acid.



– Scottish Parliament written question – answered on 8th February 2011.

Richard Simpson Labour

Question S3W-39210

To ask the Scottish Executive what progress it has made in establishing the (a) incidence and (b) prevalence of foetal alcohol spectrum disorders.

Shona Robison Scottish National Party

An expert clinician, Dr Maggie Watts, Public Health Consultant with Ayrshire and Arran NHS Board has been appointed to help develop a policy on addressing foetal alcohol spectrum disorders. This will be developed in partnership with policy colleagues from across the Scottish Government and will focus mainly on the prevention of alcohol exposed pregnancies.

The Scottish Government is funding a four-year surveillance research project in children under six years of age to estimate the incidence and epidemiology of Foetal Alcohol Syndrome. The project is being carried out by the Department of Epidemiology at the University of Edinburgh.



2012 FASD Statements by Government, MPs and Peers

Criminal Injuries Compensation Scheme

Opposition Day — [8th Allotted Day] – in the House of Commons at 4:27 pm on 7th November 2012.

Jim ShannonShadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

The hon. Lady touches on the issue of children. Is she aware that children whose lives have been wrecked as a consequence of illicit drug taking and alcohol abuse by their mothers during pregnancy will not be able to claim? Is there not something seriously wrong there?

Katy Clark Labour, North Ayrshire and Arran

 Indeed, a number of categories have simply been taken out of compensation. Jim Shannon mentioned children who have suffered as a result of their parents’ alcohol or drug abuse, particularly by the mother. They will no longer be entitled to compensation, but in the original consultation only those who had suffered from foetal alcohol problems were affected. There has been no consultation whatever on drug abuse, which is also part of the scheme.


Foetal Alcohol Syndrome

Education written question – answered on 16th April 2012.

Alex Cunningham: To ask the Secretary of State for Education (1) what plans he has for education programmes for children with (a) Foetal Alcohol Spectrum Disorder and (b) other alcohol-related disabilities; [103009]

(2) what support his Department provides to teachers who teach pupils diagnosed with Foetal Alcohol Spectrum Disorder. [103010]

Sarah Teather: The Government have no plans for introducing specific education programmes for children with Foetal Alcohol Spectrum Disorder and other alcohol-related disabilities. Decisions about the approaches used to teach children are made by schools.

The Department for Education has, however, funded the development of materials for schools on teaching children with complex learning difficulties and disabilities, including Foetal Alcohol Spectrum Disorder and other alcohol-related disabilities. These were produced by Schools Network (formerly the Specialist Schools and Academies Trust) and are available for schools who wish to use them from the Schools Network website:


Online resources that can be used by teachers, trainee teachers and teacher trainers on supporting children with severe and complex needs, including children with Foetal Alcohol Spectrum Disorder and other alcohol-related disabilities, have been produced by the Training and Development Agency for Schools. These will be available online during April 2012 from the Department for Education’s website at:



Foetal Alcohol Syndrome

Health written question – answered on 16th April 2012.

Alex Cunningham: To ask the Secretary of State for Health (1) what steps the Government are taking to ensure that doctors are trained to diagnose and treat foetal alcohol spectrum disorder; [102700]

(2) if he will take steps to encourage all medical colleges to include foetal alcohol spectrum disorder education in their curriculum. [102703]

Anne Milton: Although there is a broad consensus on the problems of foetal alcohol spectrum disorder, there is not yet full international agreement on exact diagnostic criteria for all the categories currently described. However, general practitioners are expected by the General Medical Council to participate in continuing professional development activities to ensure they remain up-to-date in their practice.

In 2006, the Department announced funding to develop the curriculum for all new United Kingdom doctors in relation to substance misuse. Further funding support was provided in 2008 to assist in implementation of this agreed curriculum in English medical schools. This will help ensure that by 2018, around 600,000 doctors will have been trained to be able to recognise, assess and understand the management of alcohol use and its

16 Apr 2012 : Column 111W

associated health and social problems, and so that in the future doctors can better advise women on the effects of substance use including alcohol, and the impact on foetal and maternal health.


Foetal Alcohol Syndrome

Health written question – answered on 16th April 2012.

Alex Cunningham: To ask the Secretary of State for Health what education programmes for teenagers the Government have put in place on (a) avoiding alcohol in pregnancy and (b) children with alcohol-related brain damage to prevent foetal alcohol spectrum disorder. [102701]

Anne Milton: All schools must have a sex and relationship education policy. Topics that are covered in the programme, such as avoiding alcohol in pregnancy, are based on helping young people make sensible and informed decisions.

The Government continue to support high quality personal, social, health and economic (PSHE) education as a means of ensuring that all children and young people learn how to maintain a healthy lifestyle. The Department for Education (DfE) is currently considering responses to its review of PSHE education and will consult on its proposals later this year.

Advice on drinking in pregnancy and possible harmful foetal effects is currently incorporated in departmental public health materials.


Foetal Alcohol Syndrome

Health written question – answered on 16th April 2012.

Alex Cunningham: To ask the Secretary of State for Health what steps he is taking to ensure that GPs make referrals for foetal alcohol spectrum disorder diagnosis. [102702]

Anne Milton: The Department has provided funding to develop the curriculum for all new United Kingdom doctors in relation to substance misuse. This will help ensure newly qualified general practitioners are trained to be able to recognise, assess and understand the management of alcohol use and its associated health and social problems.

Although there is a broad consensus on the problems of foetal alcohol spectrum disorder, there is not yet full international agreement on exact diagnostic criteria for all the categories currently described. However, general practitioners are expected by the General Medical Council to participate in continuing professional development activities to ensure they remain up-to-date in their practice.


Foetal Alcohol Syndrome

Health written question – answered on 16th April 2012.

Alex Cunningham: To ask the Secretary of State for Health what programmes he has in place to prevent women giving birth to children with alcohol-related brain damage. [102704]

Anne Milton: Advice on drinking in pregnancy and possible harmful foetal effects is currently incorporated in the Department’s public health materials. The National Institute for Health and Clinical Excellence’s (NICE) 2007 guideline also includes recommendations for doctors and midwives on the advice they should give to pregnant women about drinking alcohol.

There are programmes in place for supporting appropriate training and continuing professional development of health care staff, including for medical undergraduate training.


Foetal Alcohol Syndrome

Health written question – answered on 16th April 2012.

16 Apr 2012 : Column 112W

Alex Cunningham: To ask the Secretary of State for Health what steps his Department has taken to inform the public about drinking in pregnancy and Foetal Alcohol Spectrum Disorder in the last year; and what plans he has for such a campaign in the next 12 months. [103008]

Anne Milton: The Change4Life campaign, launched in February, focuses on the health harms from drinking above the lower-risk guidelines.

The Department’s Start4Life campaign is being broadened to incorporate maternal health and will include specific messaging on reducing alcohol consumption.

The Department is also working to make digital advice and information for parents starting from early in pregnancy more accessible and relevant to the stage of pregnancy and age and development of their child.


Foetal Alcohol Syndrome

Health written question – answered on 28th February 2012.

Stephen Barclay: To ask the Secretary of State for Health (1) what assessment he has made of the potential costs and benefits of the UK’s participation in the World Health Organisation prevalence study into foetal alcohol spectrum disorders; [97245]

(2) what cost-benefit analysis his Department has undertaken in respect of UK participation in the global World Health Authority prevalence study into foetal alcohol spectrum disorders. [97287]

Mr Simon Burns: We are aware that the World Health Organisation plans to undertake a prevalence study into foetal alcohol spectrum disorders. The United Kingdom has not been invited to participate in the study. We look forward to the findings from the study into foetal alcohol spectrum disorders in due course.


Foetal Alcohol Syndrome

Health written question – answered on 28th February 2012.

Stephen Barclay: To ask the Secretary of State for Health what assessment he has made of (a) the prevalence of foetal alcohol spectrum disorders and (b) any difference in approach to diagnosing such conditions between the UK and other countries. [97246]

Mr Simon Burns: I refer my hon. Friend to the answer given by the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), on 20 January 2012, Official Report, columns 1006-07W, in respect of work commissioned by the Department on research gaps around the prevalence of foetal alcohol spectrum disorders.

The National Perinatal Epidemiology Unit’s review of the evidence of foetal effects of prenatal alcohol exposure, published in 2006 as ‘Review of the Fetal Effects of Prenatal Alcohol Exposure’, considered evidence from other countries and the international research evidence base.


Foetal Alcohol Syndrome

Health written question – answered on 28th February 2012.

Stephen Barclay: To ask the Secretary of State for Health for what reason foetal alcohol spectrum disorders are not recognised conditions in the UK. [97249]

Paul Burstow: Foetal alcohol spectrum disorder is a term used to describe a range of disorders and disabilities associated with prenatal alcohol exposure. It is not generally regarded as a single condition, but as an umbrella term that covers several alcohol-related medical conditions.


Foetal Alcohol Syndrome

Health written question – answered on 20th January 2012.

Stephen Barclay: To ask the Secretary of State for Health what steps his Department has taken to determine the prevalence of foetal alcohol spectrum disorders; and what assessment he has made of the cost-effectiveness of (a) prevention strategies and (b) targeted interventions for high-risk groups. [90941]

Anne Milton: In 2005, the Department commissioned the National Perinatal Epidemiology Unit (NPEU) to review the evidence of foetal effects of prenatal alcohol exposure. The NPEU published its findings in 2006 as ‘Review of the Fetal Effects of Prenatal Alcohol Exposure’.

The review discussed in detail the difficulties of identifying accurately children with foetal alcohol syndrome (FAS) and alcohol neuro-developmental disorder and the resulting difficulties in estimating prevalence.

20 Jan 2012 : Column 1007W

The review considered the risks of foetal exposure to low to moderate alcohol consumption and to binge drinking during pregnancy.

The review found no consistent evidence of adverse effects from low-to-moderate prenatal alcohol consumption, although it also found that the evidence base was limited.

In 2007, UK chief medical officers (CMOs) published revised guidance on alcohol consumption during pregnancy, which took account of the NPEU’s review. The National Institute for Health and Clinical Excellence (NICE) published further guidance on this subject for health professionals in England in 2008.

NPEU’s review identified a number of research gaps, including levels of alcohol consumption during pregnancy, prevalence of FAS and foetal alcohol spectrum disorder (FASD), whether a ‘safe’ level of alcohol consumption could be identified, and how to characterise and diagnose neuro-developmental problems in children with FAS and FASD.

Prevention strategies include universal and targeted interventions. Among the former, advice on drinking in pregnancy and possible harmful foetal effects is incorporated in the Department’s public health materials. A warning on drinking alcohol while pregnant or trying to conceive, consistent with the UK CMOs’ guidance, will be included on alcohol labels as a result of an industry pledge under the Public Health Responsibility Deal, covering 80% of the off-trade market by the end of 2013.

NICE has published ‘Pregnancy and complex social factors: A model for service provision for pregnant women with complex social factors’ (NICE clinical guideline 110, September 2010). This includes advice on support for pregnant women who misuse substances, whether alcohol or drugs.



2013 FASD Statements by Government, MPs and Peers

Foetal Alcohol Syndrome

Health written question – answered on 5th December 2013.

Foetal Alcohol Syndrome

Andrew Griffiths: To ask the Secretary of State for Health how many cases of foetal alcohol syndrome were reported in the last five years for which figures are available. [179699]

Jane Ellison: The following table contains the number of finished consultant episodes (FCE) where there was either a primary or secondary diagnosis of fetal alcohol syndrome in England.

Please note that these figures are not a count of people as the same person may have had more than one episode of care within any given time period.

Number of FCEs1 with either a primary or secondary diagnosis2 of fetal alcohol syndrome3 for the years 2008-09 to 2012-134
2008-09 233
2009-10 212
2010-11 247
2011-12 310

5 Dec 2013 : Column 793W

2012-13 313
1 Finished Consultant Episode (FCE) A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year. 2 Number of episodes in which the patient had a primary or secondary diagnosis The number of episodes where this diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and seven prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record. 3 ICD-10 diagnosis code ICD-10 diagnosis code used: Q86.0 Foetal alcohol syndrome (dysmorphic) 4 Assessing growth through time (In-patients) HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, changes in activity may be due to changes in the provision of care.Notes: 1. Data quality HES are compiled from data sent by more than 300 NHS trusts and primary care trusts in England and from some independent sector organisations for activity commissioned by the English NHS. Health and Social Care Information Centre liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain. 2. Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector. Source: Hospital Episode Statistics (HES), The Health and Social Care Information Centre (HSCIC)



Health written question – answered on 14th October 2013.

Alex Cunningham: To ask the Secretary of State for Health what plans his Department has to raise awareness of foetal alcohol syndrome through public health campaigns targeting schools and local communities. [169932]

Jane Ellison: Start4Life includes the advice to avoid alcohol during pregnancy as part of our communications to pregnant women on having a healthy pregnancy but we do not specifically reference foetal alcohol syndrome. Local Health and Wellbeing Boards are ideally placed to pursue and target this issue at a local level, especially based upon their local data, identified need and prioritisation.

Start4Life is a campaign from Public Health England aimed at increasing the number of healthy babies and children under the age of five through promoting healthy behaviours in pregnancy (healthy eating, avoiding alcohol, stopping smoking, taking supplements and keeping active) and also in the early years of a child’s life (breastfeeding, safe introduction of solid foods, establishing healthy eating habits and physical activity).

Foetal Alcohol Syndrome


Foetal Alcohol Syndrome

Health written question – answered on 14th October 2013.

Alex Cunningham Labour, Stockton North

To ask the Secretary of State for Health what consideration his Department has give to strengthening current advice to pregnant women by clearly labelling alcohol as a teratogen.

Jane Ellison The Parliamentary Under-Secretary of State for Health

The Government is committed to improving the labelling of alcoholic drinks.

As part of the Public Health Responsibility Deal, alcohol retailers and producers have committed to putting the advice ‘Avoid alcohol, if pregnant or trying to conceive’, or an alternative pregnancy warning logo, on 80% of labels on shelf by the end of 2013.

As set out in the Government’s Alcohol Strategy, the Department of Health has also commissioned a review of current drinking guidelines. This is being led by Dame Sally Davies, the Government’s chief medical officer.

The evidence review will include consideration of any new evidence on alcoholand pregnancy since the current guidelines were published in 2007.

The chief medical officers for England, Scotland, Wales and Northern Irelandwill jointly oversee this work. We expect the review of evidence to conclude in January 2014.


Foetal Alcohol Syndrome

Health written question – answered on 14th October 2013.

Alex Cunningham Labour, Stockton North

To ask the Secretary of State for Health if his Department will develop a foetal alcohol syndrome strategy.

Jane Ellison The Parliamentary Under-Secretary of State for Health

The Government’s Alcohol Strategy, published on 23 March 2012, addresses the full range of harm from alcohol.

The strategy recognises that:

Fetal alcohol spectrum disorders (FASD) are caused entirely by drinking alcoholduring pregnancy and so are completely preventable; and

FASD can be caused by mothers drinking alcohol even before they know they are pregnant, so preventing them is strongly linked to reducing levels of heavy drinking in the population, especially among women.

We will continue to raise awareness of the need for women who are pregnant or trying to conceive to avoid alcohol, including by increasing the awareness of health professionals.

The chief medical officer is overseeing a review of the Government’s alcoholguidelines, including those for women who are pregnant or trying to conceive.

The Department will continue to raise awareness of research needs for FASD, including gaps in our knowledge on whether a ‘safe’ level of alcoholconsumption could be identified, how to characterise and diagnose neurodevelopmental problems in children with1 FASD, prevalence of the condition, and effective treatment.


Foetal Alcohol Syndrome

Education written question – answered on 13th September 2013.

Dan Jarvis Shadow Minister (Culture, Media and Sport)

To ask the Secretary of State for Education what plans he has to educate girls on foetal alcohol spectrum disorder.

Elizabeth Truss The Parliamentary Under-Secretary of State for Education

Education plays an important role in helping to ensure that young people are equipped with the information they need to make informed, healthy decisions and to keep themselves safe.

Schools are required to teach drug education as part of the national curriculum science key stage 2 and key stage 3. It is a matter for schools to decide whether they want to build on this provision through Personal, Social, Health and Economic (PSHE) education.

The National Organisation for Foetal Alcohol Syndrome UK (NOFAS-UK) is dedicated to supporting people affected by foetal alcohol spectrum disorders (FASD), and their families and communities. They have developed a range of materials available on their website specifically for teachers.


Foetal Alcohol Syndrome

Health written question – answered on 13th September 2013.

Dan Jarvis Shadow Minister (Culture, Media and Sport)

To ask the Secretary of State for Health what plans he has to produce a strategy to address foetal alcohol spectrum disorder.

Anna Soubry The Parliamentary Under-Secretary of State for Health

The Government’s Alcohol Strategy, published on 23 March 2012, addresses the full range of harm from alcohol.

The strategy recognises that:

foetal alcohol spectrum disorders (FASD) are caused entirely by drinking alcohol during pregnancy and so are completely preventable; and

FASD can be caused by mothers drinking alcohol even before they know they are pregnant, so preventing them is strongly linked to reducing levels of heavy drinking in the population, especially among women.

We will continue to raise awareness of the need for women who are pregnant or trying to conceive to avoid alcohol, including by increasing the awareness of health professionals.

The Chief Medical Officer is overseeing a review of the Government’s alcoholguidelines, including those for women who are pregnant or trying to conceive.

The Department will continue to raise awareness of research needs for FASD, including gaps in our knowledge on whether a ‘safe’ level of alcohol consumption could be identified, how to characterise and diagnose neuro- developmental problems in children with FASD, prevalence of the condition, and effective treatment.


Alcohol Strategy Consultation

Oral Answers to Questions — Prime Minister – in the House of Commons at 1:24 pm on 17th July 2013.

Kelvin Hopkins (Luton North) (Lab): Thousands of babies are born damaged by alcohol every year, many with permanent genetic damage. Will the Government give further serious consideration to introducing legislation making it compulsory for all drinks containers to have a written health warning aimed at women of child-bearing age, combined with a pregnant mother symbol?

Mr Browne: The hon. Gentleman makes a serious point about the terrible fetal damage that excessive alcohol consumption can cause during pregnancy, although I think that it would be better directed at Health Ministers, rather than Home Office Ministers. I know that some warnings exist to alert expectant mothers to the risks, but no doubt the Minister for Public Health, my hon. Friend the Member for Broxtowe (Anna Soubry), will take his words seriously and see what more can be done.


Clause 24 – Duty of health bodies to bring certain children to local authority’s attention

Children and Families Bill – in a Public Bill Committee at 3:45 pm on 19th March 2013.

Sharon Hodgson Shadow Minister (Education)

 Hopefully, those extra health visitors will mean that they and their colleagues will be able to spend more time with each family and child, affording health visitors a greater chance of spotting the early signs of, for example, lack of bonding, lack of attachment, developmental delay or, prior to the birth, symptoms of avoidable pregnancy complications, such as from alcohol and drug abuse or smoking.

We know that those things can cause and increase the risk of children being born with birth defects such as foetal alcohol syndrome or an addiction to drugs—or of being born prematurely, in the case of smoking. All those things can lead to disabilities, ongoing health problems or special educational needs.


Clause 13 – Control of expert evidence, and of assessments, in children proceedings

Children and Families Bill – in a Public Bill Committee at 3:45 pm on 14th March 2013.

Edward Timpson The Parliamentary Under-Secretary of State for Education

Clause 13 will strengthen the court’s control of the use of expert evidence in children’s proceedings and ensure that it is not overused or misused. It is a vital step in tackling unnecessary delays in public law proceedings—delays that can have a detrimental impact on children’s welfare. The clause has been widely welcomed by the judiciary, the Magistrates Association and others.

I am clear that expert evidence will continue to be needed in some cases where specialist expertise is required and cannot be obtained from another source. From memory, the president of the family division mentioned examples of such cases in his evidence to the Committee. Certainly, I can remember that from cases that I have been instructed in—non-accidental injury cases, cases involving foetal alcohol syndrome, cases of complex disability, and cases of particular forms of abuse, sexual abuse especially. In cases where the judge considers that specialist expertise is appropriate and necessary, it is important that it is still available, so that a case can be dealt with justly.


Examination of Witnesses

Children and Families Bill – in a Public Bill Committee at 12:00 pm on 5th March 2013.

Witness – Professor Selwyn: On the duty to inform, we have done a number of studies where adopters have said, “We were not told about the difficulties of the child. They were kept secret. The social worker downplayed the difficulties.” When I have talked to social workers and looked at the case files, however, it is apparent that the adopter has been told about the difficulties but that they have not really been explained to them.

For example, the social worker might say, “The child has attachment difficulties.” The consequences of that, however, and the reality of living with a child with that have not been explained to the adoptive parents. Or a child born with evidence of foetal alcohol difficulties: again, the prognosis and the outcome for that child have not been explained.

Another element of this is that when adopters are first getting a child, they are filled with optimism—they think, “We are going to make the difference to this child.” They look at the evidence with rose-tinted glasses. They are not in a position to understand the information that they are getting. I agree that all information should be passed over, but that is not a one-off piece of practice; it is something that the workers need to go back to the adopters with, over time, and to revisit, explaining what the consequences really are.


Alcohol Consumption (Pregnancy)

Oral Answers to Questions — Health – in the House of Commons at 11:30 am on 26th February 2013.

6. Kelvin Hopkins (Luton North) (Lab): What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement. [144341]

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Foetal alcohol syndrome is a severe, lifelong condition caused by heavy alcohol consumption

26 Feb 2013 : Column 159

during pregnancy, and foetal alcohol spectrum disorder is usually less severe. There is a consensus, however, that FASD is more widespread.

Kelvin Hopkins: I thank the hon. Lady for her answer and for her recent letter to me on this subject. She will be aware of the Medical Research Council’s research suggesting that 7,000 babies are born every year suffering from serious genetic and permanent damage. Just as worrying, however, is that even moderate consumption can have an impact on IQ. In America, all drinks containers must have the following written on them

“According to the surgeon general, women should not drink alcohol beverages during pregnancy because of the risk of birth defects.”

When will the Government insist that all drinks containers in Britain carry the same slogan?

Anna Soubry: The hon. Gentleman makes a very good point. Our advice is clear and the chief medical officer continues to give this advice: women who are pregnant or trying to become pregnant should not drink alcohol. If they feel that they must drink it, they should drink one or two units once or twice a week, at the very most. Our advice is clear, but he makes a good point, and I am happy to discuss it with him further.

Jim Shannon (Strangford) (DUP): Recent NHS figures show that £2.7 billion was spent on alcohol-related illnesses. Will the Minister consider a campaign across the whole of the United Kingdom, including the Northern Ireland Assembly and Northern Ireland as a region, to combat the issue of drinking during pregnancy?

Anna Soubry: That is a very good point. The overconsumption of alcohol, whether by a pregnant woman or not, greatly concerns the Government, and that is one reason we want to introduce a minimum unit price of 45p. It was a good point well made, and I am always happy to meet the hon. Gentleman to discuss the matter further.



2014 FASD Statements by Government, MPs and Peers

Children: Alcohol Harm — Question

– in the House of Lords at 2:59 pm on 17th November 2014.

Baroness Brinton Liberal Democrat

My Lords, the damage to the foetus from maternal drinking, especially in the first three months, can take the form of foetal alcohol spectrum disorder, which includes heart defects, learning difficulties, kidney defects and other impairments. Will the Minister encourage the Home Office to consider a publicity campaign as hard-hitting as the “Don’t drink and drive” campaign to make prospective mothers aware of the problems?

Hansard source (Citation: HL Deb, 17 November 2014, c234)

Baroness Williams of TraffordLords Spokesperson (Department of Business, Innovation and Skills), Baroness in Waiting (HM Household) (Whip)

I thank my noble friend for raising that point: it is an incredibly worrying trend. While we believe that adults should take responsibility for their own actions, the number of cases of this disorder is rising; I understand that there is currently a case in court on it. We certainly are very keen to promote health awareness in this area.






Rebalancing Project

Oral Answers to Questions — Health – in the House of Commons at 11:30 am on 21st October 2014.

Graham Allen Chair, Political and Constitutional Reform Committee 11:30 am, 21st October 2014

What contribution his Department is making in support of the health objectives of the rebalancing project on dental checks for three-year-olds, foetal alcohol syndrome and lung screening for people over 60.

Jane Ellison The Parliamentary Under-Secretary of State for Health

The hon. Gentleman and I have spoken a number of times about his valuable project. He knows that I am very interested in it and its outcomes. The Government are committed to improving oral health, with a particular focus on children, to reducing the incidence of foetal alcohol syndrome and to improving outcomes for all cancers. Results of major trials on lung cancer screening, including our own £2.4 million UK trial, are due in 2015. At that point, the UK national screening committee will review all the available evidence, looking towards a pilot.



Foetal Alcohol Syndrome — [Mr Andrew Turner in the Chair]

– in Westminster Hall at 2:30 pm on 14th October 2014.

Foetal Alcohol Syndrome

[Mr Andrew Turner in the Chair]

2.30 pm

Bill Esterson (Sefton Central) (Lab): It is a pleasure to serve under your chairmanship, Mr Turner. I hope that, like me, having done lots of research on this subject, you will have discovered how important it is and why it is so important that we are debating it this afternoon. I hope that there will be commitments from the Government on concrete action.

Last Thursday, Sir Al Aynsley-Green published on Opendemocracy.net a fantastic letter describing what goes on elsewhere to address problems caused by drinking during pregnancy. The title of his article is “If you could prevent brain damage in a child, would you?” Everybody is going to answer yes to that, but are we preventing brain damage in children? At the moment, there is a large question about whether we in this country are doing enough to prevent such brain damage.

I am going to give the Minister a bit of warning about what I am looking for from her in this debate. I should like her to reiterate the Government’s advice for pregnant women. Is that advice not to drink at all during pregnancy? Will she say what actions the Government are taking to ensure that women and their partners are fully aware of the risks and that society as a whole is aware of the risks? What is her view of and attitude to the potential for mandatory labelling of alcohol products, as in France?

I understand that, at the moment, the Government say that women should not drink at all during pregnancy, but that, at the same time, they say that women who do not want to stop drinking altogether should have only one or two units a week. Some would say that this is contradictory advice. We will return to what the advice should be and discuss whether there should be different advice and whether there is indeed a safe limit.

Kelvin Hopkins (Luton North) (Lab): I congratulate my hon. Friend on securing this debate. Does he accept the recent evidence that suggests that even moderate drinking has an effect on IQ in babies and that the wise advice is that there should no drinking at all during pregnancy?

Bill Esterson: My hon. Friend makes a point about whether there is a safe limit, and I will discuss that. From the evidence I have looked at, my conclusion is that we cannot possibly say that there is a safe limit and that the advice should be no alcohol during pregnancy.

The National Organisation for Foetal Alcohol Syndrome UK tells us that there is no way to know for sure what impact drinking alcohol might have on an unborn baby. The same point is made by the British Pregnancy Advisory Service. According to the NOFAS, alcohol could have different effects at different times during pregnancy, and it might affect one baby but not another. We know that heavy drinking and binge drinking during pregnancy could increase the risk of foetal alcohol spectrum disorder, but, as I say, we do not know what the safe limit is. My hon. Friend makes the point that the best advice is to

14 Oct 2014 : Column 25WH

abstain completely. According to the NOFAS, at any stage of pregnancy a woman can benefit her baby by avoiding alcohol.

Foetal alcohol spectrum disorder is an umbrella term that covers foetal alcohol syndrome, alcohol-related neurodevelopmental disorders, alcohol-related birth defects, foetal alcohol effects and partial foetal alcohol syndrome. When a pregnant woman drinks, the alcohol in her blood passes freely through the placenta into the developing baby’s blood. Because the foetus does not have a fully developed liver, it cannot filter out the toxins from the alcohol as an adult can. Instead, the alcohol circulates in the baby’s bloodstream. It can destroy brain cells and damage the nervous system of the foetus at any point during the nine months of pregnancy. Those findings have been backed up by research done around the world.

The effects on a child can be mild or severe, ranging from reduced intellectual ability and attention deficit disorder to heart problems and even death. Many children experience serious behavioural and social difficulties that last a lifetime. Although alcohol can affect the development of cells and organs, the brain and nervous systems are particularly vulnerable. We cannot see the neurological brain damage that is caused, but there are a number of invisible characteristics in babies born with FASD, which include attention deficits; memory deficits; hyperactivity; difficulty with abstract concepts, including maths, time and money; poor problem-solving skills; difficulty learning from consequences; and confused social skills. There are also a number of possible physical effects, including smaller head circumference, linked to smaller brain size and brain damage; heart problems; limb damage; kidney damage; damage to the structure of the brain; eye problems; hearing problems; and specific facial characteristics.

Some studies suggest that 1% of live births in Europe are affected by FASD. Many children born with FASD are not diagnosed or do not receive a correct diagnosis, which makes calculating the prevalence of the condition extremely difficult. Because there is no proven safe level for alcohol consumption during pregnancy, the only risk-free approach is to avoid alcohol completely during pregnancy, when trying to conceive and when breastfeeding.

In considering whether a child has FAS, it is also true that they can be very loving, friendly, gregarious, outgoing and trusting—all good traits—but without a sense of balance, these traits can often leave them open to being taken advantage of and abused by others. It appears that there is no cure but there are actions that can help, including early diagnosis; support for families; health monitoring; therapy and medication; support and safety at home; strong boundaries and routines, allied to flexibility from carers; simple instructions; and training and support in social skills. Above all, prevention is key. There should be better awareness so that fewer women drink in pregnancy, and that means providing more advice and support for vulnerable groups of young women. Drinking among young women has increased, so there needs to be better understanding among young women generally.

Yvonne Fovargue (Makerfield) (Lab): Is my hon. Friend aware of the work done by Gloria and Peter Armistead, from my constituency, who founded FAS Aware? They have a two-pronged approach: educating young women

14 Oct 2014 : Column 26WH

in schools about problem drinking and providing a wonderful booklet for teachers and pupils on diagnosing and working with children with foetal alcohol syndrome. Gloria was awarded an MBE for her work in this area.

Bill Esterson: I thank my hon. Friend for mentioning the excellent work done by her constituents. I, too, praise them and many others who have done such good work to raise awareness of the condition, the risks and the need for action.

On greater awareness, the Education Committee is about to start an inquiry into personal, social and health education. What better subject for children at school to learn about than the dangers of drinking in pregnancy? I hope that my comment is taken on board by my fellow Committee members when we consider what to look at during that inquiry.

Al Aynsley-Green describes sitting in a class of seven–year-olds in Canada:

“‘What do you never drink when you have a baby in your tummy?’ asks the facilitator. ‘We never drink alcohol, Miss,’ chorus the children.”

That level of awareness at that age is in stark contrast to anything that happens here. He then mentions a conference in Toronto on prenatal alcohol exposure, attended by several hundred scientists, clinicians, lawyers, parliamentarians and lay people. Emily is 16 years old and has severe learning difficulties. She stood alongside her twin sister, courageously describing what it is like to be affected by the alcohol drunk by their Russian birth mother before they were adopted by their Canadian family. Emily described social isolation, bullying, fidgeting, impulsivity, distractibility, loud noise intolerance and poor concentration, which makes learning difficult.

Canadians take the impact of alcohol before birth seriously. Federal and provincial governments are convinced that prenatal alcohol causing foetal alcohol spectrum disorder is the most important preventable cause of severe brain damage in childhood. It affects affluent families and aboriginal people. Less badly affected children exhibit poor behaviour in their schools and communities and populate the prisons. Canadians express incredulity that the economic cost, let alone the human cost of the syndrome, has not been grasped by politicians in England.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): In that Canadian classroom, the children might well, if my Canadian experience is anything to go by, have also been shouting, “And no drugs and no smoking too.” That is important. I know that the debate is not about that, but it is linked, is it not?

Bill Esterson: Indeed it is. Awareness of the dangers, particularly of smoking during pregnancy, is much higher. Why, when we know what we know about smoking and the damage it causes to the unborn child, would we not ensure that the same awareness is in place for alcohol?

We have known about the dangers of alcohol to the foetus for a long time. Judges 13:7 says:

“Behold, thou shalt conceive, and bear a son; and now drink no wine or strong drink”.

Aristotle wrote about the effects of women drinking during pregnancy. Sir Francis Bacon advised women not to drink during pregnancy. The gin epidemic saw a

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rise in birth defects in Britain in the 1700s. The infant death rate was 20% higher for alcoholic women in prison in 1899 as compared with the rest of the population. Distinct facial characteristics were noted by French researcher Dr Paul Lemoine—I apologise for the pronunciation—who studied families where mothers drank a lot in pregnancy. The term “foetal alcohol syndrome” was first used by English researchers Jones and Smith in 1973.

There has been extensive preventive and clinical work in Canada, the United States and Australia. In 2007, Lord Mitchell’s private Members’ Bill called for it to be mandatory for alcohol sellers to display warning labels. That was seven years ago, and it has not happened yet. We saw recent success when legislation on smoking in cars with children present was passed. The Minister was heavily involved, and I commend her for her work on that. Perhaps we can persuade her to do the same on the labelling of alcohol.

At the severe end of the spectrum, there are some 7,000 live births of children with foetal alcohol syndrome each year in the UK, with three or four times as many babies born with the wider foetal alcohol spectrum disorder. There is, however, a suggestion of under-diagnosis, as symptoms are similar to those resulting from such conditions as attention deficit hyperactivity disorder or autistic spectrum disorder. The neglect of children who end up in care or being adopted can also produce behaviours that are similar to those seen with foetal alcohol spectrum disorder. The combined effects of neglect and FASD can make life difficult for children in care and those around them.

Diagnosis among some groups can be difficult. As the parent of two adopted children, I have no idea whether their birth mother drank during pregnancy. As a result, behaviours consistent with foetal alcohol spectrum disorder, which my children exhibit, could be due to neglect or alcohol consumption during pregnancy or both or neither. There is no way of knowing. The point is that we have to raise awareness, because we have to reduce risk. The education and development needs of this group of children are specialised. I refer the Minister to the research and ask her to look further at what is needed and just how demanding it is to enable children with foetal alcohol spectrum disorders to achieve their potential, given their difficulties in learning and in relating to others.

In 2009, the National Organisation for Foetal Alcohol Syndrome said:

“Teachers and teaching support staff will undoubtedly meet children with FASD in their classrooms. They need to know how to respond to their learning needs effectively, enable them to maximise their potential, improve their life chances and take their places alongside their mainstream peers as citizens…FASD now accounts for the largest, non-genetic group of children presenting with learning difficulties/disabilities. The difficulties that children face in the classroom epitomise that much-used phrase ‘complex needs’…Their unusual style of learning and their extreme challenging behaviour is out of the experience of many teachers”—

and support staff—

“and, as there is significant shortfall in guidance for teachers on how to educate children with FASD in the UK, teachers find themselves ‘pedagogically bereft’.”

We have to look at how we can reduce the number of children with FASD. Advice that says that someone may want to stop could and should be harder hitting.

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As my hon. Friend said, drinking while pregnant will harm the baby, just as smoking does. The private Member’s Bill introduced by Lord Mitchell in 2007 called for mandatory labelling. In 2005, the French Government made it a legal requirement for alcohol to display a warning for pregnant women on the container. The French research quoted the same dangers, research and risks as I have. Crucially, alcohol, according to the French research, can affect the brain at any stage of pregnancy. There is no safe level. The advice in France is that the safest option is no alcohol during pregnancy. That comes from the alcohol project manager at the National Institute for Prevention and Health Education. It faced a lawsuit in 2004, and later that year moved to change the law. In 2005, the law was changed. In France, it now says on bottles of alcohol that the consumption of alcoholic drinks during pregnancy, even in small amounts, may have serious consequences for the child’s health. There is also the symbol of a pregnant woman drinking in a red circle with a red line through the centre. Why do we not have that here?

The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) was on the Health Committee in 2012. At that time, he was quoted as saying that there should be better warnings on the dangers of alcohol. He and others in the medical profession have warned of those dangers for some time, including those posed by drinking during pregnancy. He called for greater publicising of the dangers to raise awareness. As a Minister—along with his colleagues, whom he can advise—he is in a better position to act than he was in 2012.

Last week, the British Pregnancy Advisory Service raised concerns about the impact on pregnant women of the recent publicity on this issue, of which there has been a significant amount in recent months. The BPAS said that women are considering abortions because they fear they may have harmed their unborn child before they realised they were pregnant. It stated that occasional binge drinking was unlikely to cause harm to the baby. From the research I have looked at and the evidence available to us, it is true that binge drinking may not harm a baby, if it happens on occasion, but the trouble with that advice is that there is no way of knowing which babies will be harmed. The concern raised by the BPAS should not be taken lightly. It says that media coverage has caused panic among some pregnant women. That is the last thing that anyone who takes an interest in this issue wants, but, equally, there is a danger that playing down the risks of damage from foetal alcohol spectrum disorders could lead to some women continuing to drink, thinking it is safe when it is not. The BPAS points out that half of pregnancies are unplanned, so many women do not know that they are pregnant, meaning that many women will be drinking alcohol while pregnant. I agree that women should not be alarmed as there is nothing that can be done about what has already happened. However, if greater awareness of the risks can reduce the number of women drinking while pregnant in future, which is the experience in other countries, that must be a step forward.

Kelvin Hopkins: My hon. Friend is making a thoughtful speech. He spoke of unplanned pregnancies. The high level of teenage pregnancies in this country is a serious problem. The number is reducing, but it is still high.

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Young women who may have been drinking and then become pregnant following unprotected sex and are unaware of that may carry on drinking on a regular basis and cause terrible damage to their babies.

Bill Esterson: That is an incredibly important point and is why what Sir Al Aynsley-Green and others have said about Canada is so important. We need to increase awareness among much younger children about the possible damage, so that at the very least young women have the facts available to them. Many other measures are needed to make young women, and young men, aware of concerns around teenage pregnancy.

In 2008, Lord Mitchell proposed that labels on alcoholic drinks should say, “Avoid alcohol if pregnant or trying to conceive.” Some will say that that will not necessarily help the women referred to by the BPAS who are not planning to become pregnant, but it will help those who are planning a pregnancy. I wonder how many other women will consider whether they should drink alcohol if they see the advice and how many men may reiterate the advice and increase awareness, which is what has happened in France. This is not just about women. Men have an important role to play in supporting women, and education of the dangers should target men as well as women. Lord Mitchell also gave the example of tobacco labelling as a good reason for making labelling a legal requirement and not a voluntary code. The damage done to children by alcohol and the damage done by smoking are both important and deserving of maximum attention. I mentioned before the Minister’s support for banning smoking in vehicles with children, so I hope that she will agree when it comes to the labelling of alcohol.

“Foetal alcohol spectrum disorder and foetal alcohol syndrome are completely preventable intellectual and developmental deficits in individuals, resulting from maternal consumption during pregnancy.”

Those are the words of the National Organisation for Foetal Alcohol Syndrome. The time has come to listen to those words and for greater action to reduce the number of children who suffer from foetal alcohol syndrome and the wider spectrum of foetal alcohol disorders to ensure that women in particular have greater awareness of the risks and to ensure that children, families, school staff and all those trying to cope with the results of FASD get more of the support that they need. Some women become pregnant and do not drink alcohol and are giving the best protection against FASD. However, some women drink while pregnant unaware of the risks, and some drink while pregnant unaware that they are pregnant. A further group chooses to drink while pregnant and aware of the risks. Different strategies are required for each group, but it is clear that reducing the number of women who drink alcohol while pregnant is the right way forward and that should be where policy is directed. I have suggested labelling, greater awareness and education at school, and I look forward to hearing the Minister’s suggestions.

As I said earlier, the Canadian federal and provincial governments are convinced that FASD is the most important preventable cause of severe childhood brain damage. The time has come for our Government to decide whether they agree with that statement and whether they will take the necessary action.

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2.54 pm

Tracey Crouch (Chatham and Aylesford) (Con): It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Sefton Central (Bill Esterson) on bringing forward an incredibly important debate at a pivotal time, when political parties are considering alcohol-related issues and how they might form part of our election manifestos. The problems are important to many people out there.

I cannot yet speak from my own experience, but I imagine that there can be no more exciting time for a family than when they are bringing a child into the world. There is all the expectation and preparation throughout pregnancy; there are the classes that future mums and dads go to, with varying degrees of enthusiasm; there is the need to make the home baby-proof for the arrival of the newest member of the family; and there is an endless amount of information read and digested in preparation for becoming parents. That is all part of the nervy but exciting process that millions of parents go through each year. They take every precaution that they can to ensure that they give their child the best and healthiest possible start in life. Why, then, is there an ongoing problem with children being born with foetal alcohol syndrome disorder?

FASD refers to several diagnoses of permanent brain damage and can vary in severity from case to case. It could affect up to one in every 100 babies in England. One thing that does not vary from case to case is the fundamental cause: pre-natal exposure to alcohol, or the alcohol intake of women during pregnancy. We need to be careful, as the hon. Gentleman said, that we do not demonise or frighten women who may have drunk before they realised that they were pregnant, but that is not a reason for us not to discuss the issue.

The prevalence of FASD is particularly concerning because the link between pre-natal exposure to alcohol and FASD is quite clear. Expectant mothers can prevent it by taking precautions when it comes to drinking alcohol, as of course many do. No expectant mother in possession of all the facts would wilfully jeopardise the health of their unborn child by not taking precautions, so why is FASD still a problem? I would respectfully say that one thing missing from the hon. Gentleman’s speech was the point that there is a generational issue here. Many people with children of child-bearing age will say to their young daughters, “I smoked and drank throughout my pregnancy and you turned out fine,” but there is a difference in consumption. My parents did indeed drink and smoke while pregnant with me, and I turned out fine, or so I would argue; my parents might disagree. Their level of alcohol consumption was different from the level that women are consuming these days.

FASD is at root poorly understood, and little has been done by way of meaningful study into it. Our understanding of the true scale of the problem is limited, and it is feared, with some justification, that those diagnosed with FASD are just the tip of the iceberg. Nobody knows just how bad the situation is, and how bad the rate of misdiagnosis is among children who display similar symptoms, such as those associated with autism. The misdiagnosis of a child’s symptoms can have a severe impact on their development, and that really needs to be addressed. Even with this relatively limited understanding, knowledge of what to do about FASD and awareness of the dangers of drinking alcohol

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during pregnancy are patchy. There is so much conflicting information out there for expectant mothers, and so much uncertainty about what might be safe to drink and when. Some sources say not to drink at all. Some say that one glass of wine a week is fine. Some say that one glass of wine a day is fine. The messages are inconsistent, which is a major problem. That is not good enough, and while there is uncertainty in our understanding and in the messaging around FASD, nothing will change.

The all-party parliamentary group on alcohol misuse, which I chair, often discusses the lack of co-ordination in tackling alcohol-related harms. Whatever the topic, one of the key solutions to which we always return is raising awareness and education, which can succeed only if we know the facts. When it comes to policy, we talk of nothing being a silver bullet; in this instance, except in extreme cases, investing in a full-scale, holistic campaign to raise awareness of FASD, based on a full and proper study, is as close as we will get.

As often appears to be the case with alcohol and health policy, the Government could and perhaps should look to Canada for ideas and guidance on how to tackle FASD. In Canada, there is already much greater understanding of and emphasis on the risks associated with drinking while pregnant. As the hon. Gentleman said, warning statements are visible in pubs and clubs, and containers carry an explicit message about the dangers of drinking alcohol when pregnant.

The all-party group published a manifesto in August that set out key commitments that we would like all three political parties to adopt in their 2015 manifestos. One such measure was to support further health warnings on all alcohol labels. That commitment was considered rather controversial; as chair of the group, I got quite a lot of criticism for suggesting that alcohol bottles should carry better health warnings, as if that somehow infringed people’s civil liberties. In fact, having better information on alcohol labels enhances people’s liberties, because it gives them the right information.

Kelvin Hopkins: The hon. Lady makes an important point. Does she not suspect, as I do, some influence from the drinks industry, which is trying to calm fears that alcohol causes problems for babies?

Tracey Crouch: I will not criticise the drinks industry fully, because it is trying to improve its labelling. It is strongly committed to having better labels on its products. The problem is the inconsistency in labelling, not least depending on whether the product was imported or produced here in the United Kingdom. Before the APG manifesto announcement, I looked at the wine bottles in my house; there were, for example, differences between French bottles of wine, which had a warning label and an image of a pregnant lady, and Chilean bottles of wine, which had nothing on them.

As the hon. Member for Sefton Central mentioned, other countries have labels that include the Surgeon General’s advice. We do not have anything as specific as a consistent message on all our alcohol products. While one might appear on some bottles of wine, there is no such warning on bottles of beer, given the assumption—untrue, as we know—that women do not

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drink beer or lager products. We need to learn a lesson from Canada, which has much better labelling, which is focused on pregnant women in particular and better targeted.

The APG manifesto also stated that we would like commitments to introducing mandatory training on FASD for all social workers, midwives and health care professionals. Interestingly, 23% of midwives are not aware of the guidelines on alcohol and only 59% were comfortable asking about alcohol consumption. People are nervous about asking pregnant women what their alcohol consumption is, in case that somehow offends them or perhaps concerns them unnecessarily, but we have to get to grips with asking the difficult questions, so that the right advice can be given to pregnant women.

If we are to understand FASD better and to reduce its prevalence, those who come into contact with pregnant women who might be drinking alcohol play a crucial role in making brief but important interventions to give good, accurate and consistent information. Ensuring that those people are trained sufficiently and are confident enough to make those interventions would be another welcome and logical step in preventing FASD, or at least in enabling us to spot the signs and give an accurate diagnosis.

I am conscious that the debate is on FASD, but I wish to touch on the wider problem of alcohol misuse. Without doubt, more needs to be done to tackle binge drinking and alcohol-related harm in the UK. It is not difficult to assume that, in a country where alcohol is consumed in large quantities, that might have some influence on the prevalence of FASD. If we can get our approach right to tackling alcohol misuse more generally from the start, especially with young women who binge drink, we could see a drop in the number of FASD cases.

I was surprised to learn that 18% of women still binge drink while pregnant. Binge drinking is defined as drinking six units or more in one session, which is two large glasses of wine. Until we have a thorough understanding of how little alcohol it takes to put unborn children at risk, we will not make adequate progress. Although some people will disagree with some of the policy measures proposed in the alcohol misuse group’s manifesto, the entire package of measures sought to address alcohol misuse as a whole. That is relevant to the debate, and I hope that the Government will consider that.

In conclusion, FASD is preventable and its prevalence should be reduced. As I mentioned earlier, save in some extreme cases, I do not believe that any women would jeopardise the health of their unborn child if they knew all the facts. It is therefore essential that we establish the facts and invest in resources now to raise awareness throughout our society. I am interested to hear what the Minister has to say on where we are on developing a coherent strategy to tackle FASD, because it being poorly understood is not a reason to delay action. Let us put in the resources, get the issue understood and deliver meaningful measures, such as those outlined thus far today.

Several hon. Members rose

Mr Andrew Turner (in the Chair): There are four speakers, with 35 minutes available; you can do your own arithmetic.

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3.6 pm

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Mr Turner, as you used to serve under my chairmanship.

I have been interested in this subject for a long time. I am a trustee of the National Children’s Centre, which is based in my constituency, and part of the initiative to form a new children’s commission. Also, for quite a long time, I was Chair of the Select Committee on Children, Schools and Families.

I have to say one slightly party political thing: I still deplore the smaller emphasis placed by the coalition Government on children’s issues. We have a junior Minister, but we should have a Secretary of State and a whole Department. I thought that the Department for Children, Schools and Families was a breakthrough Ministry, and I am sorry that it is much diminished, although I have a lot of respect for some of the ministerial team, as colleagues know. Today, however, there is relative neglect of children’s issues.

I have some practical experience of children: three daughters, one son and nine grandchildren under the age of 10. We are quite a tribe when we are all together. When my wife and I had children, we were aware that we should not drink too much—she said that she should not drink too much—but my generation thought that a little bit of alcohol was all right. That was wrong, but luckily we survived and had healthy children. My daughters, however, never drank during pregnancy.

My hon. Friend the Member for Sefton Central (Bill Esterson) made a brilliant speech, but the speech by the hon. Member for Chatham and Aylesford (Tracey Crouch) was also thoughtful. She mentioned the growing consumption of alcohol by women. Only the other day, I chaired a session—one of those irritating breakfast meetings—by the Parliamentary Advisory Council for Transport Safety, or PACTS, on women and alcohol, and it was explained to us that the likelihood of a man being caught for drink- driving has plateaued for some years, but the figures for women are going up fast.

A senior policewoman from one of the home counties, or perhaps Hampshire, stood up at that breakfast meeting to say, “We have done a study of all the pubs by going in and asking for a small glass of wine, and they all said, ‘No, we only do medium and large.’” Three large glasses of wine in a pub is a bottle of wine. Many of the women pulled over by the police, according to that policewoman, would say, “I have only had two glasses”, but that means that they have had two thirds of a bottle of wine. With the drinks industry trying to increase sales, many more women are drinking high levels of alcohol. Is that binge drinking? Most of the people whom we describe as binge drinkers would not think that they were binge drinkers. Yes, they have a couple of large glasses of wine, but they have learned to feel that that is relatively normal.

There is one point I will take issue with. Why not scare people? When we campaigned for seat belts, against drink-driving and on the dangers of smoking, there had to be a bit of fear. We have to change the culture. If someone went into a pub now and said, “I’m only going to have a couple of pints, and then I’m driving home—I’m a better driver when I’ve had a couple,” they would be excluded from the pub and their local community, because that is not acceptable. We have to have a little element of fear to get over the message that people who

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drink while pregnant are damaging their unborn child. The message has to be very strong; it has to be from the Department of Health and all the other Departments, and it has to be loud and clear.

Let us not pussyfoot about on this—you and I do not pussyfoot about, Mr Turner. Let us be honest: people from more disadvantaged backgrounds—poorer people—drink more than other people during pregnancy. That is the truth, and we have to accept it; otherwise we cannot get the message across. Of course, a lot of middle-class women drink, but more middle-class women tend to give up drinking when they are pregnant. However, a lot of people who have copied middle-class role models over the years and who are drinking are not seeing the danger signs during pregnancy.

Bill Esterson: The point about women from disadvantaged backgrounds is right, but is my hon. Friend aware of some of the research from the United States? In some studies, mentoring of women in at-risk groups has led to something like a 50% reduction in drinking during pregnancy in cities across America. Does he agree that that is the kind of bold action we need here?

Mr Sheerman: My hon. Friend is absolutely right. I love that sort of idea, because it is holistic. We have to go right across the piece—mentors, health visitors and GPs. GPs should wake up. For goodness’ sake, what are they doing if they are not telling pregnant women, “Do not drink when you are pregnant.”? I despair when I see the level and quality of advice from some GPs, who should be telling women in very firm terms about the damage they could do to a little child.

Mr Robin Walker (Worcester) (Con): I apologise for missing the opening comments in this important debate. The hon. Gentleman mentioned GPs. Does he agree that it is important that there should be clinical leads on FASD in each part of the country? I met the clinical lead on FASD in Worcester, along with Richard Procter of the FASD Trust, to talk about the issue. We should build up clinical leads, so that they can make sure that best practice is shared among GPs and other health groups. That is one way we can make sure that there is a better approach to this issue.

Mr Sheerman: The hon. Gentleman is right, but he tempts me to make the political point that getting a message to local health people now is very complex. I used to be able to pick up the phone to one person—the trust’s chief executive—and have a conversation about health in Huddersfield. Now, I have to make about seven phone calls to get any sense of a holistic approach to anything. I admit that that is a bit of a snide reply, but we must make things as holistic as possible.

We must get the drinks industry involved. Why do we not have the sign that my hon. Friend the Member for Sefton Central mentioned—the red slash across the pregnant woman with the glass of wine? Why can we not, as we did with the tobacco industry, get industry, the pubs and the restaurants on our side? Why can we not get the schools on our side? Where are the schools in all this? We must tackle this issue across the piece, and we must have one consistent message: do not consume alcohol, drugs or tobacco when pregnant.

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3.13 pm

Jim Shannon (Strangford) (DUP): I congratulate the hon. Member for Sefton Central (Bill Esterson) on bringing this issue forward for consideration. The debate is long overdue. Now is a good time to air this matter, and Members have done that. I am pleased to also be able to make a contribution.

Foetal alcohol exposure is the most important preventable cause of severe brain damage in babies and children. For that reason, we should debate the issue and highlight it. Drinking while pregnant can cause miscarriage, stillbirth, premature birth and low birth weight. Furthermore, children with FAS have distinct facial features as a result of their mother drinking alcohol.

FAS can result in hearing problems, mouth and teeth problems, a weak immune system, epilepsy, liver damage, kidney and heart defects, cerebral palsy and other muscular conditions, height and weight issues, and hormonal disorders. Those clear health issues are preventable, which is why the debate is important for a number of reasons. First, as all the Members who have spoken have said, we should educate people. However, there is also the saving to the NHS from promoting prevention, and I will return to that.

The effects do not stop with those I listed. The invisible effects include attention deficit, memory deficit, hyperactivity and difficulty with abstract concepts such as maths, time, and money, to name just a few. People can also experience difficulty solving problems, as well as poor judgment, immature behaviour and confused social skills. We have to question why any mother would want to drink during pregnancy if she was made aware of all those horrendous effects.

Normally, there is no way of preventing a genetic condition from passing from parents to children. This is the only disorder that can be completely prevented by the mother’s actions. We therefore have to educate mothers and ensure they are aware of the issue. Some mothers may not be fully aware of the impact of what they are doing, which is why we have to look at this much more generally.

Most women are aware that they are not advised to drink alcohol when pregnant. For example, a 2007 report by the British Medical Association—a much respected organisation—concluded that women who are pregnant or who are considering pregnancy should be advised not to consume any alcohol. However, I fear that women are not always aware why they are advised not to drink or just how serious the dangers are for the unborn baby.

The hon. Member for Huddersfield (Mr Sheerman) referred to the need for the drinks industry to take specific issues on board. He also mentioned the need for GPs to—this is not a pun—harp on more about this issue and to be more aware of it. It is important that the serious dangers for the unborn baby are underlined.

When a pregnant woman drinks, the alcohol travels directly across the placenta to the foetus via the bloodstream, and the physical impact is clear. The foetus’s liver is not fully formed and cannot metabolise the toxins out of its system quickly enough. That leaves the foetus with a high alcohol concentration in its body, which causes a lack of oxygen and of the nutrients needed for the brain and other organs to grow properly. Those are the medical

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facts about what happens. If those were known to all pregnant mothers, I believe they would take steps to ensure they did not drink.

It is clear that alcohol should not be consumed even when couples are trying to conceive—the hon. Members for Sefton Central, for Chatham and Aylesford (Tracey Crouch) and for Huddersfield all referred to this—because a woman may not be aware that she has become pregnant in the initial weeks of the pregnancy. It is in the first three months of pregnancy that drinking damages babies’ organs, and it is during the first six to nine weeks that babies’ facial features are formed, so mothers who drink in that three-week window are more likely to have babies with deformities. Again, no mother wants that to happen. The question is how we ensure these things do not happen, and I am sure the reply from the Minister, by whom I am always impressed, will help us feel a bit more reassured.

The problems I have just set out are another reason why it is vital that women do not consume any alcohol at all at any point in their pregnancy, and that includes when they are trying to get pregnant. Perhaps the saddest thing about FAS is that it is the biggest cause of non-genetic mental handicap in the western world, but it is the only one that is 100% preventable.

In response to a question in October 2013, the Minister referred to the Government’s strategy. When she replies, perhaps she can give us some indication of what point the strategy has reached. There must be a way of measuring its success. Is it measured on the figures the Minister has? I would be keen to hear her thoughts on that.

The number of diagnosed cases of FAS has tripled since records about the condition were first kept 16 years ago. In 1997-98, there were 89 cases, by comparison with 2012-13, when there were 252, so clearly there is a problem. Figures for the UK are unknown at present, but international prevalence studies in the US, Canada, Finland, Japan, Australia and Italy show that at least one in 100 children is affected. That would mean between 6,000 and 7,000 babies a year born with FASD in the UK.

It is little wonder that figures show 98% of midwives agreeing that FASD and the dangers of drinking during pregnancy are a subject that should be mandatory for all practising midwives. I agree. Some midwives feel that the subject is taboo, and that they should not mention it. According to the figures, only 59% of midwives are comfortable asking pregnant women about alcohol. They should not be uncomfortable about something they do to prevent disability in a baby. The subject should be on the table for discussion early in pregnancy, to make sure that the mother knows.

The issue is a serious one, as the figures show, where there can be serious consequences. As has been noted, FASD is the only non-genetic handicap that is completely preventable. There is no doubt in my mind that we need to raise awareness of foetal alcohol syndrome. Some UK statistics are worrying, indeed. For example, recent analysis carried out at Brighton and Sussex university hospitals showed that between 80% and 90% of women of childbearing age drink regularly; 25% of people aged 18 to 25 and 21% of those aged 26 to 44 drink more than 14 units of alcohol per week; and 15% to 20% of those continue drinking during pregnancy, even though they know it is dangerous. Those are truly shocking

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figures about a serious problem, but I believe they would drop if more campaigns about FAS were started. I appreciate that the economic climate is difficult, and it is not always easy to fund new campaigns, but it is estimated that it costs us £2.5 million, based on 813,000 births each year, to help those who are living with FASD. Surely any short-term costs that would help to raise awareness and drive down the number of sufferers would be a long-term benefit, both financially and socially.

Canada leads the way in treating and campaigning about the dangers of foetal alcohol syndrome. For example, it is discussed in parenting programmes for four to 11-year-olds, ensuring that the message about not drinking during pregnancy is ingrained in the minds of the new generation. Not only that, but posters about foetal alcohol syndrome are displayed in various public places, including train stations, airports, surgeries and shops. We could do that, equally. Although large sums of money are set aside by various provincial governments each year, proponents argue that preventing FASD in just 10 babies a year saves enough money to fund the services. Undoubtedly that is the way forward for us in the United Kingdom of Great Britain and Northern Ireland.

As hon. Members know, health is a devolved matter in Northern Ireland, and I want to ask the Minister whether consideration has been given to a campaign that would encompass the whole United Kingdom. We must address the issue in England, Northern Ireland, Scotland and Wales.

3.23 pm

Kelvin Hopkins (Luton North) (Lab): It is a pleasure to serve under your chairmanship, Mr Turner. I am pleased to take part in this important debate. I congratulate my hon. Friend the Member for Sefton Central (Bill Esterson) on obtaining it, and all the hon. Members who have spoken. They said intelligent things and we are all on the same side. My objective is to put as much pressure as I can on the Minister, to persuade her to take effective action.

Research at the Medical Research Council laboratory in Cambridge provided evidence that alcohol consumed during pregnancy causes irreversible DNA damage to offspring. I think that there is some evidence to suggest that the damage carries down to further generations; it is very serious. That was supported in the science magazine Nature in July 2011, and I immediately tabled an early-day motion drawing attention to the research and calling for the Government

“to bring forward serious and effective measures”

to counter alcohol consumption by women in pregnancy. I said that

“mild exhortations to pregnant women to drink sensibly”

were misguided and “wholly inadequate”.

Birth defects and learning difficulties affect thousands of babies every year, and the Government’s inaction has been nothing less than criminal. I have raised the issue in the Commons many times in the past decade, and the response of successive Ministers has been pathetic. Thousands of damaged babies have been born as a direct result of Government inaction, and the Ministers concerned should have that on their conscience and hang their head in shame. I do not include the present

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Minister in that, but certainly previous Ministers. They cannot say that they did not know. For its 2009 report on alcohol, the Select Committee on Health was informed by the Royal College of Midwives that 6,000 babies were born each year suffering from foetal alcohol syndrome. Later research by the Medical Research Council produced a conclusion that 7,000 babies were born each year with permanent genetic damage caused by alcohol. They were the most obvious and serious forms of damage, associated with facial disfigurement and mental retardation, but more recent research has recorded that even moderate consumption of alcohol in pregnancy causes reductions in IQ. It is entirely possible that the persistence of poor academic performance in many children and the significant behavioural problems in schools, and later adult crime, are due largely to foetal alcohol damage. I strongly suspect that that is the case.

There have been persistent reports from the Government of minuscule figures for foetal alcohol syndrome cases, in the low hundreds rather than the thousands. I suggest that the malevolent influence of the alcohol industry is at work and that the hidden hand is pulling strings somewhere, somehow, just as has happened with the tobacco and, more recently, the gambling industries. For a true picture, the Government should look, as many other hon. Members have said, to Canada, where for years there has been a massive and effective campaign against alcohol consumption in pregnancy. Even seven-year-olds there are warned, as we have heard, and are fully aware. There are big poster campaigns and every medical practitioner warns mothers about the danger to their babies from drinking. I urge the British Government simply to imitate what has been done in Canada, and to avoid the situation of denial that has gone on for so long.

Exposure to alcohol before birth is the cause of brain damage in children that could affect, as has been said, one in 100 babies in England; that is 7,500 a year. Actually, however, we think that that is the tip of the iceberg—the obvious cases. As to marginal reductions in IQ, who knows? There may be people whose mothers drank in pregnancy and who go to university, but perhaps they could have been Nobel prize winners rather than school teachers. Reductions in IQ at every level are possible. The effects may not be evident when those in question are still reasonably intelligent; but perhaps they would have done better without the damage. For many people, of course, things are far worse.

Seven years ago, Lord Mitchell, in another place, introduced a private Member’s Bill to require specific warning labels on all drinks containers, as happens in the USA and Canada. I have such a bottle of wine at home, whose label states:

“According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”

That wording—“risk of birth defects”—is important. It is not just a matter of saying “Your baby might be affected.” Let us be blunt: birth defects are what we are talking about. My noble Friend’s Bill did not proceed, since when another 50,000 damaged babies have been born—at least. It could be many more. My most recent letter to a Minister on precisely that point was deflected with reference to a voluntary code. I get bottle after bottle of wine, which I drink in not-too-extreme quantities but in reasonable amounts, and none has a health warning on it, whereas in America every container has

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one. What the Government have been doing is feeble, irresponsible and cruel. All those responsible for such craven neglect should be burdened by guilt for the suffering that they have caused. I do not mince my words.

I shall not rest until we have a Minister—I hope it will be the present one, for whom I have the greatest admiration in many respects—with the courage and principles to do the right thing and propose compulsory health warnings on all alcoholic drink containers. We do not need to wait for more research before acting. The evidence is already to hand. A graphic report by Mencap shows that the nervous system particularly, among many other parts of the body, is affected from the third week of pregnancy—that is major damage. The central nervous system is the first part of the human anatomy to be damaged. Later, when the baby is more fully formed, the damage is more minor. The time to worry about is early pregnancy and the time of conception. The task is to persuade women not to drink at all when either they are at risk of becoming pregnant, or they choose to become pregnant; because it is in early pregnancy that the problems occur.

In Canada, when the campaign first started there was a serious increase in the number of abortions, with women tragically but understandably seeking to abort babies they thought might be damaged, so that they could start again without drinking to guarantee that their babies, when born, would not be damaged by alcohol. Recently, with the increase in awareness of FASD, we have seen abortions happening here for the same reason. For those with moral objections to abortion, it is perhaps even more important to make sure that all women do not drink at the time of conception or during pregnancy.

I have to say it is very unfair on women, because by and large men can get away with drinking without having to worry, certainly once they are middle aged and past child rearing, as I am—my children have all grown up and I have grandchildren. If I drink too much, it will affect only me; when someone drinks and has a baby inside them, it affects someone else who has no choice. That is a distinct difference. It is unfair on women who enjoy alcohol, but let us persuade all women that, yes, they can drink a glass of champagne when their baby is born but not at the time of conception or during pregnancy.

Much more needs to be done beyond labelling. There should be an advertising campaign, a statutory requirement for notices in all medical and drinking establishments, messages in schools to young girls and more. We must make sure that this scourge, which has affected hundreds of thousands of people—possibly, over time, millions—is avoided in future.

3.31 pm

Mrs Mary Glindon (North Tyneside) (Lab): It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my hon. Friend the Member for Sefton Central (Bill Esterson) not just on securing this debate but on his excellent speech.

Before the debate, I was informed by Balance, the alcohol campaign in the north-east, that every day in my region at least one child is born with some form of

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foetal alcohol spectrum disorder. Bearing in mind that that number goes into the thousands across the country over the year, I felt it was important to take part in the debate. I will give a slightly different take on the subject and address an injustice in current law that relates directly to the debate, which is whether children with FAS should be entitled to compensation.

Hon. Members may be aware that there have been many cases where children with FAS have sought to secure criminal injuries compensation. Before 2012, it may have been possible to secure such a claim. However, I draw hon. Members’ attention to the 2012 criminal injuries compensation scheme, which says:

“A crime of violence will not be considered to have been committed for the purposes of this Scheme if, in particular, an injury…was sustained in utero as a result of harmful substances willingly ingested by the mother during pregnancy, with intent to cause, or being reckless as to, injury to the foetus.”

In plain English, that means no sufferer of foetal alcohol syndrome or any other disability developed in the womb as a result of the mother’s actions will be compensated, even when the harm caused was reckless or fully intended. That is surely an utter scandal and warrants our serious attention.

Some people may have been put off from campaigning on this issue by highly misleading news reports claiming that awarding compensation to FAS sufferers would criminalise drinking during pregnancy. That is not the case. Although we want women to stop drinking during pregnancy, criminal injury claims are dealt with in civil proceedings and as such do not affect the interpretation of criminal law; moreover, a conviction is not needed for compensation to be awarded. Perhaps the motivation hiding behind the rhetoric is that paying out to FAS sufferers would be expensive, but saving public money is not a good enough reason to prevent children with FAS from receiving compensation. Neil Sugarman, a solicitor acting for many children affected by FAS, put it well:

“Why should these children be in any different position to those damaged during their birth or babies brain damaged by being shaken when only a few days old? The life changing consequences are the same. Is it right that a foetus exposed to a process tantamount to poisoning should be treated differently in comparison with these other classes of brain damaged children? They receive compensation that helps them access much needed treatment and therapies not readily available on the NHS and helps to improve their quality of life in many ways.”

I believe that anyone suffering from FAS deserves compensation in the same way as any other child who sustains damage at birth. I hope that those who share my concern over the increasing incidence of this terrible condition will join the campaign for that section of the 2012 criminal injuries compensation scheme to be deleted. I hope that the Minister supports that call.

3.35 pm

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my hon. Friend the Member for Sefton Central (Bill Esterson) on securing this debate and on his powerful speech. I am delighted that hon. Members have had the opportunity to debate an issue that is often overlooked.

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I pay tribute to those organisations that continue to campaign tirelessly on this issue. We have heard a number mentioned today, but they are worth reiterating: the FASD Trust, NOFAS UK, Alcohol Concern and Drink Wise North West, which has engaged with me in my role as a constituency MP. We have also heard a lot about the former Children’s Commissioner, Sir Al Aynsley-Green, who is the incoming president of the BMA, and Lord Parry Mitchell, who have both done significant work on raising awareness of the issue.

I recently had the privilege of joining a conference organised by Drink Wise North West on the issue, where I heard not only about the vital work done by those organisations but about what needs to happen to improve diagnosis of both FAS and FASD and to improve support for children and adults who experience that and for the families who care for them. Most importantly of all—the issue that is the crux of this debate—I heard about what we can do to prevent it in the first place. I will deal with each of those subjects in turn.

On improving diagnosis, we have heard from a number of Members about the wide range of symptoms that people with FAS or FASD can experience. The difficulty in diagnosis means that we have no official understanding of the scale of the problem, with many cases misdiagnosed as ADHD, bad behaviour or autism. It is estimated that around one in 100 children are born every year in the UK with some form of the condition. Figures I uncovered through a parliamentary question reveal that the number of finished admission episodes where there was either a primary or secondary diagnosis of foetal alcohol syndrome are up 37% in England since 2009-10, with 252 episodes in 2012-13. As many hon. Members alluded to, those figures are only the tip of the iceberg.

Kelvin Hopkins: I remember a report from the Home Office in the 1970s that showed that the rate of alcohol consumption in Britain was among the lowest in Europe; the only country where it was lower was Ireland. It would be simple to compare the number of birth defects in that period of time with the number now, to see the effects of alcohol consumption among women.

Luciana Berger: My hon. Friend’s remarks lead me to the challenge that the Government themselves admit in their alcohol strategy. They say:

“We do not have good information about the incidence of FASD, so it is likely that significant numbers of children are not diagnosed.”

In the response to my parliamentary question, there was no information about what action the Government intend to take to address that information deficit, so will the Minister confirm whether she has any plans to commission a much-needed prevalence study of FASD and foetal alcohol syndrome in England? Will she share with us her plans to improve diagnosis across the country?

Bill Esterson: Will my hon. Friend give way?

Luciana Berger: Forgive me, but I will not: we must allow the Minister to respond, and we have just 10 minutes.

I move on now to improving support both for people who have a diagnosis and for their families. Many sufferers have special needs that require lifelong help,

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yet slip under the radar either because they are not diagnosed or because there are no services in place to support them. Lack of diagnosis for those who do not exhibit physical signs means that those children often receive no additional help from support services or at school. I recently met a head teacher, who said she did not have a single student in her school who had been formally diagnosed, but she was sure that some students were affected.

There is no systematic record of the needs of children with FASD and no official guidance on best educational strategies, as my hon. Friend the Member for Sefton Central said. There is just one specialist FASD clinic in the whole of England, which is run by Surrey and Borders Partnership NHS Foundation Trust. It is one of the few places that can confidently diagnose the disorder. It is a national clinic, supposedly serving the entire country, yet it is not commissioned by NHS England. Out-of-area patients must be paid for, and with a cost of £2,500 per patient, many local clinical commissioning groups refuse to refer. Worst of all, I understand that the clinic is not due to be commissioned beyond April 2015. What does the Minister intend to do to ensure that NHS England commissions services and that plans are in place to improve provision and to increase both the number and the spread of specialist FASD clinics? Without specific support, people who are affected are at higher risk of developing mental health problems, getting into trouble with the law, dropping out of school and becoming unemployed. That may come at massive personal cost and in turn produce a tremendous cost for society. The crux of this debate is how to prevent that.

I have highlighted how we need to improve diagnosis and support services. Let me reiterate a point that has been made several times today. FASD is entirely preventable. It is caused by drinking during pregnancy, but the information about the risks of drinking during pregnancy is wholly inadequate. The guidance is inconsistent and confusing, and women receive mixed messages. The Department of Health recommends that pregnant woman should avoid alcohol altogether, but that if they opt to have a drink they should stick to one or two units of alcohol once or twice a week to minimise the risk to the baby. The National Institute for Health and Care Excellence advises women to abstain from alcohol completely during the first three months of pregnancy because of the risk of miscarriage. It then refers to the number of units that they should or should not drink subsequently.

People struggle to use units as a way of monitoring their alcohol consumption. Research from the Joseph Rowntree Foundation found that very few people use units as a way of measuring their drinking or of monitoring their health. Is it any wonder that women are confused? What is the Government’s official advice and what plans does the Minister have to improve much needed awareness throughout the country?


Foetal Alcohol Syndrome

Culture Media and Sport written question – answered on 22nd July 2014.

Foetal Alcohol Syndrome

Luciana Berger: To ask the Secretary of State for Health what assessment he has made of the adequacy of training for midwives on foetal alcohol syndrome. [206054]

Dr Poulter: The Government has mandated Health Education England (HEE) to provide national leadership on education, training and workforce development in the national health service. This mandate includes a commitment that HEE will ensure that midwifery training produces midwives with the required competencies to practice in the NHS.

In the Mandate from the Government to HEE for the period from April 2013 to March 2015 the Government has stated that HEE should work with NHS England and others to ensure that sufficient midwives and other maternity staff are trained and available to provide every woman with personalised one-to-one care throughout pregnancy, childbirth and during the postnatal period.

HEE is leading on the Personalised Maternity Care Project, which will make recommendations on how women who have mental health or substance misuse support requirements will receive appropriate support from specialised trained midwives.


Foetal Alcohol Syndrome

Health written question – answered on 14th July 2014.

Fetal Alcohol Syndrome

Luciana Berger: To ask the Secretary of State for Health what estimate he has made of the cost to the NHS of (a) fetal alcohol syndrome and (b) fetal alcohol syndrome disorders. [204669]

Jane Ellison: The Department has made no estimate of costs to the NHS for fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD), because estimates of prevalence for these conditions are so uncertain.

The diagnosis for babies born with FAS may not be made easily at birth, and problems may present only later in childhood, for example at school. Estimates for the incidence of FASD are still more uncertain and relate to the lack of consensus on diagnostic criteria for these conditions.


Alcohol Consumption in Pregnancy

Oral Answers to Questions — Health – in the House of Commons at 11:30 am on 10th June 2014.

Alcohol Consumption in Pregnancy

10. Kelvin Hopkins (Luton North) (Lab): What statistics his Department keeps on babies damaged by alcohol consumed in pregnancy; and if he will make a statement. [904112]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): Hospital episode statistics include finished admission episodes where there was either a primary or secondary diagnosis of a foetus or newborn affected by maternal use of alcohol or foetal alcohol syndrome. I have supplied some detail on that in parliamentary answers this week. These records cover both patients treated in NHS hospitals in England and by independent providers whose services are commissioned by the NHS.

Kelvin Hopkins: The Minister has confirmed that thousands of babies are born every year damaged by alcohol, and yet there is still no statutory requirement for all alcoholic drinks containers to display specific health warnings about the dangers of drinking in pregnancy. When will the Government introduce the necessary legislation?

Jane Ellison: Before I respond to the substantive point, it is worth saying that there is a spectrum of disorders and some of the diagnoses on certain parts of the spectrum are quite difficult. We have statistics on foetal alcohol syndrome and there is no evidence that that is increasing, although we seem to be diagnosing more in younger children. Also, the women to whom this tends to happen are extremely difficult to reach through public education campaigns as many are subject to additional, complex factors.

On bottling, through the responsibility deal, there was a commitment to get 80% of alcoholic drinks on the market labelled. That is being independently audited and is something we champion, not just with messages about drinking in pregnancy, but through guidance from the chief medical officer on drinking generally.

Henry Smith (Crawley) (Con): Prevention is of course better than cure. What is my hon. Friend’s Department doing on better guidance and support for midwives and other groups such as the National Childbirth Trust to discourage expectant mothers from drinking alcohol?

Jane Ellison: One of the slight challenges in this area is that quite a lot of pregnancies are unplanned and people have sometimes been drinking alcohol before they know they are pregnant. However, a lot of advice is available. Along with health visitors and midwives—we are putting more resource into those areas—Public Health England’s “start for life” campaign provides advice to pregnant women. There are National Institute for Health and Care Excellence guidelines, including for those women to whom I referred earlier with complex social factors. A lot of information is available, and the chief medical officers are reviewing the guidance to people generally. The simple message to women who are hoping to conceive or who are pregnant is that it is best to avoid alcohol.


Foetal Alcohol Syndrome

Health written question – answered on 9th June 2014.

Foetal Alcohol Syndrome

Luciana Berger: To ask the Secretary of State for Health how many children were diagnosed with fetal alcohol syndrome in each of the last four years. [199090]

Jane Ellison: The following table contains the number of finished admission episodes where there was either a primary or secondary diagnosis of fetal alcohol syndrome in England.

It should be noted that these figures are not a count of people as the same person may have had more than one episode of care within any given time period.

Number of finished admission episodes (FAEs)1 with either a primary or secondary diagnosis2 of fetal alcohol syndrome3 for the years 2009-10 to 2012-13.4
Age 2009-10 2010-11 2011-12 2012-13
0 45 45 34 68
1 27 40 31 25
2 20 17 27 22
3 6 16 10 36
4 10 8 17 14
5 5 9 16 5
6 6 4 11 9
7 27 4 20 6
8 5 23 5 8
9 4 5 40 5
10 7 7 2 4
11 1 5 6 8
12 3 2 8 5
13 4 5 2 4
14 1 4 1 7
15 1 4 3
16 2 4 2
17 1 4 1
18+ 9 14 32 20
Total 184 212 270 252

9 Jun 2014 : Column 54W

1 Finished admission Episodes (FAEs) A FAE is the first period of in-patient care under one consultant within one health care provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number in-patients, as a person may have more than one admission within the period. 2 Number of episodes in which the patient had a primary or secondary diagnosis The number of episodes where this diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and seven prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record. 3 ICD-10 diagnosis code ICD-10 diagnosis code used Q86.0 Fetal alcohol syndrome (dysmorphic). 4 Assessing growth through time (Admitted patient care) HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, changes in activity may be due to changes in the provision of care. Data quality: HESs are compiled from data sent by more than 300 NHS trusts and primary care trusts in England and from some independent sector organisations for activity commissioned by the English NHS. Health and Social Care Information Centre liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies. While this brings about improvement over time, some shortcomings remain. Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector.Source: Hospital Episode Statistics (HES), The Health and Social Care Information Centre (HSCIC)


Stillbirths and Infant Mortality — [Philip Davies in the Chair]

– in Westminster Hall at 2:30 pm on 26th March 2014.

Tracey Crouch Conservative, Chatham and Aylesford

 We must improve awareness of smoking cessation services and the harm caused to unborn children by smoking. Similarly, we need to ensure that people understand the dangers of smoking for those who have been born. We must also do more to discourage binge drinking during pregnancy. I was shocked to learn that 18% of women still binge drink—that is, drink more than six units in one session—while pregnant, often leading to foetal alcoholsyndrome.

Tim Loughton Conservative, East Worthing and Shoreham

 I echo the points that my hon. Friend the Member for Chatham and Aylesford made about foetal alcohol syndrome, which strays slightly beyond the confines of the debate. When I was a shadow Health Minister, I considered the issue. I visited children’s homes in Copenhagen that specialised in children born with foetal alcohol syndrome. In many cases, the child was born to parents from Greenland’s Inuit community, which has high alcoholism rates. A lot of research has been done on that in Denmark.

It is undeniable that a lot of our children are being damaged due to excessive drinking through pregnancy and that an awful lot of that is not being properly diagnosed. In my simple layman’s view, a lot of the symptoms have parallels with autism and the autism spectrum, and there may be links between autism and foetal alcohol syndrome.

The issue is very little researched in this country, but it potentially affects an awful lot of our children, and we need to do much more to identify it. More importantly, we need to give clear, stark, but accessible warnings to women about the practical perils of drinking irresponsibly at all stages during pregnancy. That is not to say that pregnant women must not drink at all, but we need to set out clearly what is and is not tolerable, just as we should for women who smoke during pregnancy.


Protection of Children’s Health: Offence of Smoking in a Private Vehicle

Children and Families Bill (Programme No. 3) – in the House of Commons at 5:46 pm on 10th February 2014.

If we are serious about this measure, we should have the courage of our convictions and ban smoking altogether. There is only one way that this legislation can go, and the natural conclusion is that there will be a ban on smoking in private homes. As I said earlier—not entirely facetiously—we must face the logic that pregnant women who can do untold damage to their unborn children through smoking and through foetal alcohol syndrome, which affects one in 100 children with very serious consequences, should be criminalised for doing the same thing in principle that this amendment tries to criminalise. Then there are the implications of not feeding our children healthy food. The amendment is unenforceable. It is bad law and is about supplanting, not supporting, the parent, and I cannot support it.