Alcohol Harm

Kelvin Hopkins Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered tackling alcohol harm.

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

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

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

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

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

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

The report paints a bleak picture. Paragraph 1 states that

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

It continues:

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

there are many of these—

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

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

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

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

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

[Kelvin Hopkins (Luton North) (Lab)]

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

[Fiona Bruce]

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

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

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[Kelvin Hopkins (Luton North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Flello, and it is an extreme pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made a superb speech. She takes a very strong lead on all the serious matters relating to alcohol, and we are grateful to her. She has also taken the lead by securing this debate, together with my hon. Friend the Member for Sefton Central (Bill Esterson) and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne). I have supported as best I can of all their efforts, and I am pleased to take part in this important debate. I admired the eloquence of the hon. Lady’s speech. Some of what I say may overlap with what she said, but I hope that that will just reinforce what she said rather than causing difficulty.

Many serious problems arise from inappropriate alcohol consumption. Alcohol is a subject about which I have been concerned since I first entered the House in 1997, shortly after which I was elected chair of the all-party parliamentary group on alcohol misuse, now the APPG on alcohol harm. Over many years I have spoken and asked questions in on the subject in the House, and I have tabled a number of early-day motions during the past 17 years, expressing concern and asking for action on the damage to people’s lives and to society as a whole that is caused by alcohol. Several of my early-day motions have referred to foetal alcohol spectrum disorders —the lifetime damage to babies caused by alcohol consumption in pregnancy. I shall speak more about that later.

Just two weeks ago, I raised concerns about alcohol in my oral question to the Prime Minister, and a little earlier I put another oral question to Ministers about Britain’s high drink-drive alcohol limits. It was disappointing that I received a most unsatisfactory, perfunctory answer to the latter question, which was little more than a brush-off. The Institute of Alcohol Studies had briefed me before that question and has again provided compelling statistics about the costs, in lives, injuries and money, of drink-driving. Indeed, it has provided today the statistics that my right hon. Friend the Member for Birmingham, Hodge Hill referred to. The total number of drink-drive accidents rose by 2% to 5,740 in 2015, there was a 3% rise in overall drink-drive casualties to 8,480 in 2014, and about 220 people are killed in drink-drive accidents each year. Going back, there were 240 deaths and 8,000 casualties just in 2013.

Our drink-driving limit is sadly higher than that in every other country in Europe except Malta. A lower limit would prevent a minimum of 25 deaths and 95 serious casualties a year—I suspect it would actually prevent a lot more. When the lower limit is imposed, as I am sure it will be at some point, rather than people perhaps having a couple of pints and thinking they are probably under the limit, the limit will be low enough to deter people from drinking at all before they drive in case they get too close to the limit. Reducing the limit to European levels would have a disproportionately beneficial effect. There is also wide popular support for a lower limit: 77% of the population, rising to 79% in towns. The limit must be reduced. In 2013, the death toll from drink-drive accidents rose by 25% in just one year.

Another serious component of Britain’s alcohol problem—especially England’s alcohol problem—is the burden on the health service, as the hon. Member for Congleton mentioned. That is another matter I have raised with the Prime Minister. According to statistics provided by the Alcohol Health Alliance UK, the NHS’s costs related to alcohol are £3.5 billion a year—the hon. Lady was absolutely right in suggesting that is probably a significant underestimate—and one in five hospital admissions are alcohol-related. In the nine years to 2013, hospital admissions related to alcohol rose by a staggering 51%.

To bring us up to date, 70% to 80% of all A&E attendances on Friday and Saturday nights are alcohol-related, resulting in a massive burden on hospital staff and resources as well as assaults on staff. I also understand from the report the hon. Lady mentioned that other patients, particularly children and elderly people, are often frightened by violent drunks on Friday and Saturday nights in A&E. Some 80% of police officers have been assaulted by people who have been drinking. As I said in my question to the Prime Minister, alcohol is heavily implicated in domestic violence and attacks on women. After that question, I was contacted by people concerned about child abuse, who again said that many cases of such abuse involved alcohol.

By far the most tragic of all the problems caused by alcohol, in my view—this view is probably shared more widely—are foetal alcohol spectrum disorders. Estimates suggest that each year some 6,000 babies are born damaged for life by alcohol consumed in pregnancy. It causes misery for those children and their families and costs the state vast sums of public money every year. In Canada, the lifetime cost to the state has been calculated as up to $3 million dollars for every child suffering from FASD. The children concerned are referred to, somewhat unkindly, as “$1 million-dollar babies”. I have a good friend who lives in Canada—a former school friend—and he tells me about the situation there.

FASD also causes learning difficulties and behavioural problems. A high proportion of people convicted of crimes and in our prisons are victims of FASD. Research by the Medical Research Council has concluded that even moderate drinking in pregnancy has an impact on IQ and learning abilities. There is no safe level, and that must be communicated to all women planning and experiencing pregnancy and, above all, to all professional medical staff. The recent report by the all-party parliamentary group on foetal alcohol spectrum disorder, which I was happy to contribute to, made strong recommendations on such information; I was pleased to emphasise the information that is required. FASD is the leading known cause of learning disabilities, and much of what is thought to be autism is actually the effects of alcohol consumed in pregnancy. The Government must wake up to the tragedy of FASD and take urgent action to ensure that all women know about it.

Again, in Canada the Government take the matter so seriously that girls are made aware of the problem in primary school. They are asked in class what they must not drink when they have a baby in their tummy, and they all say, “Alcohol.” They know about the problem. In the US and elsewhere, alcoholic drinks containers are required to have warning labels—not just a small symbol of a pregnant woman, and not on a voluntary basis. The Government warning in the US states:

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

If every woman was aware of that, I am sure that the levels of drinking in pregnancy would drop like a stone. However, women are not aware of that—even women I know have not been aware of it. I should say that my daughter-in-law did not drink at all during her pregnancies, and we have two delightful and very healthy granddaughters as a result.

Such a warning should be compulsory on all UK alcoholic drinks containers and should also be displayed in all NHS medical facilities—GP surgeries, clinics and hospitals—as well as all establishments selling alcohol. Women cannot be blamed for not knowing about the dangers, but the Government must be responsible for ensuring that in the future all women are alcohol-aware and know the dangers of drinking during pregnancy. Tackling FASD must be the priority for the Government’s alcohol policy.

Finally, we must do something to help prevent the consumption by young people in particular of strong, cheap alcohol, which the hon. Member for Congleton mentioned. It can, and does, quickly lead to addiction. In recent decades we have seen people as young as 30 dying of cirrhosis of the liver, which is quite appalling. That used to be a disease of older people, but now it is a disease of young people who are drinking vast quantities of cheap, strong alcohol.

As the hon. Lady said, minimum pricing is absolutely essential for reducing alcohol abuse and addiction. I emphasise addiction again because so many people talk about this as though it were a matter of choice. If any of us drank to excess over a prolonged period, we could become addicted. It is a serious danger. A 50p unit price would have no effect on pub prices—I am a lover of the great institution of the British pub and drink wine—but would stop the selling of vast quantities of cheap alcohol by supermarkets. In some cases, as has been reported many times, alcohol is actually cheaper than bottled water.

In recent decades Britain has had a dangerous love affair with excessive and damaging alcohol consumption. That must be stopped. Moderate and sensible consumption —as I have said, I drink myself—would not be affected. What I am suggesting would actually put a brake on the booze bandwagon, which has been out of control for some years now and has to be stopped.

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[Bill Esterson]

Yes, that is right. My right hon. Friend has described his experience before, and I am sure that he will say more later. Many people are affected by being children of alcoholics; I think that the issue is directly related and a similar concern and challenge. Poverty and inequality are clearly linked to the damage done by misuse of alcohol, and I am afraid that the group on which I am concentrating is one of the most affected in our society.

We heard in our inquiry about the lack of support. There is only one specialist clinic in this country to diagnose FASD—it is in Surrey, and is led brilliantly by Dr Raja Mukherjee, who gave evidence to our inquiry—but that simply is not good enough. If 35,000 children are affected every year, we need a lot more than one clinic to help diagnose them, because diagnosis is needed in order to ensure that support is available.

[Kelvin Hopkins]

I applaud everything that my hon. Friend is saying in his speech. It was reported at one stage during our deliberations on the report that some medical staff literally do not know about FASD, even now. That is appalling.

[Bill Esterson]

That is right. The symptoms are misunderstood and significantly misdiagnosed, and too many professionals dismiss them. I have seen entirely contradictory diagnoses—doctors have described FASD symptoms perfectly well and then said that the child does not have it, due to the kind of misunderstanding that my hon. Friend just mentioned. We must improve understanding among health professionals. We must improve awareness, information and education among professionals, not just in health but in education.

In our inquiry, we also heard that children often cope at nursery, reception and key stage 1, and well into key stage 2, and it is only much later—from about year 6 onwards, as the expectation of independence grows in the school system—that the real problems start to emerge. Children who are damaged in this way find it difficult to cope in the school system, but because they have not been diagnosed early—because there has been no awareness or understanding, and they have got that far in the school system—it is assumed that FASD is not the problem, and that it might be due to what is going on at home or other external reasons, when the true cause is a disability. Again, we need greater support, awareness, understanding and training for education professionals as well as those in health and elsewhere.

What is needed? The Government should consider the following objectives. One objective should be to reduce the number of children exposed to alcohol during pregnancy. The Lancet’s report goes into great depth: international research suggests that just under 10% of the world’s population of women drink during pregnancy, but in this country, the figure is 41%, more than four times the international average. A similar figure was presented last year in the evidence of the FASD Trust, which serves as the secretariat for the all-party group and for which I am very grateful. That level of drinking during pregnancy suggests that the incidence of FASD may be four times higher in the UK than in the rest of the world. If we follow that logic, the World Health Organisation’s international figure is 1%, so in this country it may be 4% or 5%—that is where the figure of 35,000 babies comes from.

As well as an objective to reduce exposure to alcohol during pregnancy, the Government should introduce an objective to increase support and understanding in schools, in the health and care sector, in criminal justice and in wider society. How should they go about that? During our inquiry, we heard that the phrase should be used is

“no alcohol in pregnancy is best for baby and you”.

That fits the description of the strategy that we should adopt in this country. I welcome the fact that the chief medical officer revised the guidelines after we published our report—perhaps not entirely because of it, but I am sure we contributed. That was a big step forward. The guidelines now say that women who are pregnant or are trying to conceive should not drink alcohol at all. That is right, but by no means does it go far enough, because people do not know the guidelines—I am afraid that the increase in alcohol consumption suggests that, sadly, that is all too true.

As part of our strategy, we have to increase awareness, not only among professionals but among the wider population, of the support needed for women before pregnancy. In north America, which my hon. Friend the Member for Luton North mentioned, information is displayed in all the health facilities, education facilities and even airports—I have seen big signs in Canadian airports that say “Don’t drink if you’re pregnant or trying to conceive”.

[Kelvin Hopkins]

Another factor in America that I did not mention, because people draw back from it, is that people who are under the age of 21 cannot drink alcohol, and anyone who supplies alcohol to somebody under 21 can be sent to prison. That actually happened to a young Englishwoman who was on holiday in Florida: she provided alcohol to her younger sister and was sent to prison for corrupting a minor. It is taken very seriously indeed.

[Bill Esterson]

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

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

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

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[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to speak in this important debate and I warmly thank the hon. Member for Congleton (Fiona Bruce) for securing it.

The costs that alcohol imposes on our society—the social cost, the health cost and the cost to families and communities—simply cannot be counted, because of course that cannot always be measured in pounds and pence. Across the UK, alcohol accounts for 10% of our burden of disease and death, and it is one of the three biggest lifestyle risk factors for disease and death. Alcohol is 60% less expensive now than it was in 1980, and everyone knows that when the price of a commodity goes down, consumption goes up.

I will share with the Chamber today the alcohol-related challenges that we face in Scotland. NHS Health Scotland has reported that in 2014 retail sales data demonstrated that alcohol sales in Scotland were 20% higher than in England and Wales. Scottish sales of low-cost vodka are more than twice as high as those in England and Wales. It is estimated that one in three Scots are affected by a mental health problem each year, with depression and anxiety the most common illnesses. Alcohol and problems with mental wellbeing are closely related.

We in Scotland therefore have much greater and more pronounced challenges than the rest of the United Kingdom. The damage that alcohol is doing to our population is extreme, so bold solutions are required. In Scotland, such bold solutions have not been shied away from. The overall strategic approach in Scotland is different—I would argue that it has to be different—from that of the rest of the UK. A whole-population approach is required to reduce the harm caused by alcohol.

The important point is that, in addition to analysing existing data such as alcohol-related deaths and hospital admissions, our approach uses sales and price data from market research organisations to examine the relationship between price, consumption and harm. The effects of specific policies have also been examined, such as the policy on multi-buy discounts—it is worth noting that such discounts are now banned in Scotland. Scotland is the only part of the UK to produce such detailed information on alcohol, including sales data.

Whether we are talking about alcohol, gambling, obesity or lack of physical activity, we need to consider how all of our high streets and neighbourhoods can support good health, rather than contributing to our ill health. For example, we know that deprived areas have 40% more places to buy alcohol than more affluent areas. The more widely available and easily accessible alcohol is, the more we drink, and therefore the more harm that is caused.

As well as knowing that 20% more alcohol is sold in Scotland than in England and Wales, we know that Scottish male death rates are approximately 50% higher than those of other UK countries, while women’s mortality is 30% higher in Scotland than in other UK countries.

[Kelvin Hopkins]

I think this statistic is true: life expectancy in central Glasgow is the lowest in the United Kingdom.

[Patricia Gibson]

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

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

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

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

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

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

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

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[Liam Byrne]

The hon. Lady is absolutely right. There are a million and one ways in which we can do this. Someone called Gemma contributed to the report and said:

“Going down any street with a pub on it in the UK and there will be a sign outside with a quote such as ‘Drinking at 9 am doesn’t make you an alcoholic’. Well, to be honest, it probably does.”

There are common-sense restrictions that I think we should be debating.

[Kelvin Hopkins]

My right hon. Friend is making a very good point about the opening of pubs at all times of the day. I am one of those who opposed the relaxing of licensing hours. Sadly, it was our party’s Government who did that, and I think that was a mistake. I hope that one day we shall get into power and reverse that, if it is not done before then by the present Government.

[Liam Byrne]

Let us hope it changes even before then.

The Prime Minister has put great store on two things: first, restoring social mobility in this country, and, secondly, children’s mental health. I understand that it will not be too long before the social mobility strategy, or the social justice strategy, is produced. I do not mind or particularly care what it is called, but I look to the Minister for a cast-iron commitment that children of alcoholics will be discussed at the Cabinet Committee next week, and that we will insert into the strategy that is published in the weeks to come a commitment to develop some of the ideas I have talked about this afternoon.

The Government are well aware of our ambitions. We have written to all and sundry about them, including the Prime Minister. If the Prime Minister is in any doubt about the importance and urgency of this debate, I will close with a word from His Grace the Archbishop of Canterbury, who said:

“We all know that having a parent who abuses alcohol is one of the most disruptive experiences for any child and leads frequently to long-term effects in one’s self confidence, one’s capacity to relate, and even for some people in their own relation to alcohol itself. My experience, whether easier or more difficult than that of others, was fairly difficult...One of the things I most missed was the company of others who understood the issue.”

He concluded in the most powerful of ways:

“We are never ourselves when we are solitary, but in all of human history and community it has invariably been the case that it is in relationship that we become most fully what we are called to be, provided that relationship is healthy.”

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[Kelvin Hopkins]

Another horrifying statistic is that Russia’s population has been in fairly serious decline in recent years, and the major factor in that is alcohol consumption, which is epidemic.

[Martyn Day]

I thank the hon. Gentleman for making that point.

There is sufficient evidence to show a clear link between levels of consumption and of harm. My hon. Friend the Member for North Ayrshire and Arran has already given several examples. It is particularly worrying that retail sales data show that sales in Scotland are higher than in England and Wales—they were 20% higher in 2014—particularly for low-cost spirits. It might surprise Members to hear that since 2008 vodka has outsold blended whisky by about 20% in Scotland. In 2015, 10.8 litres of pure alcohol was sold per adult in Scotland, which is equivalent to 41 bottles of vodka, 116 bottles of wine or 476 pints of beer. When I consider my consumption rates, or those of my friends and family, many of whom take less than I do, the average means that there are people out there consuming a phenomenal amount of drink. On average, alcohol misuse causes about 670 hospital admissions and 22 deaths a week, and it is costing Scotland £3.6 billion each year, or £900 for every adult in the country. How much better that would be spent on other aspects of the NHS.

I served for 13 years on the West Lothian licensing board and in that role learned a lot about the licensed trade and alcohol issues within many of the communities that I now represent in Parliament. One of the more encouraging developments that I saw during those years was the Best Bar None award scheme, which is a great example of partnership working. It has operated in West Lothian since 2008 and has 20 accredited venues, with the Glenmavis Tavern in Bathgate nationally winning overall best bar at the awards in 2015. Best Bar None is administered by the Scottish Business Resilience Centre, whose remit is to create a secure Scotland for business to flourish in. It promotes responsibly managed licensed premises in Scotland, with the aim of partner agencies working together with licensed premises to create safer and more welcoming city and town centre environments. The crux is that it is also about changing Scotland’s relationship with alcohol—something that I believe can be achieved only by working together as a society.

The Scottish alcohol strategy, published in 2009, recognises that a whole-population approach is needed to reduce alcohol harm. Harry Burns, who was the chief medical officer of the Scottish Government at the time, said:

“Every one of us must ask frankly, whether we are part of the problem and whether we are going to be part of the solution.”

I wholeheartedly agree with that comment. The approach is correct, and indeed we have encouraging signs that it is working. Scotland had the steepest fall in alcohol-related deaths between 2004 and 2014. The rate fell from a staggering 47.7 per 100,000 to the current 31.2. Significantly, the fall in death rates over the period was greatest among the lowest income groups, which helped with some of the country’s inequality issues.

A measure that has been particularly effective is the multi-buy discount ban, which has accounted for a 2.6% reduction in consumption, as my hon. Friend the Member for North Ayrshire and Arran has pointed out. In December 2014 the drink-drive limit was reduced from 80 mg to 50 mg, bringing Scotland into line with the majority of European and Commonwealth countries. There is international evidence that lower limits are effective in preventing alcohol-related road accidents.

Controlling availability through licensing has also been a feature of the Scottish strategy. There is a presumption against granting 24-hour licences to on-trade premises, and off-sales are allowed only between 10 am and 10 pm. There are also strict controls for displays and marketing materials, which are limited to single designated areas in supermarkets and shops. I agree with the point made by the right hon. Member for Birmingham, Hodge Hill about sports advertising, and the UK Government should take that on board. We have seen the effectiveness of limiting marketing in supermarkets; cutting it out of people’s bedrooms would have a massive effect. Scottish licensing legislation puts the objective of protecting and improving public health into the mix, and licensing boards may consider that when making decisions. My understanding is that there is no such public health objective in England and Wales. That is something that UK Ministers might want to consider.

Several hon. Members have mentioned the fact that pricing to reduce affordability is a key component of tackling alcohol harm. I believe that taxation is a means of doing that, but it does not deal with the reality that the availability and relative affordability of the cheapest and strongest drinks is at the heart of the problem. Minimum unit pricing is a more effective tool in targeting those cheap, high-strength products that are excessively consumed by heavy drinkers.

As my hon. Friend the Member for North Ayrshire and Arran informed us, evidence from Canada suggests that there is a direct link between changes in minimum price and changes in consumption. It is estimated that a 10% increase in minimum price might be associated with a 32% reduction in wholly alcohol-attributable deaths. That is significant, and it is an approach worth taking. As we heard, using updated modelling from the University of Sheffield, it was estimated that a minimum unit price of 50p would result in 121 fewer deaths and a fall in hospital admissions of about 2,000 per annum in Scotland. Significantly, 51% of off-sales are sold for less than 50p per unit—some for as little as 18p.

The Scottish Government will ensure that a minimum price policy is implemented as soon as possible. The policy had overwhelming support in the Scottish Parliament and it has twice been approved by the Scottish courts. The Court of Session’s Inner House granted the Scotch Whisky Association and its partners permission to appeal to the United Kingdom Supreme Court in December 2016. The appeal will be heard in 2017.

In conclusion, our nations have a long history with alcohol, and somewhere along the way things have got out of hand for many in our society—often those from the most disadvantaged areas. There is much that can be done, and we must all take responsibility. There are many reasons why we need to take action, including the impact on police workloads and the weekend A&E admissions, all fuelled by alcohol. Perhaps the most important reason is premature death—20 years earlier than the average for a heavy drinker—and its impact on families and communities. Tackling that issue alone would greatly help reduce inequality in society.

--- Later in debate ---

[Nicola Blackwood]

The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.

In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.

[Kelvin Hopkins]

To be specific, will the Minister look carefully at what I suggested in my speech? We should have notices in all medical establishments and all areas where alcohol is consumed or purchased with the wording used in America about birth defects, and we should ensure that all medical professionals know about that problem and tell all women about it.

[Nicola Blackwood]

I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.

By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.

That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.

Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.

Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.

The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.

We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.

The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.

Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.

One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.

We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.

Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.

I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.

This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.

Dietary Advice and Childhood Obesity Strategy

Kelvin Hopkins Excerpts

Monday 23rd May 2016 Commons Chamber

[Kelvin Hopkins (Luton North) (Lab)]

May I first declare that I am a believer in the nanny state? It was the nanny state that stopped children being sent down mines and up chimneys, and much more besides. May I applaud my right hon. Friend the Member for Leicester East (Keith Vaz) for raising this very important issue? Last week when I had a peanut butter sandwich, it tasted rather sweet, so I checked the jar and found it had sugar in it. May I suggest to the Minister that we go well beyond a sugar tax and have some means of stopping sugar being put wrongly into foodstuffs?

[Alistair Burt]

We now have a sugar app, which means that the next time the hon. Gentleman goes down to the supermarket and wants to check how much sugar there is in a product, he can use the app by placing a device against the barcode. My family have used it and they have found, to their astonishment, how much sugar is contained in products that they never expected to contain it. This is not only about making sure that there is a reduction in sugar content where that is possible and appropriate, but about alerting consumers to the amount of sugar, which is really important. I shall ensure that the Under-Secretary, my hon. Friend the Member for Battersea, gives him details about the app he can use.

Oral Answers to Questions

Kelvin Hopkins Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

I do not necessarily, despite the energy of the hon. Member for Liverpool, Wavertree, accept everything that she says. I gave a list of where the money is being spent. However, I think I can help both the hon. Gentleman and the hon. Lady. Much more is being done to ensure that CCGs deliver what they need to deliver in relation to mental health. This year’s figures will show that, whereas there has been a 3.7% uplift for CCGs, there has been an uplift of 5.4% in mental health spending. With more transparency and more determination by the NHS on CCG spending, hopefully what people are saying and feeling will become less justified in the future.

[Kelvin Hopkins (Luton North) (Lab)]

9. How much was spent on healthcare as a proportion of GDP in (a) 2009-10 and (b) 2014-15; and what estimate he has made of the amount that will be spent on healthcare as a proportion of GDP in 2020-21.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Because in 2010 the country faced a deficit that constituted 11% of GDP, all major political parties committed to plans that reduced Government spending, including on health, as a proportion of GDP. However, because of this Government’s commitment to the NHS, health spending as a proportion of Government spending will increase from 14.2% to 15.8% over the decade.

[Kelvin Hopkins]

Former coalition Minister David Laws has recently written that under the previous Government the NHS chief executive told Ministers that the health service required an additional £30 billion, and that he was forced to cut that figure and squeeze it down to £15 billion, but was allocated only £8 billion by the Treasury. That was a savage cut of £22 billion to what the NHS really needed. Is that not the root cause of all the NHS’s problems, and does it not make utter nonsense of the Government’s claim to be protecting NHS funding?

[Mr Hunt]

What the hon. Gentleman describes as a “savage cut” was a real-terms increase of £10 billion a year, which was £5.5 billion more than his party proposed as part of the platform he stood on at the last election.

End of Life Care

Kelvin Hopkins Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Kelvin Hopkins (Luton North) (Lab)]

I am pleased to have the opportunity to speak in this important debate, although I will not speak for too long. I have long been concerned about the long-term care of the elderly and have tabled many early-day motions in the past, including following the royal commission report in the late 1990s. The then Government went to great lengths to ensure that the report was not agreed unanimously, because they did not want to accept its recommendation for free long-term care for everyone, whether they be in residential care, at home or elsewhere. My early-day motion following that Government decision was supported and signed by more than 100 hon. Members, so my concern was shared across the House.

The Health Committee’s report “Dying without dignity” is admirable, and I congratulate the hon. Member for Totnes (Dr Wollaston) and her Committee on producing it. It recommends free social care, which I am very pleased about. The reports by the Public Administration and Constitutional Affairs Committee, of which I have the honour to be a member, are also relevant to long-term care. The Chair of the Committee is going to speak later, so I will not talk about them too much. “Investigating clinical incidents in the NHS” focuses on the appalling number of deaths and refers to the Mid Staffs hospital disaster, which was shameful.

Subsequent to the Government’s refusal to pay for long-term care, there have been a series of forced privatisations of local authority care homes, which I opposed. In my own constituency, three first-class local authority care homes, where people would spend the last days of their lives, were forced to close and the residents were handed over to the private sector, which is driven by profit rather than concern for care alone. Some of the private homes are very good, but some are not. There have been some serious, well-publicised lapses of care, and there has been an ongoing crisis in the care homes world. I am concerned about that.

We congratulate ourselves on how we care for our elderly, particularly in the last days of their lives, but the situation is not all good. Some hon. Members have referred to the problems, including people not getting the palliative care they deserve and need. That is deeply worrying. We are all going to die one day and some of us are closer to that time than others, and we want to make sure that we and our families are cared for properly in those last difficult days. The subject needs more debate, more Government action and more support.

The reports are concerned about compassion. Undoubtedly, medical and care staff are overwhelmingly compassionate people, but it is not good that they are being put under pressure and made to work long hours; that they have too many residents to care for in the homes; and that they are being rushed because of concerns about costs and the desire to maximise profits. That means that people suffer. We have all had cases—I certainly have—where people have not been treated well in their homes or have not had the right care in a hospital or a care home simply because the staff are under pressure. People’s compassion starts to be diminished when they feel they are being pressured and not being treated with respect. Pay is one thing, but compassion is damaged when a staff member is looking after too many patients or residents, or rushing around too many homes with elderly single people who are in their last days. We have to make sure that compassion is to the fore in all these matters.

I have also said on many occasions that we do not spend enough on health and social care in general. We are rightly proud of the national health service and the principles on which it is based, but it is underfunded. We spend at least 2% less of our GDP—about £35 billion a year less—on health than France or Germany. With an injection of £35 billion a year, some of the stresses that cause the problems in hospitals in particular would go away. I also think, and said to my right hon. Friend the Member for Leigh (Andy Burnham) before the last election, that long-term care of all kinds ought to be provided on precisely the same basis as the national health service, completely free at the point of need. I believe that it should be provided by public servants rather than by the private sector. Only when we accept that we have to pay properly for the health and care service and resource it appropriately—that we have to pay people properly and make sure that we have enough staff—will we ensure that elderly people are cared for when they are alive, and that they die a dignified, pain-free and suffering-free death.

I will leave it there, although I would like to say a lot more. I hope that other Members will support some of the things that I have said.

--- Later in debate ---

[John Redwood (Wokingham) (Con)]

I will draw on conversations that I have had with people around the country who have experienced a relative dying fairly recently, as well as on my own observations. I will not mention a particular case, because if I did have a difficult case, I would take it up privately in the usual way.

The first conclusion that I have formed, which I think the Secretary of State has wisely come to, is that a patient undergoing the last stages of their life and their family need a named doctor who is in charge. The family and the patient, when the patient has capacity, need to have access at reasonable times to that doctor to find out where they have got to and what the next stage is likely to be.

I believe that Ministers have put in place a requirement for there to be a named general practitioner for every patient when they are at home or in a care home. That is very welcome and let us hope that it works, so that there is someone people can turn to, whom they trust and know. However, when, as so often happens, people enter hospital and may not come out again, because of the way in which rosters and rotas work, it means that every day or every other day there is a different group of doctors and nurses in charge of them.

That can mean one of two things. Sometimes, the family and/or the patient are constantly retold very bad news because the new team feels that they have a duty to tell them. It may not be helpful for people to keep getting the same bad news. Alternatively, the family or the patient with capacity may want information at a particular time, but no one is up to speed because they have only recently taken over and have not had time to read the notes. Indeed, reading the notes is not necessarily as good as being continuously in charge of the patient and talking to them over the days or weeks in which the treatment is undertaken or as their last days draw near. I therefore urge Ministers to get behind the idea that it is best if there is a named senior doctor—perhaps a consultant or registrar.

Often, people in their last few weeks or months of life have complex and multiple medical conditions, so a series of different consultants are involved, but no one consultant feels as if they are ultimately in charge. I am told that in some hospitals patients are moved from ward to ward at very short notice, with different specialties in mind. The family then turn up and do not even know where the patient is, because they think that they will be where they last saw them. That can be very disruptive for the family. More care and attention is needed in some cases to deal with that issue.

The second issue, which has been mentioned by other colleagues, is the interface between social care and hospitals. All of us who visit hospitals as Members of Parliament and sometimes as family members will have observed that a very large number of patients in a lot of our wards are extremely elderly and very frail, with lots of complex medical conditions. Some of them may not be easy to treat. Others might be better off in a care home or at home, but there has been a failure to put together the set of services that they need.

I do not really believe that that is a money issue, because in many cases one could buy an awful lot of social care for the cost of the hospital bed that the person is occupying. Social care might even be cheaper. I am not recommending that we take people out of hospital because somewhere else is cheaper, but if they would be better off somewhere else, if they want to be somewhere else and if there are no longer any medical interventions that the hospital can make, it is sensible to take advantage of social care if it is also cheaper.

[Kelvin Hopkins]

I hear what the right hon. Gentleman says, but when local authorities know that they have to pay for care when somebody comes out of hospital, they will try to persuade them to stay in hospital for as long as possible. Different budgets put different pressures on different institutions.

[John Redwood]

The hon. Gentleman is right. Throughout the time he and I have been in the House, under Governments of different persuasions, we have all known about the problem, we have all said that we need to solve it and still we have not managed to do that. I hope that our current talented Ministers can do something that no previous groups of Ministers have been able to achieve. There is an experiment because, with the devolution models that Ministers are considering, if the health and social care budgets are put together under the same authority, the excuse that there is a budget row goes. One would hope that the best interests of the patient were dominant and that authorities would realise that, in some cases, the best interests of the patient also enabled them to save money through switching from an expensive hospital bed to a decent care package. That could be helpful, and I hope that Ministers will do that.

For the families of those who die, the need for care does not end at the moment of death. That is generally understood by the public sector, but there are serious problems with delivering the support and administrative back-up that families need when a loved one dies. Several people who have been through this recently told me that the first thing that happens is a delay in getting a death certificate. Without a death certificate, nothing can be done to settle things. People cannot even hold a funeral because they cannot instruct a funeral director until they have a death certificate.

Not only is there a delay in getting the death certificate from the medical staff at the hospital, but people cannot register the death because of the insistence on a face-to-face meeting with the registrar, which can mean a further delay of many days before a slot becomes available. Quite a lot of families therefore end up with one, two, three and four weeks of delay before they get the death certificate, which is necessary to trigger the funeral and any financial changes consequent on a person’s death.

The Government have introduced a sensible “Tell Us Once” system so that when a person dies, the family can fill in quite a complicated electronic form, which is meant to tell all Departments with which the dead person may have been involved what the Government need to know. There are two problems with that. First, families often do not have all the knowledge that they need. Unless they have that knowledge, the Government seem unable to cross-refer and discover that, for example, the person had a benefit as well as a pension. It would be helpful if Government computers talked to each other more adequately so that the Government could do more of the work and families just had to notify them of the death and did not have to know every detail of the dead person’s financial affairs.

Secondly, because the delays with the death certificate and registrar appointments often mean that registration of the death is delayed, the Government make payments to the deceased person, and the families, having used “Tell Us Once”, get a set of not terribly friendly letters—I appreciate that they have been dressed up a bit—saying, “Your dead relative owes us this much money”. The families cannot necessarily get their hands on that money, but they are none the less obliged to pay the Government back, at an unsettling time when they are mourning and grieving and were not expecting a tax or benefit bill.

In the interests of handling the families better, the Government should speed up their side of the administration so that the death can be registered promptly, the Government do not make wrong payments and the families are not faced with letters demanding money back when they have other things on their mind and are trying to deal with the hurt. It does not make it better when the Government say, “We’re very sorry you’ve had a loss” if they go on to say, “but you owe us this much money. The usual rules apply. See you in prison if you don’t pay”.

We need to improve greatly on dealing with the first few weeks for the poor grieving families, who do not necessarily know the process, are very lost because they have lost their loved one, and are not helped by delays and sometimes the incompetence of the regulatory authorities.

NHS: Financial Performance

Kelvin Hopkins Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

My hon. Friend is entirely right that the new Leader of Her Majesty’s Opposition made that point. It is surprising because, as a representative, I would not like our A&E targets to be missed for seven years in a row, as has happened in Wales. If we replicate what has happened in Wales here in England, we will see worse care for patients. I am sure that Members from all parts of the House would not wish to see that happen.

[Kelvin Hopkins (Luton North) (Lab)]

Comparable developed countries spend a substantially higher proportion of GDP on health than we do. In my view, that means that our health service is substantially underfunded. Will the Minister report back to the House on those comparisons and explain why we spend so much less than those countries on health?

[Ben Gummer]

The hon. Gentleman is right that, in the past, the NHS has not had the funding that it requires. That is exactly why the Government have committed £10 billion to the NHS at a time when efficiency savings are being made across all other Departments. That is the mark of a party that believes in the NHS and the reason why only this party can fairly claim to be the party of the NHS.

NHS Specialised Services

Kelvin Hopkins Excerpts

Thursday 15th January 2015 Westminster Hall

[Kelvin Hopkins (Luton North) (Lab)]

I, too, congratulate you on your knighthood, Sir David, which is well deserved. It is a pleasure to serve under your chairmanship. I also congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on launching and promoting this very important debate.

I want to speak up for robot-assisted surgery, which should be the subject of national commissioning and should not be localised. The case for it is very powerful indeed. Some 500,000 robot-assisted surgical procedures took place in the world in 2013, and 5,000 of those were in Britain—but 5,000 is quite a small number when compared with the total number of operations across the whole field of health during a year. These operations are very specialised; a small number of very specialised surgeons do them. Clearly, such surgery is wholly inappropriate for local decision making, local funding and local commissioning. My hon. Friend the Member for Bristol East (Kerry McCarthy) made the point very strongly: these operations should be part of a national service, where we can get economies of scale and a focus on centres of quality and expertise.

The operations are used, among other things, to treat patients with prostate cancer, kidney cancer and bladder cancer and, to a lesser extent, in the areas of colorectal surgery and gynaecology. Having seen some of the operations on film, I know how incredibly precise and difficult they are and what miracles can be worked by robotic surgery. It cannot be done by human beings: however brilliant a surgeon is and however delicate their hands are, they cannot be as precise as a robot. Robots will increasingly become part of the way we operate on human beings more broadly.

My reason for being so interested in this issue is personal. Over the last four years, I have been invited to speak, briefly, at an international symposium on surgical robotics at the Royal Geographical Society. It has been led by my noble Friend Lord Darzi, of another place. As we all know, he is a gifted and brilliant surgeon himself. I make a brief address at the beginning—not because I am a medic myself or know anything about these things, but because my late father was Professor Harold Hopkins FRS. He was a gifted scientist who designed the first successful optical endoscopes. Flexible fibre optics were his, as were rod lens cystoscopes and all the endoscopes that followed from them.

If anyone has ever had a colonoscopy or a gastroscopy—or, indeed, had their bladder inspected through the urethra—they will have had one of those instruments poked inside them. I have experienced more than one of them, but fortunately I was in perfect health, so I was pleased about that. I also had the unusual experience of seeing the first ever clear picture of bladder cancer; my father showed it to me when the first endoscope was used to take it. It was an historic moment.

The point I want to make is how important it is that these procedures are promoted within the national health service, because Britain must be at the forefront of this technology. We have brilliant surgeons and brilliant designers and scientists designing these things, but when my father first invented his cystoscopes, his endoscopes, he could not get them produced in Britain. Eventually, he met a man called Storz in Germany, who manufactured the endoscopes and made millions of pounds from them.

The Deutsches Museum in Bonn has a case devoted to those instruments in a part of the museum for foreigners who have made a contribution to the German economy. It could all have been done in Britain, but it was not. I fear that if we do not keep funding this cutting-edge technology—“cutting” is perhaps an unfortunate word—we will lose our position in the world at the head of all these developments. It is so important for Britain, as an economy, that we sustain these things, but they will not be sustained if we have penny-pinching local commissioning, which will undermine the procedures and their availability.

These are very serious concerns. Sadly, my father died of prostate cancer himself some 20 years ago. There is a hereditary component in prostate cancer, so I have a personal interest in making sure that all these operations are available and that we have the best possible technologies to deal with the disease.

A recent front-page report in The Guardian or The Independent—I forget which—showed that prostate cancer treatment varies enormously from area to area, and death rates are higher in some areas than in others because some treatments are not available nationally. Some treatments, such as implanting into the prostate small radiation-generating components that kill off cancer cells, are not available to all sufferers, and they should be.

There are all sorts of reasons for national commissioning to ensure consistency of provision across the country and that people do not die unnecessarily of dreadful diseases. There is a powerful case in many other fields for national rather than local commissioning. We are talking not about hip replacements and tonsillectomies, but about very specialised operations, sometimes for rare diseases and conditions, using technology that is not available in every area. There should be national centres for such things.

That is my case, although I could speak at much greater length. I want to finish on the question of funding for the health service. There has been a lot of press comment and alarm about the state of the health service, and quite rightly so. I do not speak for my Front-Bench team—I only wish I did, and from time to time I try to persuade them that I should—but I believe that NHS spending must be increased. We spend at least 2% less of GDP on health than do the French or the Germans, and 2% of GDP is the equivalent of approximately £60 million per constituency. I would like to see an extra £60 million spent on health in Luton North, as I would in Luton South and in every other constituency. That would simply match the current situation in Germany and France.

The NHS does a wonderful job and is incredibly efficient, despite what people say. It has a high level of productivity, although that is being damaged by fragmentation and creeping privatisation. It is a remarkable organisation, envied across the world. It is still, in many ways, the best health provision in the world, but it is in danger from underfunding. I want us at least to match what the French and Germans do, especially as our economy is now evidently stronger than theirs.

There is a possibility of spending more. The population regularly indicate in polls that for certain areas, particularly health, they would be prepared to pay a little more tax to make sure that they are safe. I look forward to the next Labour Government, who should be in office in the next few weeks. We will then be able to move forward and properly fund the NHS.

[Sir David Amess (in the Chair)]

I call Mr Mark Tami, who, as it turns out, has plenty of time at his disposal.

--- Later in debate ---

[Norman Lamb]

I totally accept the point. Again, I hope to reassure the hon. Lady.

The hon. Member for Luton North (Kelvin Hopkins) referred to robotic assistive surgery. I do not want to give him any particular hope, but it is always possible for new procedures to be added to the list of those that come within specialised commissioning. The prescribed specialist services advisory group keeps the list under review. Just as there are proposals to remove procedures, there is always the possibility, if the case is made and the four conditions that need to be taken into account are met, that additional areas can be included.

[Kelvin Hopkins]

I should have mentioned that robotics make possible an increase in non-invasive surgery, which is not only better for the patient, but much cheaper for the NHS, because there is less recovery time and so on.

[Norman Lamb]

I totally take that point. The hon. Gentleman is absolutely right that the NHS must be, as he put it, at the cutting edge of new technologies and new ways to reduce the invasiveness of procedures, although I add that having things in specialised commissioning is not the only way for the NHS to do so.

The hon. Gentleman was at risk of going into too much detail when he started talking about various procedures. Despite being a Health Minister, I am at risk of passing out on such occasions, so I was glad that he stopped when he did.

[Kelvin Hopkins]

rose—

[Hon. Members]

No!

Oral Answers to Questions

Kelvin Hopkins Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point. The PFI schemes negotiated by the previous Government were, quite frankly, disastrous for many hospitals. His hospital has seen that the way forward is to buy out the PFI and free up more money for front-line patient care. We will support as many more hospitals in doing that as can be achieved, because this is about making sure that we deliver more money for NHS patients.

[Kelvin Hopkins (Luton North) (Lab)]

I was fascinated by the question from the hon. Member for Hexham (Guy Opperman). Would not the simple solution be to take all PFI assets back into public ownership, reintegrate them with hospitals’ existing assets, and save millions of pounds for hospitals every year and billions of pounds for the public purse over time?

[Dr Poulter]

I understand that the hon. Gentleman is unhappy with the way in which the previous Government negotiated PFI contracts. We are unhappy with it as well, because it is costing the NHS almost £2 billion on current forecasts. We are making sure that we can put in place measures to support hospitals in mitigating the worst excesses of these poorly signed PFI deals.

Foetal Alcohol Syndrome

Kelvin Hopkins Excerpts

Tuesday 14th October 2014 Westminster Hall

[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 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.

--- Later in debate ---

[Bill Esterson]

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

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

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

Aristotle wrote about the effects of women drinking during pregnancy. Sir Francis Bacon advised women not to drink during pregnancy. The gin epidemic saw a rise in birth defects in Britain in the 1700s. The infant death rate was 20% higher for alcoholic women in prison in 1899 as compared with the rest of the population. Distinct facial characteristics were noted by French researcher Dr Paul Lemoine—I apologise for the pronunciation—who studied families where mothers drank a lot in pregnancy. The term “foetal alcohol syndrome” was first used by English researchers Jones and Smith in 1973.

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

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

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

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

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

and support staff—

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

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

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

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

[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. 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.

[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 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 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.

--- Later in debate ---

[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 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 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.

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[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.

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?

--- Later in debate ---

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

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

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

[Kelvin Hopkins]

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

[Jane Ellison]

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

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

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

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

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

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

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

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

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

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

[Kelvin Hopkins]

Will the Minister give way?

[Jane Ellison]

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

[Kelvin Hopkins]

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

[Jane Ellison]

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

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

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

Oral Answers to Questions

Kelvin Hopkins Excerpts

Tuesday 10th June 2014 Commons Chamber

[Kelvin Hopkins (Luton North) (Lab)]

10. What statistics his Department keeps on babies damaged by alcohol consumed in pregnancy; and if he will make a statement.

[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.

Care Homes

Kelvin Hopkins Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

My hon. Friend makes an important point and it is right to highlight the great places that are providing excellent care. The Care Quality Commission makes it clear that it encourages members of the public to come forward and alert it to concerns, but we must do much more to make it easy for members of the public, so that they understand exactly what they need to do if they have concerns.

[Kelvin Hopkins (Luton North) (Lab)]

I applaud my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) for her comments, particularly on local authorities. A major factor in all this and across the care sector has been the widespread privatisation of very good local authority care homes. In my constituency, three superb homes were forcibly closed. They were loved by their staff, their residents and the families, and admired by local health professionals—all closed; all gone. Is it time to re-establish a role for local authorities in providing care services and making all care locally and democratically accountable?

[Norman Lamb]

Unacceptable standards of care must be condemned and challenged wherever they occur, whether in the private, public or voluntary sector. Mid Staffordshire hospital was an NHS hospital, yet awful things happened. We must be intolerant of abuse or neglect wherever it happens. On local authorities—the shadow Minister raised this point—we have the power to require the Care Quality Commission to inspect on specific issues, including where there are concerns about the commissioning of care. It is important that those powers are there to be used.