Foetal Alcohol Spectrum Disorder

Steve Brine Excerpts

Thursday 17th January 2019 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Nobody has ever handed over to me that way before, but I like it. I was just saying to the Whip on duty that I should congratulate the hon. Member for Sefton Central (Bill Esterson) not just on getting this debate, but on his consistent record of campaigning in this area over many years. I am sorry that that came about due to bad personal experience, but I hope that his two adoptive daughters are okay and are proudly watching him do his work in the House tonight.

I thank the hon. Gentleman for all his work to raise awareness of the condition through the all-party parliamentary group on foetal alcohol spectrum disorders. I chaired many APPGs when I was on the Back Benches, and I always say—I make no apologies for repeating it—that so much good work in this House goes on in APPGs. There is so much expertise, and they do not get enough awareness in the public or in this House, but they should. The hon. Gentleman has certainly helped with that tonight.

It is true that we do not know enough about the extent of FASD. The recent Bristol screening tool study suggests that between 6% and 17% of people in the general population could be suffering from FASD, but I suspect that that is an underestimation. The study is an important contribution but, even as its authors acknowledge, there are limitations to the data, and its prevalence estimates should be treated with caution. There is no question that the hon. Gentleman is right that more needs to be done to clarify the true prevalence of FASD, and the Department will consider future research in this area—I take the hon. Gentleman’s challenge. We do know that the impact of FASD can be severe, with the lifelong physical, behavioural and/or cognitive disabilities that he mentioned. Unfortunately, there is no cure, but we know that early intervention can help improve a child’s development and help them to lead an improved life. The hon. Gentleman made well the point that FASD does not just affect babies.

Touching on prevention, the hon. Gentleman will know that it is one of the key priorities of the new Secretary of State for Health and Social Care, which is music to my ears as the Minister for Public Health, Primary Care and Prevention. The hon. Gentleman is right that FASD is an entirely preventable condition, so that makes my ears prick. Prevention is vital, and the all-party parliamentary group has made it the fulcrum of its work to raise awareness of the dangers of drinking in pregnancy in order to protect future generations from an entirely preventable condition.

First and foremost, we need to be absolutely clear to women about the facts on alcohol so that they can make well-informed decisions. That applies both before they become pregnant and when they come into contact with the health system—in primary care we call it making every contact count. The UK chief medical officer, Professor Dame Sally Davies, with whom I work closely, published low-risk drinking guidelines in 2016, which provide very clear advice to women not to drink alcohol if they are planning for pregnancy or if they are pregnant. Public Health England, for which I have ministerial responsibility, reinforces that advice through its public health messaging, both global and targeted.

We have been very clear with the alcohol industry that we expect the guidelines to be reflected on the labelling of all alcoholic products, and we have given the industry until September 2019 to ensure that its labelling reflects the updated guidelines. The industry knows that I will be watching it like a hawk.

There is also central advice through NHS.uk and other media platforms such as our Start4Life branding to inform women of the dangers of drinking during pregnancy. Of course, all upper-tier local authorities in England are now public health authorities. As part of their local public health duties, they rightly continue to educate the public about the dangers of alcohol during pregnancy, and it is encouraging to hear about initiatives such as “Be your baby’s hero, keep alcohol to zero,” which is one of my particular favourites. In Blackpool, of all places, areas of high alcohol use in pregnancy are being targeted to stop future cases of FASD. Be your baby’s hero, keep alcohol to zero—I just like saying it.

Once women are pregnant, they generally come into contact with health services frequently, which gives many opportunities for healthcare professionals to give advice on alcohol. As I mentioned at Health and Social Care questions this week, there are many campaigns on diet and nutrition, and health professionals are very aware of the dangers of drinking. Cancer Research UK has been helpful on this issue, and it is very aware of the dangers of drinking alcohol during pregnancy. The key thing is that pregnant women are given consistent messages, delivered in a supportive, non-judgmental way. The same goes for obesity, another area for which I am responsible. Messages about being overweight should be delivered in a supportive way and alongside a call to action, and many primary care professionals find that difficult, which I understand. It is easy for us to say, “Well, they should just mention it,” but it is not quite so easy.

Midwives and health visitors have a central role in providing clear, consistent advice and early identification and support, and they are well equipped to do it supportively. We are reinforcing that role through a number of strategies. Through the maternity transformation programme, the Department is working with NHS England, Public Health England, the Royal Colleges and a range of charities such as Sands, the stillbirth and neonatal death charity. The House will be well aware of Sands, which does such good work to promote safer maternity services. This programme covers a range of initiatives, which include raising awareness of the known risk factors among pregnant women and health professionals, as the hon. Gentleman has asked for. This will ensure that women receive consistent, supportive advice on how to minimise the risk of stillbirth, including the importance of healthy eating and of not smoking—I am responsible for the tobacco control plan—or drinking alcohol during pregnancy.

The National Institute for Health and Care Excellence has updated its guidelines to reflect the CMO’s advice not to drink during pregnancy. The Department will continue to work with the Royal Colleges—I was with the head of the Academy of Medical Royal Colleges last night—and various other regulatory bodies to raise the profile of the CMO’s guidelines and to recommend that they include those guidelines within their training, which the hon. Gentleman has consistently asked for.

[Bill Esterson]

I appreciate the tone and content of the Minister’s response so far. I neglected to ask him about the alcohol strategy. Will he say a few words about his intentions to include action on FASD in that strategy? That would be an extremely important and welcome step for those interested in this subject.

--- Later in debate ---

[Steve Brine]

I do not directly own the alcohol strategy, but obviously I am involved in it. I take the hon. Gentleman’s challenge on board, and maybe we can discuss it further. I know he has stuff he wants to feed into the strategy—he has produced it through the all-party parliamentary group—so perhaps we can discuss it further. I can then discuss it with my ministerial colleagues in the Home Office. It would make absolute sense to do so as part of the strategy, and I suggest linking it to our Green Paper on prevention, which we will be bringing out this year. His question is spot on.

I will now touch on services for affected families. We know that FASD can have a huge impact on the early years development of children and on their life chances, and the hon. Gentleman gave a number of good examples. We also know that early intervention services in this area, as in every area, can help to reduce some of the effects and, therefore, the secondary disabilities that come as a result. The responsibility for commissioning services in this space lies with the clinical commissioning groups in England, working together across all different sectors of the local health economy. We have heard of cases of long waiting times for a diagnosis. My Department will consider how we can improve access to these services and a diagnostic pathway, but we also need to learn from best practice. The Tameside and Glossop Integrated Care NHS Foundation Trust has developed the maternity alcohol management algorithm pathway—why can people not come up with something snappier, like that first one? It has introduced screening and awareness of FASD, enabling what we think is effective early intervention. Just as the long-term plan gives different examples on smoking, with the Canada example on challenging smoking rates among pregnant women, I am interested in the best practice ideas and that trust has a lot to bring in this space. The Surrey and Borders Partnership NHS Foundation Trust has a specialist centre, although sadly it is the only one in England. The trust provides a comprehensive and rapid diagnostic pathway for those with FASD and it has a lot to share from its journey and with its ideas for service delivery, and on the success it has had.

[Bill Esterson]

The Minister mentions Surrey and Borders, and I have had significant interaction with Dr Raja Mukherjee, the specialist who runs that centre. I am glad the Minister acknowledged that it is the only one in the country. May I encourage him to intervene to make sure we have such centres right across the country, as that would make a massive difference?

[Steve Brine]

The hon. Gentleman can certainly encourage me in that regard, and I will look at that in terms of the prevention paper. We would have to be guided by the clinicians and the CCGs on where they would see the greatest need for that provision to be. That is very much the spirit of the long-term plan, but it is not ideal that that centre is the only one. Surrey is near my constituency, but a long way from Sefton.

Finally, I wish to touch on the wider departmental policy engagement in this area. Our deputy chief medical officer, Gina Radford, has held roundtable meetings on the subject, which considered the future development of policy to improve prevention and support. I do not know whether the hon. Gentleman has been involved in that. These meetings were attended by experts in the field and, crucially, FASD service users. I thank NOFAS UK—the National Organisation for Foetal Alcohol Syndrome-UK—which has been helpful in supporting and contributing to these meetings, along with other charities working in this field. We are also providing wider support to children and families affected by alcohol misuse, through the children of alcoholic dependant parents programme, which I am proud of. It was one of the first thing I got to announce in this job. The previous Secretary of State working as one with the current shadow Secretary of State had managed to do this, which shows that cross-party working can happen in this Parliament between the two main parties—and there were no preconditions to it.

[Lyn Brown]

That is a career-limiting comment.

[Steve Brine]

The preconditions did not come from this side; I filled it in nicely. Through that programme, we are investing some £6 million over three years to support a vulnerable group, as part of our new alcohol strategy.

The Government take alcohol concerns, across the board, very seriously and even more so when they relate to pregnancy. We are making progress—I hope—to prevent future FASD cases, and trying to change the landscape on prevention and treatment for those affected. But there is not an ounce of complacency in us—there certainly is not in me. We will continue to work towards improvements in the area. I can promise the hon. Gentleman that and I know, given his consistent work in this space, he will make sure he holds us to that and continues to raise awareness of the dangers of drinking alcohol during pregnancy in this House and outside. I thank him for that.

Question put and agreed to.