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Westminster Hall

Tuesday 14 October 2014

[Sir Edward Leigh in the Chair]


Motion made, and Question proposed, That the sitting be now adjourned.—(Dr Thérèse Coffey.)

9.30 am

Jessica Lee (Erewash) (Con): It is a great pleasure to speak in front of you during this important debate, Sir Edward. I am grateful for the opportunity to raise the matter in Westminster Hall today.

Of the many functions of Parliament, one of the most important is to respond to changes in society and, when appropriate, to legislate accordingly. The law on surrogacy is outdated, limited and in places illogical. It is difficult to see how the current law, such as it is, can be said to help people who are starting families without the process involving significant stress and risk. Although there is no small or completely straightforward change to alleviate such problems, the time has come for Parliament to take a fresh look at the rules around surrogacy and to commit to helping people to start a family. I have some experience and interest in the matter from my time as a family law barrister.

Surrogacy is on the increase. Despite a lack of official figures, save for what is recorded on the parental order register, it is estimated that between 1,000 and 2,000 children are born through surrogacy each year, which is up from between 50 and 100 in 2008. The numbers are rising sharply, which is why the time is right for Parliament to explore the solutions to help the families and surrogates involved in the process. To start with, it is worth considering why families or individuals turn to surrogacy. There are of course several reasons, including unexplained infertility, cancer, couples being of the same sex or, occasionally, individuals wanting a child. Whatever the reason, however, the current system has uncertainties throughout. Some commentators have described surrogacy as a legal and political minefield, which may be right, but Parliament’s role is to face up to such problems and to try to find solutions.

Not only are there problems with the law in this country, but an international framework for surrogacy, unlike adoption, is lacking. The rules in the UK are so ambiguous that potential parents are increasingly turning to other countries to find surrogates, which has its own problems. The lack of an international structure leads to delays and complications when they return to the UK with their children. The problems were highlighted over the summer with the case of baby Gammy, one of a set of twins born to a surrogate in Thailand for Australian parents. Gammy happens to have Down’s syndrome, and there is a dispute between the surrogate and the intended parents as to the reasons why he is now separated from his twin, who has gone to Australia. It cannot be right for such children to be left without a clear set of international rules to resolve the dispute.

The Minister may not be surprised to hear that I am not short of possible solutions to the issues around surrogacy and ask her to reply directly to my proposals. I am sure that she will agree that the current system has

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problems and those problems must be the starting point. With that in mind, I am sure that she will be grateful for the opportunity to work with me and others and across Government Departments to help families by seeking solutions that can reform the system.

In summary, I am calling for the following changes. First, I want new legislation to be brought forward to update the law or to amend the current legislation to help prospective parents and surrogates. Secondly, there should be written agreements for those going into surrogacy to ensure that all potential future issues around the pregnancy have been discussed and agreed. Thirdly, I want an international framework for surrogacy. Fourthly, there should be a code of practice for prospective parents and surrogates. Fifthly, we should have pre-birth orders, because it is right that there should be an immediate transfer of parenthood upon birth. Sixthly, payments to surrogates need to be regulated and transparent and should be for the surrogate’s “inconvenience” rather than for the acquisition of a child. Finally, we should end the non-extendable deadline of six months for applying for a parental order. I will discuss a related development that came in a recent judgment later, but it cannot be right to have no flexibility in a family law application of this nature.

The Surrogacy Arrangements Act 1985 and the Human Fertilisation and Embryology Act 1990 provide for the current legislative arrangements. The 1985 Act made it a criminal offence to advertise for a surrogate mother, to advertise oneself as a prospective surrogate or for third parties to broker a surrogacy arrangement on a commercial basis. The Act made the UK surrogacy arrangement unenforceable and the legislation was perhaps aimed to discourage surrogacy. The reality, however, was that surrogacy cases were beginning to rise in the UK and the legislation left the whole structure without professional support, which was reflected on by High Court judges at the time. In 2007, Mr Justice McFarlane commented:

“Given the importance of the issues involved when the life of a child is created in this manner, it questionable whether the role of facilitating surrogacy arrangements should be left to groups of well-meaning amateurs.”

He makes a good point.

The 1990 Act created for the first time a bespoke legal process enabling married intended parents to reassign legal parenthood to themselves and obtain a parental order. It was updated in 2008 and extended those eligible to apply for a parental order to include unmarried and same-sex couples. That, however, is it. That is our entire legal framework. The various pitfalls in the current legislation are many and I will now speak of how Parliament can best legislate to help all involved.

Enforceable written agreements and a code of practice would deal once and for all with the uncertainty surrounding surrogacy. There are an infinite number of questions to ask before going into a surrogacy arrangement. A written agreement and a code of practice would provide clarity for intended parents and for surrogates. All those involved need proper advice and proper safeguards against all eventualities. What if the pregnancy results in more than one baby? What about communication between all involved during the pregnancy? What if the child has a disability? What about the arrangements for the actual birth? Those are just a few of the obvious, practical problems that need to be addressed and could be addressed by written agreements.

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I have been discussing the matter with other MPs and some of my constituents. Following a conversation with a couple in my constituency, I will put it like this: I would not expect my constituents—the good people of Erewash—to have to purchase a house or lease a car without a contract, so why when trying to form a family, which is the most important thing that they will ever do, with a surrogacy would they do so with an inadequate framework? It cannot be right, but it is within Parliament’s power to change the rules.

The next change I would like relates to pre-birth orders. It is important to establish legally who the parents are from the moment of birth. At the moment, the surrogate, and their spouse if they have one, are the legal parents of the child. It has been said to me over the past few days that there is always the risk that surrogates will change their mind and that it must happen all the time. It is a common misconception. To my knowledge, only two cases of surrogates seeking to keep their baby have been reported in the past 30 years compared with some 1,000 successful arrangements. Typically, surrogates are mothers who have found pregnancy easy and then want to help other families. They have a commitment to help the intended parents and want to see them have their own family and see the child grow up in that unit. We need to support those women and to make the law work for them.

Furthermore, many children are being born abroad, if the surrogate is based there. That creates more problems, because the child can be born stateless, making arrangements to come home to the UK complex. If the parental order could be obtained during the pregnancy, arrangements to come home with the child would obviously be far more straightforward. A number of MPs have dealt with scenarios in which a child is born abroad and there are difficulties in returning to the UK.

The international context of surrogacy can add to the difficulties of applying existing UK legislation to the reality of modern surrogacy. Surrogacy law can be complex for foreign surrogacy arrangements. There is no international harmonisation of English and international law, and we do not automatically recognise a foreign birth certificate naming the donor parents as the legitimate parents of a surrogate-born child. In stark contrast with adoption, which requires the thorough vetting of parents, anyone can enter into a surrogacy arrangement abroad.

Automatic recognition of the surrogate as the legal mother, however, can cause its own problems in the context of international surrogacy agreements. In 2008, a British couple who had paid £23,000 to a surrogate mother who bore twins for them in Ukraine were at first unable to bring the children back to the UK, since the couple were not recognised as the legal parents. That situation took a year to resolve, during which time the children were left “marooned, stateless and parentless”, leading the judge dealing with the case to issue a stark warning about how dangerous such a scenario is.

There are many practical problems to getting home safely to the UK with the surrogate-born child after the birth, because of issues to do with the right travel papers, entry clearance and citizenship. Parents then have to look at the legal status of the child as soon as they return and any necessary interim legal measures. For instance, are the eligibility criteria for a parental

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order all in place? What about the legal position of the surrogate, and her partner if that is relevant, under English law? The complications are many.

Rules on surrogacy vary from country to country, so not only do we need to look at our domestic law, but all countries ultimately need to look at the international framework. In some countries, surrogacy is banned completely, such as in Germany, Italy, France and Sweden. In some countries, the law is complex, such as in the UK and Australia. Elsewhere, 19 states in America have laws clearly recognising surrogacy and another 10 states allow unpaid surrogacy. Also, anecdotally, I know of same-sex couples who have moved to the States with work, in part because they know that in due course it will be more straightforward there for them to have a child through surrogacy. Thus, all children born via surrogacy in the USA are eligible for a US passport, regardless of the citizenship of the parents, but that is inconsistent with other countries.

In July this year, the Government of Thailand announced changes to their regime for commercial surrogacy, stating that all surrogates will have to be blood relatives. As I made reference to earlier, a case in Thailand hit the headlines over the summer, and one can only feel sympathy for everyone involved in it. The case of baby Gammy, however, absolutely highlights the pitfalls and difficulties for all concerned. The outcome of such international situations—involving Thailand in this case, but it could be anywhere—might be that surrogate arrangements become more covert, and no one wants that. What we want is clear and transparent arrangements in this country and abroad.

Stuart Andrew (Pudsey) (Con): I congratulate my hon. Friend on securing this important debate. Among a number of concerns, many people fear exploitation. Is not preventing that another reason for the importance of reaching international agreements?

Jessica Lee: My hon. Friend makes a good point. The way to avoid such exploitation is clearly to have a clear and transparent structure. That is what is missing in domestic law, where there are arrangements, although they are not working properly, and internationally. Far fewer UK couples would consider going abroad if the domestic arrangements for them in England and Wales were completely straightforward, preventing them from feeling the need to travel around the world to find a suitable surrogate.

Parental orders, as I said near the beginning of my speech, have a strict six-month deadline in which to be registered once a surrogate has had the child. The law provided for no flexibility on that until very recently—a judgment was published in the past few days. In that case, the president of the family division of the High Court made the following comment:

“Can Parliament really have intended that the gate should be barred forever if the application for a parental order is lodged even one day late…It is the very antithesis of sensible; it is almost nonsensical.”

The judge then went on to make the parental order and the wardship was set aside. There had been significant delays in returning the child to the UK.

It can be said, therefore, that case law has moved matters forward, but the rules remain the same and that is a matter for Parliament to resolve and to do so early.

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We are dealing with people’s families and with emotive issues. That is the most important thing. If there cannot be flexibility in obtaining a parental order, that is a most unsatisfactory position. That must be one of the first matters in which there has to be flexibility in an application under family law.

I want to address the issue of same-sex couples. Since the Marriage (Same Sex Couples) Act 2013 passed through Parliament, we probably have had an increase in the number of same-sex couples looking to have a baby through surrogacy. That has been on the rise for some time, but the Act supports it as well. On Second Reading, the Minister gave one of the most thoughtful and measured speeches on the legislation, which I recall clearly, so I am delighted that she is responding to the debate today. She has always taken a thoughtful approach to the issues surrounding same-sex couples.

In the UK, anecdotally, same-sex couples conceive with the help of a friend, relative, or a surrogate introduced to them by a UK-based non-profit surrogacy organisation. As we know, such surrogacy arrangements commissioned in the UK are unenforceable by UK courts, so the problem remains. Increasing numbers of same-sex couples are travelling abroad for surrogacy. As I mentioned earlier, a popular destination is the USA, because some states can guarantee that both fathers will be named on a child’s birth certificate from the outset. But, again, we come back to the problems that I have raised before. Parliament did well by passing the same-sex marriage Act and progressing matters in that way, but for issues that follow on from that, Parliament needs to do the same. We must have an even-handed approach in addressing every aspect of people’s social and family lives, and that is why we need to update the law.

I have set out for the Minister my key requests. I accept that they are not small ones, and some will take time to grant, in particular those concerning an international framework. However, I genuinely feel that there is a real change in emphasis. There is a momentum to address the issue. Judges, as I have quoted, are saying that statute law is not right, and we need to move matters forward. We have an opportunity here today to take the initiative. We very much need to start the process, which would be welcomed across the parties. I have been helped by the right hon. Member for Birkenhead (Mr Field), who apologises for the fact that he cannot be here today. There is strong cross-party support for moving things forward. I urge the Minister to take this one-off opportunity and take a stand today and offer some solutions to these complex and extremely important questions, which could transform people’s ability to have their families in this country.

9.49 am

Richard Harrington (Watford) (Con): It is a great pleasure to speak in this debate under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Erewash (Jessica Lee) on securing the debate, which, I know, is an extremely difficult thing to do.

I am here today because I had a surrogacy case concerning a constituent, and nobody could help me to help my constituent other than my hon. Friend, who gave so much of her time and showed a level of expertise way beyond the remit of this House. I am not sure whether that expertise was professional or political, but it was a huge help and I am very grateful to her.

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That case gave me an interest in the subject, and in surrogacy from an international perspective. Some constituents of mine, the Patels, who are both UK citizens and who have lived in Watford for many years, decided to enter into a perfectly legal surrogacy agreement in India—I understand that surrogacy is legal there, both nationally and in each state. The surrogacy took place in a place in India that they knew well. There was no question as to their British citizenship or indeed that of the baby.

Notwithstanding that, I was shocked to find that despite my constituents having a legal contract and a certificate from the Home Office signed on behalf of the Home Secretary, and despite having done everything they possibly could—that was extremely expensive for them, but they are a decent, law-abiding professional couple and did everything properly—their son spent the first eight months of his life without meeting his father. It might seem ridiculous, but the father had to send the Home Office not just his birth certificate, but his passport, so that proceedings could take place. He therefore could not go to visit his son in India. Despite every effort by his solicitors and others—I even spoke to the high commissioner in India—the case was treated as an administrative matter about passports, and everyone was told to look at the website, with its 16-week service standard. No one was interested in the surrogacy aspect of the case.

I must commend the efforts of the Immigration Minister, whose office regularly contacted the Passport Office. However, I began to realise something that my hon. Friend the Member for Erewash had warned me about—surrogacy is not understood at all because there is no international agreement or protocol. I know nothing about this sort of thing myself—I have picked up this information from one particular case. It seems absolutely ridiculous that people who are trying to do everything properly, who have done what their lawyers have advised them and who have dotted the i’s and crossed the t’s, still had to wait weeks and months, as if the case was a passport application for an immigrant and there was a suggestion of fraud or some kind of trickery.

When my hon. Friend told me of her intention to campaign for an international agreement on surrogacy because of the need to bring things up to date, I thought that fell exactly in line with what my constituents wanted. To this day, the baby is in India, despite the fact that, as a result of the Immigration Minister’s good intentions, the father got his passport back. He has been able to go and spend time with his baby, although temporarily he has had to give up his professional practice. That situation is outrageous.

I commend my hon. Friend for what she is doing. She is one of the leading experts in the field, both in this House and in the legal sphere. I wish her all the best and am pleased to be able to support her in this debate.

9.54 am

Stephen McPartland (Stevenage) (Con): It is a pleasure to serve under your chairmanship, Sir Edward, and to follow my hon. Friend the Member for Watford (Richard Harrington) who, as always, has given an impassioned defence of his constituents’ interests. I congratulate my hon. Friend the Member for Erewash (Jessica Lee) on calling this important debate.

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Surrogacy is a complex minefield, as we are all aware. Many Members of Parliament are concerned about the issue but, as we can see from the Chamber today, they are not keen on speaking about it publicly, because it is complicated, with many facets and problems. There are some religious undertones to the subject. I am pro-life and support all life. As a Catholic, I know that some Churches do not support surrogacy, but my view is that, whether or not it is supported, there is a system in place that we need to try to fix, as the exploitation of people using surrogates must stop.

Some of my constituents have fertility problems. They have looked into surrogacy as an option, but they have found it to be such a minefield that they do not wish to pursue it, despite the fact that having a child is their lifelong dream. At the moment, there is a real problem that is affecting our constituents.

As technology moves on, the way in which surrogacy is done has evolved over the years, but essentially we are still talking about a woman carrying and giving birth to a child for somebody else. There are a huge range of problems. For example, in the United Kingdom, we do not know how many children are conceived through surrogacy. We are a 21st-century modern democracy, but we do not have the full figures. There are no official records apart from the parental order register. To put that register into context, an estimated 1,000 children are born through Indian surrogacy each year, but in 2012, the family court granted only 213 parental orders. That suggests that there maybe thousands of children in the UK living with adults who are not their legal parents.

That may not be an issue for many people, but let us consider what my hon. Friend the Member for Watford said about families wanting to do what is legally correct and best for those children. As my hon. Friend the Member for Erewash stated, many of the children are born stateless. If they try to get into university, for example, which type of fees will they pay—the fees for foreign students or those for domestic students? How will they access and enter higher education in the United Kingdom? What if they have a problem accessing benefits in future because of some of the changes that we have made to access to benefits—if someone is considered stateless, how will they access benefits? Surrogacy impacts on a huge range of issues for families. As we change laws in the UK, the impact on those families will get bigger and worse. We need to look at that and work out a way of moving forward and creating some kind of international agreement.

My particular passion is to ensure that those families are safeguarded against exploitation. However, I would not wish to push too hard on that matter: as my hon. Friend the Member for Erewash clearly stated, there have been only two recorded cases of surrogates changing their mind in the past 30 years, but thousands of surrogates who, because they have enjoyed carrying a child for somebody else, have happily given the child over and helped the family to have another child. That is important, and I would not wish to scaremonger. However, it is incredibly important to me—as it is to my hon. Friends the Members for Erewash and for Watford—that surrogates are safeguarded and that the families who use surrogates are not exploited.

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My hon. Friend the Member for Erewash raised the issue currently in the news of families who are being broken up, and she mentioned the case of the two children. Whoever is right or wrong, the reality is that the case has been a huge problem for the families and countries involved because there is no way of dealing with the situation or of identifying whether any law—rather than a moral and ethical code—has been broken. The issue needs to be looked at, and I support my hon. Friend’s wonderful campaign for some kind of international agreement on surrogacy.

I also want to make a plea to the Minister on parentage. At the moment, the surrogate and her husband are considered to be the child’s parents. That leads to the problem of statelessness that we have mentioned and the problem that my hon. Friend the Member for Watford raised concerning his constituents, where one parent was kept separate from the family for many months—in some cases, no doubt, it is for years. We need to tackle that, as it has a detrimental effect on our constituents and our society. I congratulate my hon. Friend the Member for Erewash on her wonderful campaign, and I thank her for raising the matter in the House.

Julie Hilling (Bolton West) (Lab) rose—

Sir Edward Leigh (in the Chair): Order. I will call the hon. Lady, but she did miss most of the opening speech. I am sure she will want to apologise, although I am also sure that there is a good reason why she was late.

9.59 am

Julie Hilling (Bolton West) (Lab): I am grateful for being called in the debate. Of course I give my full apologies for missing a great deal of the speech by the hon. Member for Erewash (Jessica Lee). I congratulate her on securing a debate on this important issue.

I want briefly to tell the story of a wonderful surrogate family in my constituency. Members might remember that I have talked quite a lot about Kiran and Bina Salvi because, sadly, they got caught up in the passport debacle. They had also been trying for a baby for 12 years. They went through all the normal tests and goodness knows how many rounds of in vitro fertilisation until, in the end, the doctors said they had to stop because it was damaging Bina’s health. They had had years of IVF and years of terrible disappointment every time the pregnancy did not work out.

The couple considered adoption, but the problem they then had was one that many couples have: by the time people have gone through all those years of trying, they are often considered too old to adopt a baby, so they are really in a cleft stick. The Salvis did much research and eventually took the brave decision to use a world-renowned specialist surrogacy clinic in India. They had five attempts at surrogacy, and their wonderful surrogate mum eventually became pregnant with their baby. On 3 March, they had a beautiful boy and girl—and they are beautiful; I went to visit them, and it was a proud moment to see them.

The babies were extremely underweight when they were born—they were little more than 2 lb. They were then stuck for four months in a hotel room in India with no passports, and they got more and more distressed. Spending the first four months of your life in a hotel

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room is no joy for anybody. The couple were also frightened about malaria and the rainy season. In addition, of course, it was not a four-star hotel, but the kind of hotel the couple could afford to stay in for that long.

The Salvis were with many other couples from the UK who were caught up in the same situation. They saw, however, that couples from other countries went through a much quicker process. Within a couple of weeks, couples from America and Canada were back at home with their babies. I therefore absolutely support the call for an international agreement on this issue.

Getting citizenship was extremely quick and easy for the Salvis, and the children were British citizens within two weeks. However, there was a difficulty. Rightly, the Indian Government require an exit visa for any children leaving the country, but because the couple’s children could not get passports, they could not get an exit visa. The couple had to go to New Delhi to sign more documents—something that they were not aware of in the first instance.

That shows the problems we have. The situation was probably compounded because we had closed the passport office in Hong Kong, which would normally have dealt with the issue. The office in the UK did not know how to deal with such cases, and that compounded the problem for the Salvis. We need to make sure we have experts in our passport offices in the UK who can deal rapidly with these cases and understand their intricacies. Eventually, however, the family got the passports and returned home.

The other point I want to raise is about the benefits to the surrogate parents. In this case, they gave the precious gift of life. The Indian mum was so pleased to have been able to help the Salvis, and the two couples are still in close contact. However, the surrogacy also gave the Indian couple a real lift in their lives, and they managed to start two businesses on the basis of surrogacy. Giving the gift of life, and the financial benefit from it, therefore fundamentally changed their life and that of their family.

There are strict rules in India about the number of cycles of surrogacy people can have, but the rules are not necessarily the same in other countries. Any international agreement therefore needs to make it clear how many rounds of surrogacy there can be, and to guarantee the health of the surrogate mother and the babies born to her.

I absolutely agree that we need international agreements, so that parents who seek surrogacy understand the rules that are in place and are not held up in the country where the children are born and so that surrogates are not exploited in their home countries. We also need to examine surrogacy in this country to see whether we should have different rules to allow payments to be made for surrogacy, rather than the deals we have at the moment.

Many thousands of would-be parents are suffering badly because they cannot have children. They see their friends around them having children, and becoming parents themselves becomes their life goal. I think we can all share their pain, and anything we can do to assist them will be really important. Again, I congratulate the hon. Member for Erewash on raising this important issue.

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10.5 am

Andrew Gwynne (Denton and Reddish) (Lab): It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Erewash (Jessica Lee) on choosing this interesting and important subject for a Westminster Hall debate. She put the case eloquently, sensitively and sensibly.

It is some decades since the main rules controlling surrogacy were put in place, and it is no exaggeration to say that they are a product of their time. Although there has been welcome progress on some aspects of surrogacy—for example, provision for adoption leave and pay for intended surrogate parents was included in the Children and Families Act 2014—a more fundamental examination of our position on surrogacy is needed, so the debate is extremely timely.

Of course, it is important to say at the outset that the health and well-being of any children born as a result of surrogacy arrangements must be at the heart of our concerns. As the hon. Member for Stevenage (Stephen McPartland) rightly said, that must sit firmly alongside the need to prevent exploitation of any of those involved in surrogacy, but the welfare of children must be paramount.

Aspects of the current situation can certainly be described as troubling. The growth of the internet continues to accelerate, and it takes only a few keystrokes to bring up a search engine web page with paid advertising for commercial surrogacy services abroad. The revelation that Britain may account for as many as 1,000 surrogate births in India every year is shocking enough, but when it is contrasted with the low numbers known to be taking place in Britain, it is clear that the situation requires serious review. There is a clear need for further research to establish the size of the international trade in surrogacy and to enable the development of a deeper understanding of how it functions.

It is not just the hon. Member for Watford (Richard Harrington) and my hon. Friend the Member for Bolton West (Julie Hilling) who have experienced tricky constituency casework on this issue. Earlier this year, she and I had almost identical cases, which we discussed. The legal issues got very tricky, and that was compounded by the passport fiasco. Thankfully, my case, like hers, has been satisfactorily resolved for the parents and the child. However, the cases were tricky, which highlights just how difficult some of these surrogacy arrangements can be. While that can be compounded by factors outside the control of those involved, the arrangements in India were incredibly tricky and caused the parents a lot of heartache and trauma, as well as a lot of unex—I am trying to think of the word. I have lost my train of thought.

Sir Edward Leigh (in the Chair): Unexpected.

Andrew Gwynne: Thank you, Sir Edward—unexpected expense. That placed the family in severe difficulties while they were in India.

Although our legislative framework might restrict exploitation in connection with surrogacy in the UK, it might simply be shipping exploitation abroad, where there are undoubted commercial opportunities to make large amounts from the exploitation of poor women. In the past few days the case has been reported of an Australian couple who are said to have abandoned one

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of two surrogate twin babies born in India, taking only one of them back with them. That amply demonstrates the need for international action. I hope that today’s debate will highlight the need for consideration of an international convention on surrogacy, so that we can put an end to such unethical and immoral practices.

The international dimension is important, but inevitably the question arises of how we might alter the situation in the UK to enable aspiring parents to explore the option of surrogacy in a way that protects all parties and puts children’s interests first. I suggest that we consider three things. The first is an assessment of the scale of the need for surrogacy and whether we can reduce that need through action to reduce the incidence of infertility in women. The second is an assessment of the extent of the international trade in surrogacy; on international health questions, we are much more effective if we operate in concert with other countries. The World Health Organisation appears to take little interest at present in surrogate motherhood issues, and perhaps the United Kingdom, as a member of its executive board, should take a lead in raising the issue and ensuring that it is included in the WHO programme of work. I should be interested to hear how the Minister can take that matter forward. The third thing to consider is a review of UK legislation on surrogate motherhood. Difficult issues will inevitably need to be considered, particularly the potential involvement of commercial interests in arranging surrogacy. The hon. Member for Erewash set out a possible framework, and that should be considered carefully. I am interested to hear the Minister’s response to the important points she made.

The current position is clearly unsatisfactory and in need of attention. If the population is to continue to make use of surrogate motherhood to deal with the problem of infertility, it would surely be better for the processes to take place within an ordered, regulated system here, than in a system that is not ordered, halfway round the world. It would be better for the parents, the surrogate mother and the child. The comments and suggestions made by the hon. Member for Erewash were compelling. She is right to raise the question of how to strengthen our domestic law to protect all concerned. This is a sensitive area that needs to be considered carefully, but there is a need for change at home as well as internationally, and I look to the Minister to give direction, answer questions and consider the possible solutions that Members have suggested. Thank you, Sir Edward, for filling the gaps that were left in my speech when, sadly, my train of thought left my brain.

10.13 am

The Parliamentary Under-Secretary of State for Health (Jane Ellison): It is a pleasure to serve under your chairmanship, Sir Edward. We have had a thoughtful debate, which is no surprise given the expertise of my hon. Friend the Member for Erewash (Jessica Lee). I thank her for raising this important subject, and other hon. Members and the shadow Minister for their speeches. This occasion makes me even sadder that my hon. Friend is leaving Parliament at the general election; it is an ample illustration of the fact that Parliament’s loss will be the family Bar’s gain. My hon. Friend has shown that she is good and knowledgeable lawyer, and I am

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conscious that I am not a lawyer of any description, let alone a good one. I hope that she will therefore understand that I may want to respond on some of the more complex legal issues after the debate. There is a significant cross-Government interest in the area, with some issues falling within the Home Office’s area of responsibility, and others in that of the Ministry of Justice.

Surrogacy is, obviously, an emotive issue, and it is good that we have had such a calm debate. It is recognised by all that it is not an easy area in which to make progress, but a case has been made that the time has come to examine it, not least because of the complexity of the international situation. My comments are partly about where we may begin to direct our attention, and to caution against the idea that it will be easy to make significant progress, particularly internationally. A cursory look at the different regimes in the world, and at different countries’ approaches, would give rise to caution.

Surrogacy is a way forward for couples who, for any of a range of reasons, cannot have their own children. Hon. Members have made the point that these days new families can be formed that we would not even have thought about a few decades ago. Happily, new and different shapes of family are emerging all the time, and the issue will become more relevant, more rapidly, to more people than we perhaps anticipated 20 years ago. We always recommend that ideally surrogacy should take place in the UK, with sound legal advice and the use of licensed premises, for all the reasons that have been shown in the debate. However, we recognise that that will not always happen and that, for some individuals and couples, achieving a much-wanted family will involve going abroad and taking one of a range of approaches.

The law is aimed at striking a balance in protecting the rights of the surrogate mother and her family, the child and the commissioning couple. The overall aim is the safeguarding of the child’s welfare, which should be kept as a paramount consideration. There is consensus about that, I think. The two ways in which that happens in the UK legal framework are by criminalising commercial surrogacy and by facilitating the transfer of legal parenthood to the natural commissioning parents. My hon. Friend the Member for Erewash is right to say that that sometimes proves difficult.

The Surrogacy Arrangements Act 1985 makes commercial surrogacy, including negotiating and advertising for surrogacy, a criminal offence, although individuals and not-for-profit organisations can make those arrangements without offending under the Act. However, as my hon. Friend pointed out, a surrogacy arrangement is not legally enforceable, and any prosecution requires the relevant consent of the Director of Public Prosecutions. For those parents who use their own sperm and/or eggs in a surrogacy arrangement, sections 54 to 55 of the Human Fertilisation and Embryology Act 2008 enable legal parenthood to be transferred to the commissioning parents by way of a parental order and the rights of the surrogate and any husband or partner of hers to be extinguished for ever. Section 54 sets out the criteria that must be fulfilled for a couple to apply for a parental order. Recent cases that have been mentioned show how the courts have interpreted the legislation to ensure that the long-term welfare needs of the children are met. The Government, like my hon. Friend, are still reflecting on the interesting order made in a recent judgment. I understand that the judge returned to the parliamentary

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debates on the legislation before issuing the judgment that Parliament did not intend that going one day over the limit should prove such a barrier.

International surrogacy is an even more difficult matter, as the debate has showed. We are well aware that some UK couples choose to travel abroad for surrogacy, and the reasons why that trend is likely to accelerate—and probably already has done in recent years—have been explained. However, fundamental issues arise for the family and child when they return to the UK. The law does not provide for the automatic recognition of an overseas surrogacy arrangement, and as we have heard, there is no international agreement on surrogacy arrangements, or harmonisation of the law and practices on surrogacy overseas. We would take the welfare of the child to be paramount. The Government have an obligation to protect children from abduction or trafficking and not to seem to sanction any situation or arrangements that might too easily tip into that. We must proceed cautiously.

The UK legislative framework for surrogacy has some international application, in the sense that a surrogate for the purposes of obtaining a parental order is defined as a woman anywhere in the UK or elsewhere. Applicants for a parental order need only be domiciled in the UK—not habitually resident here. However, as my hon. Friend the Member for Erewash pointed out, there is no harmonisation of that.

At the 2014 general affairs council meeting of The Hague conference on private international law, member states considered issues to do with legal parentage, the legal status of children and international surrogacy. In view of the sensitivity of these matters, the conference agreed at its meeting in March 2015 to make a decision on the feasibility of undertaking further work in these areas. The Hague conference is probably the best placed international body to consider what is achievable, but it should be noted that there is considerable divergence in the attitude and approach of different countries. I suspect that this is not something on which the World Health Organisation would take the lead, as the shadow Minister suggested it should, but we will look at the matter to see whether that is the case. Our feeling is that The Hague conference is more likely to make progress in this area, not least because I understand that it made progress on adoption.

We do not have precise figures on exactly how many people who are domiciled in the UK or are British citizens use surrogacy services at home or abroad, nor how many go on to apply for a parental order. There is no obligation to obtain a parental order, but people in the UK are clearly advised and encouraged to do so to achieve a recognisable transfer of parenthood. That order provides legal certainty for the commissioning parents and the child, and there are clearly psychological benefits in linking the child’s identity with that of his or her parents. There are also practical reasons—some were illustrated by hon. Members today—for ensuring that those caring for the child are able to do so legally without recourse to surrogate parents.

When an application for a parental order has been made, the Children and Family Court Advisory and Support Service is asked to report to and advise the court on the desirability of granting the order. I am advised by Ministry of Justice that 675 parental order applications were made to the court in England and

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Wales in 2013-14 and that 302 applications were made in the first two quarters of 2014. However, as many hon. Members have said, including my hon. Friend the Member for Erewash, anecdotal evidence, which we accept, suggests that many more surrogate arrangements take place. That illustrates that we can do more work to emphasise to all commissioning parents the benefits of a parental order.

As my hon. Friend described, surrogacy is evolving. I accept that she feels strongly—she made the case eloquently—that it should evolve much more quickly and that the time has come for proper momentum in looking at some of the provisions. We are considering the implications of recent judgments and the various issues that cross Departments. We are evaluating these matters while reflecting on our approach to surrogacy more generally. The Department of Health is working with other Departments that are involved with international surrogacy issues and is looking at ways to improve the information and guidance available to potential commissioning parents, so that they are fully aware of the processes involved, the potential pitfalls during their journey and the benefits of good legal advice, and not just from my hon. Friend. I note her generosity in providing support to another hon. Member in that regard.

As we have heard, there are pitfalls in the difficult journey to much-wanted parenthood and there are benefits to parental orders. That has been amply illustrated, which has been helpful for me because I have not previously responded to a debate on this subject during this Parliament. It is good that we have had this chance to hear about individual cases, which hon. Members know often illustrate a wider legal point more movingly and resonantly that just looking at the principle of the law.

The Government have no plans to make the commercialisation of surrogacy lawful in the UK; I do not believe that would have the support of the majority of people in this country. I do not believe there is agreement within the surrogacy stakeholder community about the approach to take in that regard.

My hon. Friend raised the issue of pre-birth contracts and immediate birth certificates for commissioning parents. That would amount to pre-birth provisions and would go further than any UK Government—and, probably, the majority of other countries’ Governments—have felt comfortable with going. I recognise that in the past people have been cautious and a little concerned about creating a commercial framework for surrogate babies while reducing the scope to consider the child’s welfare. My hon. Friend made the case thoroughly, and we will reflect on that and the fact that she and other hon. Members believe that it is possible to exaggerate the concerns and to get the balance between the some of the benefits wrong.

My hon. Friend suggested that the Government should introduce some form of regulation into the sector. That would, of course, involve significant changes in the law and would give rise to many questions to consider. Today’s debate has given us plenty to reflect on, not least the point that we all want to safeguard the rights and future welfare of children born under these arrangements.

Surrogacy is highly complex, and I suspect that in a wider debate outside this calm debating Chamber it would be slightly more contentious. It is an evolving

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area that society requires to evolve quickly, both legally and ethically. The current legislation seeks to strike the difficult balance between what is right for parents and children, but hon. Members have made the case today that they do not believe that that balance is being achieved, and I hear that. We recognise that there is scope for improving information—we could perhaps do that more quickly than changing the law for those considering surrogacy to clarify the position and to ensure that the child’s welfare is safeguarded.

Bringing this important matter to the attention of the House and my hon. Friend’s expertise show that there is a case for looking more widely at it and for opening a wider dialogue. I shall be interested to hear the responses she receives after this debate. People with a particular interest in a matter often cannot attend our debates, but may express a view afterwards. I shall be interested to hear about the interest in the debate throughout the House. It is obvious from the shadow Minister’s response that there is a cross-party appetite for looking at the matter and a feeling that we must ensure that our laws reflect the modern world. That is on the record and noted.

I mentioned the cross-Government working group on surrogacy. Perhaps the next step following this debate is to invite my hon. Friend the Member for Erewash to address that group and to make her points to it. I would be happy to facilitate that and afterwards to see where the debate and evolving discussion might go. She has made her case eloquently, and I thank her for that.

10.27 am

Sitting suspended.

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Sepsis (Preventable Deaths)

11 am

Sarah Newton (Truro and Falmouth) (Con): It is a great pleasure to serve under your chairmanship, Sir Edward, and it is a great honour to raise such an important issue with one of the Ministers with some responsibility for sepsis.

Before I outline the detail of my argument, I will share the scale of the challenge caused by sepsis. It is no exaggeration to say that sepsis is a hidden killer that claims more than 37,000 lives across the UK annually. Sepsis accounts for a third of the UK’s critical care expenditure, and it is the leading cause of death from infection here in the UK and across the world, but it can be stopped. An average constituency in the UK will have 140 cases of severe sepsis each year, resulting in more than 50 deaths. Simple interventions could cut those deaths by more than 50%. Timely interventions across the NHS could save 12,500 lives and £170 million each year with minimal budgetary requirements. Scotland and Wales have adopted the “sepsis six” and have better outcomes for patients than England.

So what is sepsis? Sepsis is a time-critical condition that can lead to organ damage, multi-organ failure, septic shock and, eventually, death. Sepsis is caused by the body’s immune response to a bacterial or fungal infection. It commonly originates in the lungs, bowels, skin, soft tissues or urinary tract. Rarer sources include the lining of the brain, liver or indwelling devices such as catheters. In a patient with sepsis, changes in circulation reduce the blood supply to major organs such as the kidneys, liver, lungs and brain, causing them to begin failing. Although most dangerous in those with impaired immune systems, sepsis can cause death in young and otherwise healthy people.

In my role as co-chair of the all-party group on sepsis, I have had the great pleasure of working with the UK Sepsis Trust, which is a registered charity comprising ex-patients and people bereaved by sepsis. In addition to raising awareness and providing support to members of the public affected by sepsis, the trust supports the actions and campaigns of its associated voluntary professional body, the UK Sepsis Group. Health professionals led by Dr Ron Daniels of the UK Sepsis Trust have identified simple, timely interventions and procedures, labelled the “sepsis six,” as a standard of care for sepsis patients when delivered within one hour. Early sepsis treatment is cost-effective, reducing hospital and expensive critical-care bed days for patients, and will save thousands of lives.

Mr Jim Cunningham (Coventry South) (Lab): I am finding this information illuminating. I did not realise that 12,500 people a year are dying of sepsis. Will the hon. Lady indicate whether that figure is increasing or decreasing?

Sarah Newton: I thank the hon. Gentleman for his helpful intervention. The figures are, of course, estimates, but they are well founded estimates from clinical leads. As I will say later, the problem is that sepsis is poorly recorded, especially within acute trusts. We do not currently have a full picture of the number of people who are dying of sepsis. Often, the cause of death is

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registered as a result of sepsis, rather than from sepsis itself. Without the collection, mapping and use of accurate data, it is difficult to target interventions where they are most needed. The information I have been given is based on good, up-to-date evidence from clinical experts.

The hon. Gentleman is right to say that the scale of the challenge that we face is shocking. That is why I decided to work with the UK Sepsis Trust to set up the all-party group on sepsis in November 2013, following a successful reception for world sepsis day, and many parliamentarians on both sides of the House have been involved. At the same time, the Parliamentary and Health Service Ombudsman published her first report on the treatment of a particular condition. The ombudsman felt so strongly that we were not addressing sepsis in hospitals that she undertook research and published a report. That report, “Time to act. Severe sepsis: rapid diagnosis and treatment saves lives”, was truly groundbreaking, and it highlighted the number of preventable sepsis deaths and advocated swifter sepsis diagnosis and treatment across the NHS to reduce the numbers.

In June 2014, the all-party group launched a report, “The state of sepsis in the NHS”, which addressed the reliable collection of data on sepsis deaths in England and the wide variation in the adoption of the ombudsman’s recommendations across the country The report, however, noted progress, which we further discussed one month ago at our reception on world sepsis day. We noted that the National Institute for Health and Care Excellence will produce a bespoke clinical guideline on sepsis by 2016. NHS England is engaged and has launched a level 2 alert for sepsis, and it is discussing the possibility of a national commissioning lever. The Public Administration Committee recently held a one-off inquiry on sepsis, and it pushed the Government to act more holistically and make more rapid progress on implementing the ombudsman’s recommendations. Like me, the Committee was frustrated with the amount of time it has taken NICE to develop its guideline.

Some parts of the NHS have taken a pioneering approach to sepsis. I am proud to speak up for nurse Susan Bracefield, who has done excellent work in establishing an integrated sepsis pathway for children in the south-west, which I am sure will save lives through early detection and rapid treatment.

Mr Cunningham: It was remiss of me not to congratulate the hon. Lady on securing this debate. Is there any specific reason for the variation across the country? Can she identify what those reasons are?

Sarah Newton: I thank the hon. Gentleman for his kind words. I encourage him to visit the all-party group’s website, where he will find our report, which addresses each region of the NHS. I made a freedom of information request to every trust across the UK asking a series of questions about the identification, recording and treatment of sepsis in their area. The report shows stark regional variations in England. As in all matters, it is a question of leadership. Good leaders who identify and recognise that sepsis is a problem galvanise their colleagues into taking action. I have seen that in the south-west, particularly in the work led by Susan Bracefield on a paediatric pathway. Sadly, otherwise fit and healthy young children can quickly succumb to sepsis, with tragic consequences that none of us wants to see.

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The all-party group’s report highlights the variations across the UK. Clearly more needs to be done, and this debate is about what more we can do about sepsis. It is important that we have education programmes for everyone involved in the health care environment. Sepsis is not only the responsibility of the acute trusts. We need early diagnosis by general practitioners, carers and ambulance staff. Everyone who comes into contact with people in the caring environment must be able rapidly to diagnose the early symptoms of sepsis and ensure that people get the appropriate treatment. That first hour is absolutely critical.

We need some sort of national commissioning lever to get things going. The commissioning for quality and innovation payment framework could be a good approach, and I am interested to hear what the Minister will say about that point. Public Health England also needs to develop a robust public awareness campaign. Terrific success has been achieved on stroke, through the work done to help people identify the early symptoms of stroke so they get to hospital or to their doctor quickly; health outcomes for stroke victims have improved in the UK. We should take a similar approach to sepsis, informing and educating the public about its symptoms, so that they seek medical help urgently.

Health Education England has a key role to play in disseminating education to health care professionals. Ron Daniels and the UK Sepsis Trust have done a huge amount of work with the royal colleges to consider training modules for people throughout the health service, and they need support to disseminate them widely. We also need a national registry of sepsis deaths and survivors to understand the longer-term impact. That will require resources, and exemplar sites will need to be developed and accredited to highlight best practice across the UK. Some parts of the country, such as Nottingham, are doing excellent work, and other parts of the NHS can learn from what their colleagues are implementing elsewhere in the country.

The Government could take a more joined-up approach to the issue. Three or four Ministers have some responsibility for sepsis in their portfolio. We need an approach that brings things together and a lead Minister to co-ordinate the work of their colleagues, and we need to sign up to the world sepsis declaration to reduce sepsis deaths by 2020. We need to make it a UK effort, but it is also a global effort; sepsis is a huge hidden killer around the world. Finally, we must consider how we can use commissioning within the NHS to drive forward the improvements that we all want.

Sepsis deaths can be reduced further. There are proven things that can be done, including implementing the sepsis six, that would have a huge effect on reducing avoidable deaths in the UK and would save the NHS considerable money. Sepsis is not only heart-breaking for families who have to watch otherwise healthy and fit young people, or people of any age, succumb rapidly to undiagnosed cases; it is traumatic for NHS staff who, due to a lack of education, sometimes feel powerless to give their patients the care they need or prevent those avoidable deaths.

We have made progress in the past 12 months. As one of the co-chairs of the all-party parliamentary group, I have been heartened by the extent to which the NHS has engaged with us on the issue. We must not lose that momentum. We must ensure that the issue continues to get the urgent attention that it needs.

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Often, in debates on sepsis, we link in the issue of antibiotic resistance. Some very mixed messages can be sent out, particularly to people in general practice: they must prescribe fewer antibiotics to prevent antibiotic resistance, but they must prescribe antibiotics to prevent sepsis. However, I do not think that the issue is contradictory at all. As we deal with antibiotic resistance, we must understand that it and sepsis are intricately related. The two messages are actually aligned, as both campaigns encourage better and more appropriate antibiotic use.

I hope that in responding to this debate, the Minister will be able to address the specific challenges that I have set out and reassure me and all the parliamentarians with whom I am working that the issue remains of great importance to the Government and that the work of the ombudsman, the UK Sepsis Trust and parliamentarians through the all-party parliamentary group will be built on with great urgency in the months ahead.

11.14 am

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): It is a great pleasure to serve under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, and I thank her for bringing this issue to the House. I also thank the hon. Member for Coventry South (Mr Cunningham) for his helpful and supportive interventions. This is a chance to discuss an important issue. I know that the lack of colleagues here today is not a sign of disinterest; it is merely because the House is on a one-line Whip. I pay tribute to my hon. Friend for her campaigning work on the issue and her co-chairmanship of the all-party parliamentary group on sepsis, which is doing important work to raise the profile of this urgent condition.

Let me say at the outset that the information and case studies in the reports by the all-party parliamentary group and the parliamentary ombudsman make for sobering reading. I extend my regret and sympathy to the families affected by these preventable deaths, particularly the family of Sam Morrish. Every preventable death is a tragedy from which we must learn. I pay tribute to the important campaigning work of his family and others to improve sepsis care and treatment across the NHS.

We entirely accept that more can and should be done to address sepsis, paying particular attention to the points raised in the reports by the ombudsman and the all-party group. I am grateful to my hon. Friend for sharing the key points of her speech in advance. I will do my best to deal with all of them in the time available, but I hope that she will indulge me. If the clock beats me, I will write to her and deal with them all clearly in writing.

Colleagues should be in no doubt that the Department takes its responsibilities on sepsis very seriously indeed. In fact, sepsis is one of the few issues on which three departmental ministerial colleagues each have a specific responsibility for overseeing action. I take my hon. Friend’s point about the need for co-ordination, and I will pass it on. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), covers sepsis management

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in hospitals, and the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has responsibility for sepsis management in the community. In the House of Lords, Lord Howe covers sepsis management in hospitals.

Although I am standing in for my hon. Friend the Member for Central Suffolk and North Ipswich, who is indisposed this morning, coincidentally, only last week, when we went to the US to visit pioneering clinical innovators in the life sciences, one issue that we discussed was the early detection of sepsis through greater use of digital technology in community health care. Early diagnosis in that first hour is crucial. It is one of many areas in which investing in new technology, particularly data technology, provides a much higher chance of early intervention and thus of preventing complex and costly downstream complications. Point-of-care diagnostics are a crucial part of that, and I am mindful of that in my work on innovation.

Hon. Members will appreciate that although the Department is accountable to Parliament for health care, the delivery of that care is the responsibility of NHS England, the executive non-departmental public body responsible for overseeing the running of the NHS; Ministers no longer run the NHS. NHS England works with NHS staff, patients, stakeholders and the public to improve health outcomes for people in England. We hold NHS England to account through the mandate, which sets out its priorities. I am glad to say that sepsis is incorporated in the patient safety and premature mortality provisions of the mandate.

We all agree that we will have the greatest impact by focusing our efforts on improving the clinical management of sepsis by health care providers and ensuring a consistently high standard in sepsis care across the whole system. We are doing so through a range of initiatives, including better education and training in recognising the warning signs of sepsis; ensuring that trends in sepsis are monitored —that is where data become important—raising the profile of sepsis in the community; and ensuring collaborative working across the whole system.

In the period between the publication of the ombudsman’s report in September last year and of the all-party parliamentary group’s report in June this year, we made significant progress. For example, we have mandated that Health Education England must include sepsis in its work to improve the training and education of health care professionals. We have also ensured that sepsis is included as a key patient safety priority in the NHS business plan for 2015-16.

The NHS outcomes framework sets out the indicators that are used to hold the NHS to account for the outcomes that it delivers through commissioning health services. Sepsis is captured in the overarching indicator measuring potential years of life lost from causes considered “amenable to health care”—a clumsy phrase, but it is a statement of the importance attached to the condition. Reducing the number of deaths from sepsis is specifically included in that indicator.

NHS England is considering the range of commissioning levers that it will put in place for 2015-16. The commissioning for quality and innovation payments framework is one option. I cannot comment further at this point as internal discussions are ongoing, but we are conscious of the interest in a specific lever on sepsis.

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NHS England has also initiated work to develop a consistent methodology for a robust, retrospective case-note review of deaths in hospital. That is part of further work to develop the NHS outcomes framework, which will offer a way of establishing much more accurately how many deaths are attributed to sepsis, identifying any shortcomings in sepsis care management and feeding any improvements into local practice. That work is expected to be completed by 2016 and rolled out thereafter.

Regarding paediatric care, a children’s sepsis summit is planned for tomorrow—15 October—as I am sure my hon. Friend is aware. It will bring together a range of national experts and key personnel from the south-west, particularly those involved in the review of the tragic case of Sam Morrish, to share learning and to set the direction for further work on the timely recognition and treatment of children with sepsis.

Furthermore, NHS England has developed a webinar series to promote greater awareness among clinicians of the actions to be taken to treat patients who are critically ill. Sepsis clearly features in this “deteriorating patient as a medical emergency” campaign; the first webinar in the series covered sepsis and was held on 17 September.

Regarding the timely recognition of sepsis, we fully endorse the work carried out by NHS England’s surgical services patient safety expert group, its children and young people patient safety expert group and the safety board of the Royal College of Physicians to roll out the “sepsis six” guidelines, to which my hon. Friend referred and which were produced in collaboration with Dr Ron Daniels. That has led to the development of a series of clinical toolkits for health professionals, which were launched by the UK Sepsis Trust.

To support the implementation of existing resources and guidance on sepsis, such as the sepsis six and the paediatric sepsis six, NHS England issued a stage 2 patient safety alert. I am advised that that alert has been cascaded to all trusts, social care providers, community providers and, via area teams, to GPs and public health directors in all local authorities.

Wider work to further the sepsis agenda includes initiatives to combat antimicrobial resistance more generally. While some might argue that there is a tension between limiting the inappropriate use of antibiotics to reduce the incidence of antimicrobial resistance and the provision of early antibiotics in cases of suspected sepsis, we would argue that those activities are complementary and do not cut across each other. The key issue is the appropriate use of antibiotics, which is common to both agendas, as each requires the appropriate use of antibiotics for the right patients at the right time.

It is also important to note that we have strengthened and updated a key resource on the appropriate use of antibiotics. This guidance, called “Start smart—then focus”, was originally published in 2011. We are currently consulting on an update, which is due to be published shortly. The resource has been updated to refer explicitly to sepsis and to draw particular attention to the need to act promptly

“between the onset of sepsis-related hypotension and the administration of appropriate antibiotics”.

Equally importantly, it focuses on the need to initiate effective antibiotic treatment

“within one hour of diagnosis in patients with life-threatening infections”.

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It also sets out clear guidelines on the need to review the clinical diagnosis within 48 to 72 hours and to make a clear plan of action when additional information becomes available, such as new microbiological, radiographic or clinical data.

Let me turn to another point raised by my hon. Friend in the all-party group’s report, which is the need to establish robust pathways to deal with sepsis. That is an absolutely key objective, which NHS England has been developing in conjunction with the UK Sepsis Trust. The action includes the development and publication of toolkits for acute medical units and emergency departments. The toolkits, which were published in September, identified organisational standards for the acute management of sepsis in both locations.

I understand that the UK Sepsis Trust is working with NHS England to establish sepsis exemplar sites and to recognise publicly those providers that excel at the processes and behaviours that improve the early detection, diagnosis and delivery of interventions to patients. The sepsis exemplar standard initiative is to be welcomed, as it encourages joined-up thinking between health care units, which will help to strengthen further the provision of seamless care for critically ill patients.

The programme is expected to include three phases. The first phase is the accreditation of excellent emergency departments, which will identify departments with traditionally strong links with primary care, pre-hospital systems, acute admission units and critical care, and which have demonstrated willingness and drive to improve sepsis care and an engagement with sepsis-related audits, changing improvement strategies and improving data collection.

The second phase is the accreditation of further health care units. Following the pilot testing for emergency department standards, and building on lessons learned in creating those standards it will involve the development of accreditation plans for other health care units, such as ambulance trusts, in-hospital critical care outreach or sepsis teams and acute medical units prior to expansion in other areas. The final phase is the assigning of exemplar unit status as part of our commitment to demonstrate best practice.

I turn to the National Institute for Health and Care Excellence, which my hon. Friend mentioned and for which I have ministerial responsibility. Of course, we recognise that we need to support NHS colleagues in addressing sepsis with the provision of comprehensive and up-to-date guidelines, so in April we asked NICE to develop such guidelines to aid the recognition, diagnosis and management of severe sepsis. These guidelines are under development and will be comprehensive and thorough. They are scheduled to be published no later than July 2016, but I very much hope they will be published earlier than that.

Sarah Newton: At the Public Administration Committee hearing, frustrations were demonstrated by Committee members, which I certainly share, about the fact that a “90% good” NICE guideline would begin to save lives and that the time that NICE is taking to get this guideline 100% right is allowing preventable deaths to continue. I urge my hon. Friend the Minister to go back to NICE and say that, while it is important that whatever it does is excellent and should be based on the best available evidence, in the meantime the delays in developing guidance are costing lives.

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George Freeman: My hon. Friend makes an excellent point, which I will pick up. NICE rightly prides itself on making thorough health assessments, but it is equally important that we get the right guidance out quickly. I will raise her point with NICE.

I will touch on data collection, because we will also fund work by Public Health England to improve the data collection mechanisms in emergency departments. Awareness raising is also important, and there are two key initiatives in that regard. First, the “Sign Up to Safety” campaign was launched by my right hon. Friend the Secretary of State in June. It has a three-year objective to halve avoidable harm in the health care system and to save 6,000 lives. It is for everyone in the NHS, and will include information on sepsis.

The second initiative to publicise sepsis will be part of Public Health England’s work on this year’s European antibiotic awareness day on 18 November. Social media messages will highlight the importance of the appropriate use of antibiotics, to ensure that they are effective for the treatment of infections such as sepsis, and there will be a number of other measures as part of that campaign.

We have also commissioned work to revise the code of practice in the Health and Social Care Act 2008 on infection prevention and control to strengthen provisions on the diagnosis, treatment and management of multi-drug resistant infections and severe sepsis. That code will be used by regulators such as the Care Quality Commission and Monitor as part of their inspection regime.

Finally, I will touch on the world sepsis declaration, which sets a number of targets. We are not in a position to sign up to the declaration, but we support the intention behind it and we are considering supporting it in future.

In conclusion, I thank my hon. Friend for bringing this matter to the attention of the House this morning and for giving us a chance to raise awareness of this important issue. I hope that the measures that I have scuttled through at speed give some indication of the concerted effort given to treating this important condition, not only by the Government but by NHS England, Public Health England, NICE and other agencies, to try to get on top of it. Above all, we owe the families of those patients who have lost their lives as a result of sepsis nothing less than a robust and comprehensive response to the threat that sepsis poses. For their sake, and for all patients who entrust their care to our health care services, we are determined to ensure that lapses in the recognition and treatment of sepsis are minimised, and the provision of safe patient care remains paramount.

11.29 am

Sitting suspended.

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Foetal Alcohol Syndrome

[Mr Andrew Turner in the Chair]

2.30 pm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

and support staff—

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

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

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

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

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

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

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

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

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

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

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

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

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2.54 pm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Several hon. Members rose

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

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3.6 pm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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3.13 pm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3.23 pm

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

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

“to bring forward serious and effective measures”

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

“mild exhortations to pregnant women to drink sensibly”

were misguided and “wholly inadequate”.

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

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

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

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

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

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

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

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

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

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

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

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

3.31 pm

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

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

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

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

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

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

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

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

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

3.35 pm

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

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

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

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

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

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

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

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

Bill Esterson: Will my hon. Friend give way?

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

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

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

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

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

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