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1.04 pm

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I congratulate my noble friend Lord Mitchell on introducing and securing the Second Reading of his Bill. I also congratulate him on the fine quality of his speech, as I do other noble Lords who have spoken. It has been a short but highly informed and high quality debate.

This issue, I know, is close to my noble friend’s heart, reflecting his close involvement with the National Organisation on Fetal Alcohol Syndrome, to which I pay warm tribute today. The organisation is at the forefront of efforts to alert women to the potential dangers of alcohol consumption during pregnancy, and its work is well known to the Government, particularly through its regular contact with my ministerial colleagues in the Department of Health. I commend the organisation and wish it well in the future.

There is no doubt whatever that foetal alcohol syndrome is a devastating condition and the effects of foetal alcohol spectrum disorder on a child’s future life can be grave. The Prime Minister’s Strategy Unit interim analytical report on alcohol estimated that there are between 240 and 1,190 cases offoetal alcohol syndrome per year in England and Wales.Moreover, NOFAS estimates that in the UK as a whole, more than 6,000 children are born each year with the more prevalent condition of foetal alcohol spectrum disorder.

When my noble friend last spoke to the House about this subject, he painted a worrying picture of the health symptoms of the syndrome and the spectrum disorder. He did so again today and was very persuasive on that point. His remarks and those of the noble Baroness, Lady Neuberger, about the problems of misdiagnosis and non-diagnosis were also persuasive. It is clear that much more needs to be done to educate health professionals in this area.

Understandably, our debate took in a number of issues around alcohol consumption. There is no question that, particularly among young women, there has been an increase in alcohol consumption. The evidence that I have is that the proportion of 16 to 24 year-old women who had drunk more than six units on at least one day in the previous week increased from 24 per cent to 28 per cent between 1998 and 2002 but had fallen to 22 per cent in 2005.

Thirty-nine per cent of women aged 16 to 24 reported drinking more than three units on at least one day compared with 5 per cent of those aged 65 and over. Average weekly alcohol consumption in the past 12 months in England for women increased from 5.5 units in 1992 to 7.6 units in 2002. Among women, the proportion drinking more than the recommended

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weekly benchmark of 14 units increased from 12 per cent in 1992 to 17 per cent in 2002. Nine per cent of women are drinking more than twice the recommended daily amount and 15 per cent of women drink at hazardous or harmful alcohol levels.

The latest figures that I have are that in the UK in 2000, 30 per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy. Those mothers who continued to drink during pregnancy reported drinking very little, and 71 per cent of those who continued to drink consumed less than one unit of alcohol a week on average. Only 3 per cent drank on average more than seven units a week.

In 2000, 87 per cent of mothers who had recently given birth reported drinking alcohol before their pregnancy and 61 per cent continued to drink while they were pregnant—a fall from 66 per cent in 1995. I understand that older mothers are more likely to drink during pregnancy—71 per cent of mothers aged 35 or over did so compared with 53 per cent of those under 20. Thirty per cent of mothers who drank before pregnancy reported giving up drinking during pregnancy, which compares to 24 per cent in 1995. In addition to the 30 per cent of mothers who gave up drinking during their pregnancy, 65 per cent said that they reduced their alcohol intake.

Clearly, there are a lot of statistics there. They suggest that there is a general issue about an increase in alcohol consumption, but they also suggest that pregnant women have taken to heart some of the messages that have come through.

Noble Lords made a number of interesting remarks on the question of units of alcohol. Noble Lords will know that the Chief Medical Officer recommends that men should not regularly drink more than three to four units a day and that women should not regularly drink more than two to three units a day. The definition that I have of a unit is 8 grams of alcohol—typically, one small glass of wine, one half pint of beer, though not a strong variety of beer, and one measure of spirits. However, I fully accept the arguments made by noble Lords that the size of glasses can vary considerably and the use of very large glasses has become more frequent, both in pubs and restaurants but also at home. Equally, more generally, I take to heart the point that the noble Earl, Lord Howe, and my noble friend raised about the lack of awareness in that regard.

The noble Baroness, Lady Finlay, made some very telling points about the more general issues in relation to alcohol, and gave some recommendations for the Government to take on board. I listened very carefully to that. We launched the alcohol harm reduction strategy for England in 2004, with the specific aim of minimising the harm caused by alcohol through better education, prevention efforts and the improved identification and treatment of alcohol problems. We are committed this year to reviewing that strategy and to identifying what further actions we wish to take. Of course, today’s debate will be very helpful in informing officials as they advise the Government on taking the new

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strategy forward. We have launched the Know Your Limits campaign—the first national campaign on alcohol, focusing on young people who binge drink, to which a number of noble Lords have referred. We are taking action to tackle underage drinking, which has led to targeted enforcement including the wider use of issuing fixed penalty notices.

Drinkaware Trust has been established as a new organisation, independent of government and the alcohol industry, and it is developing work to change behaviour and the UK national drinking culture. We have developed Models of Care for Alcohol Misuse Services, published in June 2006, and we have launched alcohol misuse interventions, which is guidance on developing local programmes of improvement. We are not complacent; we understand very clearly the importance of action in this area. As I have said, the review of this strategy in 2007 will be a very good way in which to take on board the comments that noble Lords have made today.

The noble Lord, Lord Monson, and the noble Earl, Lord Howe, referred to the evidence specifically in relation to alcohol drinking by pregnant women. In 2005, my department commissioned the National Perinatal Epidemiology Unit to undertake a review of existing evidence. The main aims were to update what we knew from existing evidence about the effects of prenatal alcohol exposure. The principal findings were that there is no consistent evidence that low to moderate consumption of alcohol during pregnancy has any adverse effects, although there is some evidence that binge drinking can affect neuro-development of the foetus. The department has commissioned a recent review from the National Perinatal Epidemiology Unit on the effects of low to moderate alcohol consumption in pregnancy. The review has broadly concluded in support of the scientific conclusions of the 1995 Sensible Drinking working group.

I have to say that this evidence base is not strong. While the current advice remains scientifically correct, there is a perception that it might be construed as too permissive. It is interpreted by some as meaning that it is safe to drink a little when pregnant, when a little can differ from person to person. Most women, as we know, stop drinking or drink very little in pregnancy, so a slightly stronger message could be aimed at those who do not reduce their consumption to appropriate levels. I echo the words of the noble Earl, Lord Howe, that action must be based on scientific evidence. His speech was a tour de force of some of the available evidence that we now have. It is clear that we do not have enough evidence—but clearly we need to do more to obtain it.

It is clearly important that labelling is used as a strong component in a preventive approach. We are committed to action on labelling, as was laid out in the Government’s alcohol harm reduction strategy, which was published in 2004. We know that the public support labelling. I refer noble Lords to the recently published Eurobarometer survey on attitudes to alcohol, which showed that almost eight out of 10 people agree with putting warning labels on

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alcohol products and in adverts, in particular, to warn pregnant women of the dangers of misusing alcohol. In the UK, 75 per cent of people supported labelling.

Labelling is not a panacea and is no substitute for other actions, such as education and wider information. The evidence for the effectiveness of health warnings alone is not particularly strong, but it can be an essential component of a broader strategy to help consumers to estimate their own unit consumption and to help people to become more conscious of drinking in relation to their health.

I agree with the noble Earl, Lord Howe, and my noble friend that doing nothing is not an option. We are working in close partnership with the alcohol industry and wider stakeholders to implement the many initiatives that were set out in the 2004 alcohol harm reduction strategy. Industry has shown its willingness to help us to achieve that aim and we know that more than 75 per cent of spirit labels and 85 per cent of beer for sale in the UK market already carries information on unit content. It is much less for wine and it is clear that more needs to be done. It is also pleasing to remark that many supermarkets’ own brand beers, wines and spirits include that information on their labels—but we need to move beyond this.

Providing only unit information, important though it is, is not sufficient. We have asked the industry to go further to ensure that there is more consistency and visibility in the information that is provided and to add a short health message on drinking for adults and on pregnancy to ensure a link to the Government’s wider campaigns, and that there is an agreed timetable for intervention. We want government intervention to regulate the industry to be proportionate. We do not want to impact unfairly on responsible consumers, manufacturers and retailers, and we need to work with industry on this, but we are not opposed in principle to legislating in this area should a voluntary approach fail or prove ineffective. I can say to the noble Baroness, Lady Neuberger, that I think that that is an entirely sensible approach. If in a very short time we can pull off an agreement with industry that produces the kind of advice that we want, that is a very desirable way forward.

Baroness Neuberger: My Lords, what does the Minister make of the observation of the noble Earl, Lord Howe, that we started having this debate in this Chamber in 2004 and nothing has happened? I regard it as absurd that nothing has happened since 2004—and that is why maybe the voluntary method is not enough.

Lord Hunt of Kings Heath: My Lords, my understanding is that we hope that we can report progress on our discussions with the industry very soon. I entirely accept that if talks became protracted and it looked as if there would not be a successful outcome, noble Lords would be absolutely right to come back and say to the Government, “The time for talking is over; let’s see some action”. But I have discussed this with officials and we are confident that

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we shall be able to report progress very soon. However, I reiterate that we shall not shrink from tougher measures if we do not reach a satisfactory agreement with the industry. I say to my noble friend that there is no question that there is a need for women to be alerted to the potential dangers of alcohol for the unborn child and his or her future well-being. The points made by noble Lords today were entirely persuasive. We have a responsibility to future generations to ensure that parents, and mothers in particular, are fully aware of the dangers for unborn children of drinking. This is a very serious matter.

We consider that there is great hope of partnership with the industry. It is worth spending a little more time ensuring that we reach agreement. I thank my noble friend for raising this matter so effectively and powerfully. I again reassure the House that if a voluntary approach does not work, the legislative option remains.

1.21 pm

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

I say to the noble Baroness, Lady Finlay, that I thought very seriously about notices in pubs and off-licences. She made a very strong point. As I said in my opening remarks, I wanted to keep my speech very focused. I take the point that she made about the cost to society and the nation of children who are affected by this syndrome.

I say to the noble Lord, Lord Monson, that we are not saying that all pregnant women who binge drink will have foetuses with some form of foetal alcohol syndrome. Nor are we saying that the foetuses of all pregnant woman who drink will have foetal alcohol syndrome. We are talking about the minority who drink a lot or perhaps even a little, whose foetuses may be affected if the alcohol is consumed at the wrong time. We are not preventing them from drinking, we are just issuing a warning.

On the subject of labels, to the best of my knowledge the relevant labels that I have seen are on the back of bottles of wine. That is certainly the case with bottles that I have seen in the United States. In Australia, I believe that they are on the side. I have no desire for such labels to be inspired by the designs of Matisse or any other great artist.

I should have loved the noble Baroness, Lady Neuberger, to be a co-sponsor. I agreed with everything that she said. I thank the noble Earl, Lord Howe, for the support that he gave on the previous occasion the Bill was introduced and again today.

I thank the Minister for his remarks. It was good that he said there was government understanding of the issue and no complacency about the fact that something needed to be done. He gave a very strong hint about a voluntary code. If such a code were 100 per cent effective, it would be a good thing. However, he hinted strongly that if there were any wavering on this issue, the Government would

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

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

Sexual Health: Contraceptive Services

1.24 pm

Baroness Tonge rose to ask Her Majesty’s Government what steps they are taking to increase provision of contraceptive services, prevent the closure of specialist community clinics and increase the availability of training in contraceptive services and sexual health.

The noble Baroness said: My Lords, it gives me great pleasure to bring this matter to the attention of the House. I know that noble Lords—members of the all-party pro-choice and sexual health group—who cannot be here due to short notice, will read with great interest what the Minister says in response to the debate.

For 30 years of my medical career I was closely involved with family planning services and services for women in general, from the early years when services were run by charities such as the Family Planning Association, Marie Stopes and Brook, through to the heady years when services were at last taken over by the National Health Service and were free to all women who needed them—family planning and abortion counselling in particular. Those were very heady days for those of us who had campaigned so hard and long.

Special clinics were set aside for young people in every area. Screening services for cervical and breast cancer were introduced and latterly the clinics played a significant part in helping to meet the genito-urinary medicine 48-hour access targets. As noble Lords know, those clinics are very hard pressed and the community family planning clinics have helped a lot in that area. In most areas, initially area health authorities and then primary care trusts had a senior doctor and senior nurse to run the service. I was one such for many years, being head of women’s services for Ealing Health Authority. These community specialists managed the service, supported primary care and managed complex contraceptive problems in liaison with GPs if the latter did not feel competent to deal with them.

A faculty of family planning and reproductive health was formed at the Royal College of Obstetricians and Gynaecologists—a great leap forward—to set standards and organise training for doctors and nurses who wished to pass the faculty’s diploma or membership examinations. It was a very thorough and rigorous training with heavy emphasis on practical skills and took place under the guidance of a training doctor such as myself in the community clinics. Until recently, 80 per cent of the training of doctors in family planning took place in the community clinics.

In the early days women and young people loved us because the service was mainly walk-in and easy

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access, often to a woman doctor. We forget that 20 years ago or more there were not so many women doctors but patients liked to see one if they could, to avoid the embarrassment of seeing the family doctor, who they probably knew well, for very personal matters. The services were particularly valuable in areas with large ethnic minorities. I have worked among ethnic minority communities in Birmingham, north London and Southall, trying to make the services more accessible and to understand their problems in the context of their cultures. We even set up a cervical screening service in a local mosque for women who were either reluctant or prevented by their families from coming to a clinic. We provided the service in the mosque instead. The home visiting service was also useful for difficult cases.

When I entered Parliament in 1997 I received huge support and enthusiasm from the then Ministers, in particular Frank Dobson and Yvette Cooper, and civil servants at the Department of Health, particularly for my campaign to allow emergency contraception, the morning after pill, to be available over the counter in local pharmacies. That was another great leap forward for womankind. The Government are still hugely enthusiastic and supportive whenever we talk to them.

Both White Papers, The Health of the Nation and Choosing Health, have focused on public health and preventive health services, and the latest paper also promised an audit of contraceptive services. Three years later, however, we have still not seen the results. I am a little worried, because there may be nothing left to audit if it is not done pretty quickly. The audit is important because, despite £300 million being earmarked for sexual health services, there have been reports of closures of community family planning and sexual health clinics all over the country. We suspect that primary care trusts have used the money to offset their deficits and to address target services, such as the genito-urinary medicine clinic targets. Because there are no targets for the family planning service, it is a soft option for closure by PCTs, who expect the work to be done by the general practitioner.

Community specialist posts in reproductive healthcare, such as the one that I occupied many years ago, are not being advertised, and retiring doctors and nurses are not being replaced. Dr Penny Oakeley, whom I know and who is a hugely experienced and valuable doctor who ran superb services in Wandsworth, retired in September 2006, but the trust is not replacing her or the senior nurse, who retires this May. There is no intention of continuing the service. Doctors wishing to obtain the family planning diploma or membership now have great difficulty accessing practical training. They do not know where to go. That practical training is required under the NICE guidelines if they are to offer the full range of family planning methods, particularly the long-acting ones such as implants and IUCDs. We are telling patients that these methods should be available, but the doctors cannot access the training. The service is disappearing, and with it patient choice.

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The Faculty of Family Planning and Reproductive Health Care conducted a survey of just under 3,000 clinicians in 2004, which is sadly a bit of a time ago. It was useful, however, and included GPs, family planning doctors, senior doctors in the health service, and consultant obstetricians and gynaecologists. Eighty-four per cent of GPs in that service were worried about the standstill or actual reduction in resources for family planning in their area. Ninety per cent wanted the services to continue to ensure that patients had choice and that there was the expertise for them to refer their patients to. Forty-five per cent were very concerned about restricted access to training in long-acting methods of family planning. Seventy-six per cent were concerned about the postcode lottery for abortion services, which I know the Minister will tell us has improved considerably, and it has. There has been a great improvement in abortion services, but I do hope that this improvement will be maintained, especially in the light of the news this week of the shortage of doctors willing to perform the operation. I suspect that there is another problem of a slightly different kind looming there. Eighty per cent of doctors surveyed emphasised the value of those community clinics for the distribution of condoms. Condoms are still seen as the first defence against sexually transmitted disease. Indeed, the fact that young people in particular can get them free in those clinics means that there is a way of contacting that young person and perhaps giving them more advice or letting them find out a little more about themselves and relationships and what they should do with their lives. Clinics are a very good point of access for young people in particular to get those free condoms.

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