Conception to Age 2: The First 1001 Days

Conception to Age 2: The First 1001 Days - 17^th December 2015

Fiona Bruce (Congleton) (Con): I must apologise to the Minister. I have a long-standing engagement in my constituency this evening, and I would be grateful to him if he released me to attend it. I will not therefore be able to listen to his winding-up speech.

I want to concentrate on the first part of the 1001 days—the period between conception and birth. A report was published earlier this year by a team from leading UK and US universities who had studied pregnant women in rural Gambia and the children to whom they gave birth. It is clear that the children conceived in the dry season, when there was not an abundance of leafy green vegetables, were seven times more likely to die in young adulthood than those conceived in the wet season, when their mothers’ diet was so much better. The research team said that later in life the impact could be seen in a lack of ability to fight viral infections and in their chances of surviving cancers such as leukaemia and lung cancer. That report shows the clear impact of what the mother ingests on her system and that of the unborn child.

Something that we ought to be much clearer about in this country, but that we sadly are not, is the effect of alcohol consumed by the mother during those first precious days of a child’s life in the womb. The National Society for the Prevention of Cruelty to Children estimates that about 7,000 babies born in the UK each year suffer the effects of alcohol drunk during pregnancy.

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I pay tribute to the hon. Member for Sefton Central (Bill Esterson), who is chair of the all-party parliamentary group for foetal alcohol spectrum disorder, of which I am the vice-chair. This week, we published a report on the picture of FASD in the UK today, following an inquiry that ran throughout the autumn. We held a number of hearings with families and young people who have been affected by FASD, as well as with members of the medical professions and other interested organisations. The report is so substantial and so deeply concerning that, although you have been good enough to call me before the chair of the all-party group, Madam Deputy Speaker, it might have been more appropriate if we had been called the other way around. None the less, the report has such a lot of substance that I hope what I say will complement, rather than duplicate, what he will say.

The evidence that we gathered was severely alarming in respect of both the far wider impact of FASD compared with what is understood in this country and the lack of clinical and other support available to families who are affected. We learned that a mother need not consume large amounts of alcohol during her pregnancy to be affected, because individual women’s constitutions respond differently to alcohol consumption.

The impact on the unborn child, which can last for the rest of their life, can be profound. FASD causes organic brain damage in an unborn child. We were told that it causes heart defects, dental issues, eyesight problems, bladder difficulties, walking difficulties, cognitive challenges and memory and behavioural difficulties. Often it means that babies are premature. We heard about the emotional impact on those affected by FASD as they develop into young people and move into adulthood: they can withdraw from society, become unpredictable and even become suicidal. That places great stress on parents and carers, many of whom experience periods of isolation and ill health. The inquiry heard that it is likely that a much higher proportion of children are born with FASD than is currently recognised. Those children will have a variety of difficulties in childhood and in later life.

The tragedy is that, theoretically, FASD is 100% preventable if all pregnant women are given clear advice on the risks of alcohol intake to their unborn child. We were told that the best advice for young women is not to drink if they are considering becoming pregnant, since there are effects even at the earliest stage.

Equally tragic is the fact that in the UK, there have been decades of mixed messages regarding the right level of alcohol intake during pregnancy. I remember that from when I had my children, which is well over 20 years ago. The all-party group was advised that a clear message should be given by Government Departments that, just as smoking during pregnancy affected the unborn child and should be avoided, so too did alcohol and it too should be avoided.

For the UK not to be sending that message is not only tragic for the families concerned; it goes against international best practice, which is to advocate that alcohol be avoided if a woman is pregnant, thinks she might be pregnant or is trying to conceive. In Canada, children as young as primary school age are taught that. Pregnant women in Denmark, France, Israel, Norway, Mexico, Australia, Ireland, New Zealand, Spain and the Netherlands are advised to abstain completely from alcohol. Since 1981, the USA has advocated that

“no alcohol is safest for baby and you.”

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Without such a clear message, pregnant women in the UK are left confused and uncertain. I know from my work as the chair of the all-party group on alcohol harm that few people can accurately measure one unit of alcohol. If a message is sent out that one or two units a week is okay, it is probably easy to think, “Well, why not three or even four or more?”

One of the reasons that women are confused stems from the unclear guidelines provided by UK professional and governmental bodies. Although NICE and the Department of Health warn of the potential for alcohol to harm an unborn child, incredibly they do not go on to stipulate that women should abstain from drinking during pregnancy. The Government are currently carrying out an alcohol review, and I hope they will seriously consider that issue. By contrast, the British Medical Association advocates that no alcohol should be drunk during pregnancy. As a result of those mixed messages, not only are women confused but many midwives are uncomfortable about giving advice on alcohol. A study that questioned 200 midwives found that only 60% asked women about their drinking habits, 30% advised against binge-drinking, and only 10% were aware of FASD. As our report says:

“this is astonishing and deeply worrying, and something which must be rectified as a matter of urgency.”

More encouragingly, 93% of midwives said that they would be comfortable advising that no alcohol should be drunk during pregnancy if that was the consistent message from the Government. In the absence of such clarity, however, they are afraid to offer such advice.

Our inquiry also revealed a similar lack of in-depth knowledge about FASD across the medical profession. There is only one specialist FASD clinic in the UK, and it is wholly overstretched. That lack of in-depth knowledge means that children with FASD are often given multiple inaccurate diagnoses, such as ADHD, autism or an attachment disorder. Appropriate support mechanisms are rarely put in place, and families are left frustrated and confused. It is critical that FASD is given a higher priority within the NHS for research, diagnostic, and support services.

Mr Graham Allen: The hon. Lady is making a fascinating contribution. Given that the Minister is in his place, is this a good moment for her to comment on the failure to fund research into the prevalence of foetal alcohol syndrome? I am sure she is coming to that, but given that the Minister is paying great attention, perhaps this is a good moment to get that message sprayed on to the Department’s eyeballs.

Fiona Bruce: I thank the hon. Gentleman for that intervention. Our report states that because of inadequate research in this country, there is insufficient information to encourage those involved—including, we believe, Government representatives—to take action.

Several of our witnesses testified that there must be more appropriate training on FASD among the medical profession, and national standards must be adhered to. For example, we heard how diagnosis could take place as early as for a one-month-old child, or as late as at 10 years, or not at all. It appears to rely on which professional a child sees. Time and again we heard from families, including parents, grandparents, adoptive parents and foster carers, that they had to explain to medical staff the diagnostic nuances of FASD.

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As I have said, the extent of this condition has been under-recognised by successive Governments. Research now indicates that 30% to 50% of children in foster care could be affected by FASD, and a study mentioned in our report from an audit in Peterborough, published in October 2015, showed that 75% of children referred for adoption had a history of pre-natal alcohol exposure. If those figures are extrapolated across the UK, that should have major implications for Government policy on fostering and adoption. Sadly, there are also impacts on the criminal justice system, and our inquiry heard of vulnerable young people with FASD who move into adulthood where they cannot meet societal expectations and behavioural norms. Those people are being exploited by criminal gangs and sexual predators, which is a result—certainly in part—of a lack of concern, understanding and support for them and their condition.

In conclusion, the seriousness of the problem cannot be overstated. Our report makes a number of recommendations that the hon. Member for Sefton Central may well go into in more detail. The impact on the early stages of a child’s life cannot be overstated. Even the alcohol industry has taken considerable steps to send warnings not to drink during pregnancy. Ninety-one per cent. of alcoholic drinks in bottles and cans now carry a warning.

That is not enough, however. A study by Drinkaware revealed that more than half of pregnant women in the UK receive no advice at all about drinking while pregnant. The original clinical diagnosis of FASD was made in 1973. Our inquiry showed that

“in the four decades since then, the UK as a whole has still barely acknowledged its existence.”

That must change, and the Government must take a lead.

International Human Rights Day

Fiona Bruce (Congleton) (Con): I congratulate the hon. Member for Strangford (Jim Shannon) on opening the debate on international human rights day so comprehensively, and on all that he does in this regard. It is a pleasure to follow the hon. Member for Walsall South (Valerie Vaz), and I commend her on her speech and all that she has done, particularly with regard to the people of Burma, over very many years.

This House is debating the most crucial of issues. A former Foreign Secretary was clear that human rights are at the very heart of foreign policy. I thank the Foreign Office Ministers for attending this debate, and for regularly raising human rights issues around the world, as I know they do. It is important that Ministers from the Department for International Development do so, too.

As a member of the International Development Committee and the Joint Committee on Human Rights, I was concerned to see a lack of any focused reference to human rights in the recently published Department for International Development strategy, “UK aid: tackling global challenges in the national interest”. Yes, there was reference to supporting women and girls, and yes there was reference to the disabled, but it is my contention that if there is not a core focus on human rights in our strategy for international development, we will miss out on addressing the cause of so many humanitarian problems around the world, which, ultimately, DFID and our aid funds have to address.

There must be much more focus on human rights in our international aid work. For example, not addressing article 18 disproportionately affects women and girls in any society. Not addressing inequality disproportionately affects the disabled. Twenty one of the 28 countries in which UK aid is spent are either fragile or conflict-affected, and for many of them, that fragility is at least in part—if not in large part—a result of their Governments’ lack of respect for human rights.

The hon. Member for Strangford mentioned Pakistan, which is a recipient of substantial UK aid, but many other countries that receive UK aid should be challenged on their human rights abuses. In Bangladesh, for example, freedom of expression is denied to journalists, dissidents and bloggers, who are arrested and detained. In Uganda and Sudan—also recipients of UK aid—the rights of 

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the child are under attack. There is forcible conscription of child soldiers, and child labour. In Ethiopia, where we support women and girls, there is a closing down of the political and media space. In Nepal, where we have done so much to help with the recent disaster relief outcomes, there have been recent endeavours to restrict the constitution. In every country where UK aid is spent, DFID Ministers and in-country officials should challenge it when they see that human rights are not being respected.

Bob Stewart (Beckenham) (Con): I thank my hon. Friend for giving way. I have a huge respect for what she does. Is it her belief that we should not give aid unless human rights are maintained in a country, or do we have to compromise in giving aid? I think we do. What does she think?

Fiona Bruce: It would be a tragedy for the people of those countries to suffer even further and not receive our aid, simply because their Governments were abusing their human rights.

The UN Secretary-General Ban Ki-moon recently said that the freedom for civil society to operate is diminishing around the world, and there is real concern that the space for human rights has been closed down in many countries. Increasing restrictions in some countries are limiting the ability of non-governmental organisations to work or receive funding. If civil society is to play its full role, the international community, with the UK in the lead, needs to act to protect its operating environment, particularly as implementing the sustainable development goals—the new global goals recently signed up to by 93 countries—is a huge challenge. In those countries, the contribution of a healthy civil society, which very much needs those goals to succeed, will be essential. We cannot afford to see civil society space closed down.

Let me give examples of how even in the past few years, new laws and policies in countries that we support have restricted NGOs’ ability to operate. In Kenya, legislative restrictions on freedom of information are inhibiting the fight against corruption, and hundreds of NGOs have been shut down or had their bank accounts frozen. Amendments have been sought to legislation with the aim of capping foreign funding for NGOs at 15%, basically making it impossible for many to operate. Ethiopia, too, had similar restrictions on organisations receiving more than 15% of their money from abroad, and on working on issues such as women’s rights, child rights or peace building. What are the Government doing to help protect civil society space, particularly in countries with which the UK has a relationship?

Let me turn to concerns about sovereignty. If human rights are to be universal, the sovereignty of a country cannot be used as an excuse for ignoring them. We need to resist the growing argument that sovereignty is somehow paramount, and that that therefore allows countries to interpret human rights subjectively. If human rights are universal, they are universal. China cannot say that it is justified in incarcerating its human rights lawyers without due trial process, as it has recently, simply because it is a sovereign country and they have broken its laws. Nor can North Korean officials say, as they did to me only this morning, that they have their “own way” of interpreting human rights. They certainly do. When their view of 

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human rights is state-sanctioned prohibition of freedom of expression, the imprisonment of anyone who utters even the slightest contradiction to the Government’s views and a host of atrocities, including against children, we need to stand up and speak out about them. Particularly when countries have recently signed up to the global goals, with their integral commitment to good governance and strong and stable institutions, we should speak out and challenge them on human rights.

It is a long time since 1948, and somebody asked me recently whether we would be able today to get the same broad sweep of clear human rights expressed in a document as we did then. We at least have the SDGs, or global goals, which were signed only in September; many of the statements in them re-express a clear commitment to human rights. Human rights should be not only universal but transparent. We should be transparent in how we challenge countries such as Saudi Arabia. We are challenging and should challenge it, as a country with which we trade, though it does not receive aid from us. It might be uncomfortable for those countries, and they might not like it, but the public require it, and it is right that we do it.

There are a number of other countries that I would have liked to have spoken about in more detail. The Conservative party human rights commission, which I chair, has done a lot of work to highlight the need to raise human rights and concerns about them across the world. Will Ministers reconsider some of the recommendations that our commission has made over time? For example, we recommended that there be a Minister responsible for international human rights in the Foreign and Commonwealth Office, who could focus on this issue, and that he be supported by an ambassador at large for international human rights; perhaps there could also be a number of special representatives on issues such as genocide, war crimes, crimes against humanity and women’s rights—a model employed effectively in other countries.

Will Ministers consider a high-level international conference, in which the UK takes the lead, perhaps similar to the summit held last year on preventing sexual violence, to raise international attention of increasing concerns about human rights abuses? It could co-ordinate international strategies, and ensure that media institutions and Governments around the world both speak out for oppressed individuals and help to ensure that, in their lifetime, we can truly say:

“All human beings are born free and equal in dignity and rights.”

Charities (Protection and Social Investment) Bill

Fiona Bruce (Congleton) (Con): I rise to support the rationale behind the Bill, which is of great importance to many members of the public. Its purposes are indeed to protect the public from unscrupulous fundraisers and to stop individuals who run charities abusing them. I agree that action should be taken in such cases, and I agree that the Charity Commission should have appropriate powers where misconduct is proven to have occurred.

I am pleased to note that the National Council for Voluntary Organisations has said that

“it is widely acknowledged that deliberate wrongdoing in charities is extremely rare”,

and it is important to remember that when we debate this Bill. There are many millions of people across the country who devote themselves and give selflessly of their time to charities. It is very important that we do nothing that in any way inhibits them from engaging and contributing to this important part of our civic society.

Having highlighted that motivation, I now want to highlight some of my concerns about the Bill, particularly about some of the new powers it contains. I hope that expressing my concerns is helpful and that they can be explored further in Committee. I speak with particular reference to the new measures in clauses 3 and 11, and the wide-ranging wording of the powers, which I fear could severely curb civic engagement, possibly deterring responsible people from wanting to be appointed as an officer to a charity.

I have more than 30 years’ experience of working in private practice on charity law, and the representation of charities was a particular part of that practice. I know that it has become increasingly difficult over those years to get individuals to step up to the plate, to coin a term, and to agree to an appointment in a charity. That often proves to be one of the challenges that new charities face, particularly—and interestingly—when it comes to the appointment of a treasurer.

I come to this debate, as I say, with over three decades of practical experience of working in this field. I want to ensure that we encourage and do not deter the very responsible people that the Bill is designed to support.

I note that clause 11 provides for new powers to suspend and disqualify. It has an extensive list of reasons within it, but I note that these could in future be varied by Ministers through the laying of new regulations—subject to those regulations being consulted on. We all know, however, that with the best will in the world among the Government, consultations can often reach only a few members of the public. There is the further problem of the regulations being scrutinised only by a few Members in Committee. That is why I am concerned about the excessive powers that will be granted if the Bill is passed, which if extended could come to embrace actions that might not have been fully scrutinised or intended by Members. I enter that caveat about the extension of disqualifications merely by Ministers laying new regulations.

The Bill gives immense power to the Charity Commission. Indeed, in its policy paper of May 2015, the Charity Commission acknowledged that it was gaining 

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“a significant new power” to disqualify people from serving as trustees or senior managers of charities. I am concerned about the wording. The Charity Commission is able under clause 1(1) to issue a warning,

“to a charity trustee or trustee for a charity who it considers has committed…misconduct or mismanagement”.

Clearly, “who it considers” is a very wide-ranging phrase. I note that clause 1(2) allows the Charity Commission to issue a warning that it can “publish”. Yes, the charity or person subject to that warning can respond, but the publication might already have occurred, so I am concerned about the damage to the reputation of the charity in general and the individual. I am worried if there is an opportunity to publish without an opportunity to respond, and I would be grateful if Minister corrected me if I am wrong on that point.

Let me deal with some of the conditions for disqualification. The Charity Commission interprets unfitness to be a trustee to mean failure of honesty and integrity, competence or credibility, the latter being defined as undermining the confidence of the public. That is what I want to highlight in the next part of my speech—how the Charity Commission could take steps to act and issue a warning solely on the one criterion of conduct that might damage public trust and undermine public confidence.

The Charity Commission says that it will use an evidence base relating to the knowledge it gains from the surveys it takes into public trust. I am rather concerned about that. Does it mean that the Charity Commission could carry out a poll, asking people with certain views whether they think the public would be more or less likely to trust an individual or charity? What if those views were very much in the minority or if the views were greatly opposed to current Government policy—views on foreign policy, for example?

That is quite a broad-ranging power, and so far as I can see there are no requirements for any independent review from the Government before the warning is issued. It seems to be based on an individual undertaking some activity or saying something that might be contrary to the views held by the majority of the public who respond to a survey. When the Bill refers to “any conduct”, does that include conduct that someone might have undertaken several years before becoming a trustee? We all know—including many of us in the House—that views can change over time. Many of us might have expressed views some years ago that have changed. How is an individual going to be protected from action taken against them, on the basis of this Bill, which could have far-reaching repercussions?

This is not a merely theoretical issue. Let me highlight how serious a problem this is. I remind Members of the challenges faced by the Plymouth Brethren in the last Parliament. Their charitable registration was threatened because of the interpretation of the words “public benefit” within the Charities Act 2006. We are fortunate now to have William Shawcross as chairman of the Charity Commission. He is an excellent head, a man who possesses wisdom and expresses his opinions, conducts his deliberations and makes his decisions very carefully and with great common sense. Following his appointment, I felt that an appropriate approach was being taken to the plight in which the Plymouth Brethren found themselves when their charitable status was challenged. The case was to go to a tribunal, the Plymouth Brethren had to engage lawyers, and more than 300 churches were affected.

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The Plymouth Brethren are a long-established denomination that exists throughout the country, but the challenge that they faced was very serious. They had to spend hundreds of thousands of pounds on legal advice. As I have said before, it was to their the credit that in the past they had done an enormous amount of voluntary work without shouting about it, but now they had to start producing documentation, and indeed they produced some excellent booklets citing the work that they had done to the public benefit. They continue to do that work, one example being disaster relief.

Some major debates were held about the case in the House. More than 40 Members of Parliament attended a debate in Westminster Hall to speak up for the Plymouth Brethren and to say that the Charity Commission’s action should never have been taken, because it had been based on a subjective interpretation of the words “public benefit”. Ultimately, as we know, the commission withdrew its action, and the charitable status of the Plymouth Brethren—and many other charities that had been standing by and waiting for the decision—was secured. However, we do not want a rerun of that case.

Some may claim that minority views undermine public confidence, but where would the suffragettes have been had all this been happening years ago? Our society contains a wide range of views and beliefs, which are often held with passion and principle. Disagreement is common, as we saw in the House only yesterday; indeed, it is a characteristic of a free society. However—and social media can be very cruel in this regard—many people despise or reject others entirely on the basis of their sincerely held but different, or minority, views. Charities are often formed for the purpose of protecting minorities, and it is important for us to ensure that genuine people with genuinely held minority views are protected from what I am sure would be the unintended consequences of the Bill.

Let me return to the subject of faith groups. Many religions in this country espouse views that are rejected by the majority, and a number of those views are very strongly rejected. Creationism, for instance, cannot be taught in schools as a scientific fact, but one would hope that it can still be expounded in RE lessons as a belief. If a charity’s work involved the promotion of creationism as a belief, would that be considered likely to undermine public confidence? There are many other examples—for example, different views on sexual ethics.

I am not, in this context, talking about minorities. A few weeks ago I spoke to a Church of England vicar—and it should be borne in mind that the Church of England is our state Church—who said that he had gone into a school and spoken about a particular view from a biblical perspective, and had gained the distinct impression that he should not come back and talk about the issue again. We must protect people with sincerely held but minority beliefs from the chilling effect that legislation can have on free speech in our society.

Let me now say something about the connection between the new powers in the Bill and the Government’s counter-extremism strategy. I understand that the Government are seeking to ensure that charities are not abused for extremist purposes. The problem is, however, that there does not currently appear to be a clear 

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definition of extremism. That problem affects the Bill, and I think that it could have a very negative impact. The Government’s information document on the counter-extremism strategy defines extremism as

“the vocal or active opposition to our fundamental values, including democracy, the rule of law, individual liberty and the mutual respect and tolerance of different faiths and beliefs.”

That sounds fine, but previous definitions contained two or three additional words that now appear to be missing. They referred to

“mutual respect for and tolerance of those with different faiths and beliefs”.

That was one of our fundamental British values, alongside democracy, the rule of law and individual liberty: mutual respect and tolerance of people who held different faiths and beliefs.

In March, I said in the House:

“It is entirely right that we should respect other people, including those with other beliefs, and to respect their right to hold those beliefs”.

I added, however, that we should be careful not to conflate that

“with a requirement to respect all other beliefs, which is quite a different thing altogether.”—[Official Report, 12 March 2015; Vol. 594, c. 496.]

That is the problem with the current definition of extremism. If I say that I respect scientologists but I do not respect scientology, I mean that I respect those who hold different beliefs, but I do not respect the belief of scientology. Does that make me an extremist? We must be very careful about the way in which we define extremism, and in that connection it is interesting to note that the Government have yet to provide a statutory definition of non-violent extremism.

We all value free speech very highly in the House. A free society is based on disagreement and mutual respect, and I believe that that is strengthened, not compromised, when I respect my fellow citizens without necessarily respecting their beliefs. I mentioned the suffragettes earlier, but the issue of slavery is another example. The wording of the current definition is deeply troubling, and we need to clarify it, because otherwise we could end up contributing to the marginalisation that feeds extremism. Open dialogue with those who hold different views is essential if we are to understand each other’s views, reduce prejudice, and promote community cohesion.

The role that faith groups play in community cohesion through their involvement in the voluntary sector is staggering. Research carried out earlier in the year established that they contribute about £3 billion to social action in their communities, and that is just in monetary terms. In my view, the social cohesion that they provide is unquantifiable. Thousands of churches have run, or helped to run, charity projects for decades. It concerns me greatly that the removal—or the mere deterrence—of those who hold faith-related views that, in our present society, might not be popular, and certainly could not be considered mainstream, could deprive the charitable sector of valuable experience and expertise for decades.

Having had more than 30 years of experience in legal practice and of working with the charitable sector, I know that people are increasingly worried about falling foul of legislation and, as a result, are not becoming charity trustees. Will the Minister look again at the 

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powers relating to disqualification? It is interesting that he used the term “self-regulation”. I would not like to become self-disqualified. I am concerned because the powers are so wide, and we need to ensure that the thousands of experienced servant-hearted volunteers involved in the charitable sector are not deterred from being involved in our civic society. I know that that is not the Government’s intention, and I would be grateful if they looked at these concerns. I am sure that that would be an unintended consequence, but we cannot afford any further marginalisation and exclusion of people from a sector in which they play such a vital role.