Breastfeeding etc (Scotland) Bill: Financial Memorandum
Item 3 is consideration of the Breastfeeding etc (Scotland) Bill, which is a member's bill and was introduced on 16 December. I welcome Elaine Smith, who will answer questions as opposed to asking them–—that will be an unusual experience. Members have a copy of Elaine Smith's submission and of submissions from the Equal Opportunities Commission, the Association of Chief Police Officers in Scotland, the Federation of Small Businesses and the women and children's unit of the Scottish Executive Health Department. I invite Elaine Smith to make an opening statement.
Thank you. I have not given evidence to a committee before, so I am not sure about the protocol, but I presume that I should declare any interests in relation to the bill. I have had assistance from Govan Law Centre and the breastfeeding steering group, and Unison has provided money for a research project, which is being carried out by Kay Sillars. I take the opportunity to thank everyone else who has helped the bill to reach this stage.
Consultation began in 2002 around the possibility of establishing legal measures to protect the rights of mothers when they breastfeed their babies in public. Such measures would in effect end the practice of segregating or impeding mothers while they breastfeed in public, which can prevent them from accessing public services. For example, in one case in Edinburgh, a woman was put off a bus. That seems a pretty absurd and unsustainable approach in 21st century Scotland.
I have attempted to consult as widely as possible on the merits of the bill. I carried out a consultation exercise in August 2002, which sought views from, among others, local health care providers, local authorities, trade unions, elected representatives and representatives of the retail and leisure industries. Members might have read the analysis of consultation responses that the Scottish Parliament information centre kindly collated.
The associated costs of the proposed measures have not featured prominently in the consultation process. The limited research that I and my staff have carried out, for example by asking parliamentary questions, leads me to conclude that the bill will not require extensive public expenditure. I am satisfied that the requirements for the implementation of the bill could adequately be met through existing budgets and that additional public expenditure would remain a discretionary matter for the Scottish Executive.
Of course, additional funding for the promotion of breastfeeding would be gratefully received and I would welcome investment from the Executive in that area. Research appears to indicate that the Executive would be spending to save, because an increase in breastfeeding would have a positive impact on children's health, which would lead to savings for the public purse in the longer term. Given the low breastfeeding rates in more deprived communities, the bill could be regarded as a necessary tool in tackling the social exclusion and poor health that are linked to poverty and low incomes.
I am not a financial expert, but I am happy to try to answer questions that the committee might have.
Obviously, the committee is concerned with financial issues, rather than with policy issues, which will be dealt with by a different committee.
I congratulate Elaine Smith on the huge amount of work that she has done. In the written submission that she has provided, she identifies research that shows that successful promotion of breastfeeding can produce significant savings for the national health service. She goes on to state:
"potential savings for the NHS in Scotland following a change in breastfeeding rates have been estimated at £3.82 million annually."
Can she give us a breakdown of where those savings would come from? Her written submission refers to research that has been undertaken by M Broadfoot, entitled "The Economic Consequences of Breastfeeding for less than 3 months". I was intrigued by the scale of the savings. I think that I understand where some of them might derive from, but I would be interested to hear Elaine Smith's views on the matter.
I thank Fergus Ewing for his kind words.
The figure was cited by the national breastfeeding adviser. When I looked into the background of it, I found that it comes from a paper entitled "The Economic Consequences of Breastfeeding for less than 3 months" by Mary Broadfoot, which details some of the hard facts and figures. I would be happy to circulate that paper to the committee. Interestingly, the figure relates only to the incidence of bottle-baby gastroenteritis; therefore, the savings could be much greater. The problem is in trying to find research into the matter. That is the only piece of research that I have been able to track down that puts a specific figure on what the experts think could be saved.
That is what I meant in my opening statement by spending to save. The benefit of breastfeeding is what it can prevent in the future. Looking beyond gastroenteritis, I am sure that much more than that amount of money could be saved. We have a big problem with childhood obesity, for example, and it would be interesting to find out whether any research is being undertaken into breastfeeding in that regard. The positive impact that breastfeeding can have on mothers' health is also something on which I do not have specific figures. I cite the figure of £3.82 million because there is some research to back it up.
I am interested to hear that the figure of nearly £4 million a year relates simply to one possible way in which breastfeeding can improve health. You argue that breastfeeding can have all sorts of other benefits for both the baby and the mother, but especially for the baby and its development. I imagine that those benefits are extremely difficult to quantify because they are not measurable or attributable to that one aspect of bringing up a baby. Would you welcome the Executive's taking an interest in the matter and applying its firepower to the task of quantifying other benefits? When we considered Michael Matheson's member's bill, we did not have the benefit of the Executive's thoughts on the financial consequences of the bill. Similarly for this bill, we do not have the benefit of the Executive's financial thoughts, as there is no financial memorandum from the Executive.
I and my colleagues on the committee feel that it would be extremely helpful if the Executive could offer assistance and constructive criticism at an early stage when a member introduces a bill. There could be all sorts of other benefits of breastfeeding that the Executive might be able to quantify through the Health Department—the impact of breastfeeding on maternity services and public health, for example. Would you welcome such a contribution from the Executive, setting out its views on the costs and potential savings? Would you also welcome that input being given before the bill goes to the lead committee, so that you would have the benefit of the Executive's input early on in the parliamentary process rather than towards the end of the process?
Any member who is leading a bill through the Parliament would welcome such input from the Executive because members have limited resources, as you will be aware. I have received assistance from the Govan Law Centre, the breastfeeding steering group and my own researcher, Catherine Murphy. However, it is difficult to get the information as a back-bench member. Therefore, I would welcome such assistance. Some research can take a number of years to complete. The Dundee study has been going on for a number of years and has been following children from birth to find out how breastfeeding can impact on their health in adult life. Such studies take time. I would welcome anything from the Executive that helped to show the benefits of breastfeeding.
It is difficult to make arguments about savings over the longer term—they will not be seen immediately. I was approaching the financial memorandum from the perspective of whether or not the bill itself would have particular implications for the public purse.
Some of the submissions on the financial consequences of the bill suggest that there could be issues with the cost of training. I was a bit surprised by that, as I could not see what additional training would be needed in relation to the bill, as opposed to the additional training that might be required to promote breastfeeding. I wonder whether you agree with that point. The Equal Opportunities Commission raised a further issue about the possible costs to employers of making areas suitable for the feeding of children. Do you have any comments on that?
You have done research around the issue of women not being permitted to breastfeed. I am aware that your bill also covers other forms of feeding, but I presume that most objections have been to breastfeeding. Do you have any indications from your research of how often the provisions of your bill might have to be implemented?
Those remarks are very helpful—thank you very much.
The fact that training might be required has been highlighted, but training because of the bill would not necessarily have to be intensive. If the Parliament passes the bill, then it might simply be a matter of providing induction training to raise awareness that the legislation exists.
I have been looking into how the recent campaign concerning mobile phones is being carried out and it seems that awareness about that change in the law is being raised through the normal channels of advertising and promotion. Training could be more intensive should employers want the bill's measures to be part of an equal opportunities package. Rather than simply point out that the legislation exists and making staff aware of it, the training could help to raise awareness about the benefits of breastfeeding.
I turn to the Equal Opportunities Commission's submission. The aim of the bill is to try to make breastfeeding in public more visible. That would have an impact on women as they make choices about feeding. If areas for breastfeeding were to be provided, that could equate to telling women, "I'm afraid you can't sit here to breast feed. We have an area," and so the segregation might continue. The bill does not necessitate the provision of such areas. Of course, if employers or those in charge of public places wanted to provide them, to give women the choice, that would be fine.
There are examples in chemists' shops and so on of certain areas being provided, but often they are next to baby-changing areas, which I would not say are particularly suitable. Recently I spoke on breastfeeding at a meeting of Ayrshire and Arran NHS Board, and I remember laughing about the fact that a notice had been put up in the town of Ayr saying "Ladies and Nursing Mothers". I wondered what that was all about, since the place was a public toilet. The sign is still there now, unless the council has taken it down since I raised the issue. People might want to provide areas for breastfeeding, and mothers might choose to use them, but the bill in no way necessitates the provision of such areas.
Could you repeat the last part of your question?
Does the research that you have done on women being prevented from breastfeeding in public indicate how often the bill might need to be used? The police say that the costs for them appear to be minimal.
I do not expect there to be a large number of prosecutions.
So the bill would be a preventive measure.
That is how I see it. I mentioned the instance that was highlighted in the Parliament of a woman being put off a bus in Edinburgh. There have been examples of people being asked to leave dentists' waiting rooms because of breastfeeding. The bill is not just about cafes and restaurants; it is also about accessing public services. That is an important point.
The bill is also about changing culture. If it is passed, that will send a message. It will say that we know about the health benefits of breastfeeding and, as a society, we want to support the feeding of children however people choose to do that. As Elaine Murray says, breastfeeding is generally the form of feeding that is frowned on. Such disapproval is not always as overt as people saying that mothers must move or leave; there are also looks, glances and negative attitudes. It is difficult to legislate for those, but the bill aims to make breastfeeding much more publicly acceptable and visible. I hope that there will not need to be prosecutions, but the bill will provide protection for mothers. Many mothers cite embarrassment as a reason for either giving up breastfeeding or not starting at all. If we can create a culture that is breastfeeding friendly—which the bill will help to do—we can break down such barriers.
I add my congratulations to Elaine Smith. The bill is a bit too late for my family and me, but I am grateful that it has been introduced.
I am interested in the fact that researchers at Highlands and Islands health research institute have been commissioned to carry out a three-year study that will evaluate the clinical effectiveness and cost-effectiveness of breastfeeding. I link that to any awareness-raising campaign that the Scottish Executive might wish to initiate. I have the feeling that breastfeeding may have implications beyond its direct clinical effectiveness and cost-effectiveness. It has implications for health, long-term nutritional awareness, education and, one could argue, enterprise. By allowing women to have better continuity at work, breastfeeding could trigger better nursery provision. Beyond that, the reinforcement of confidence and modern Scottish values are important. Are there plans to widen the remit of the Highlands and Islands health research institute's study and to trigger the Executive, so that we get something much bigger than the research that was originally commissioned?
I am not sure that that question is within the scope of the bill, but never mind.
I read about the study with interest and cited it in my submission. The media release announcing it states:
"Breastfeeding reduces childhood gastro-intestinal, respiratory, urine and ear infections",
and refers to other health benefits. It continues:
"breastfeeding rates in Scotland are amongst the lowest in Europe and increasing them could produce significant savings for the NHS."
I note Jim Mather's comment about the economics of breastfeeding. In the policy memorandum that I produced for the bill, I referred to a bill that has been introduced in the state of Washington, which affirms:
"Breastfeeding improves maternal health and contributes economic benefits to the family, health care system, and workplace".
It is interesting that that has been noted there.
The bill, like disability and seat-belt legislation, is about changing attitudes and culture. If it helped to focus more spending, that would be welcome. I am saying only that the bill does not place any additional strain on the public purse.
I want to target the provisions in section 4 relating to the promotion of breastfeeding, as that might be the area in which the bill triggers a requirement for additional expenditure.
Presumably, as a long-term advocate of breastfeeding, you are not entirely happy that neither the Executive nor the health service is spending enough money on the promotion of breastfeeding. You seem to be saying that the bill will not of itself generate a requirement for increased spending, but you would welcome increased spending in that area. Is that a fair summary of your position?
Yes, that is an extremely fair summary. When questions are asked of the Executive, it is quite difficult to get information on funding for breastfeeding. The answer tends to be that it is up to individual NHS boards. Lots of different funding pots could be used for the promotion of breastfeeding.
If we were to look at individual NHS boards, we would see that there is no standard; the position varies across the country. Indeed, although most of the boards have a strategy, I think that there is one board that does not yet have one in place. If the Executive wants to meet its 50 per cent target by 2005, it would be helpful if it were to increase its spending on the promotion of breastfeeding, but, as the convener said, the bill puts no requirement on the Executive to do so.
I note that NHS Health Scotland—which used to be the Health Education Board for Scotland—plans to run a promotional advertising-type campaign for breastfeeding awareness week this year. It has also had successful campaigns in the past. If the bill is passed by the Parliament, I believe that awareness of the existence of the new legislation could be raised as part of that kind of campaign.
As there are no further questions from members, I thank Elaine Smith for coming before the committee. We will produce our report on the financial implications of the bill, which will go to the lead committee. Our report will be made public and you will see it at the same time as the committee does.
Thank you.
Do we want to take up the point about inviting the Executive to express its view on the financial implications of the bill? Surely that would help Elaine Smith. Following Michael Matheson's evidence, I thought that we had formed a view that it is desirable for the Scottish Executive to provide its view on the financial consequences of any member's bill before we consider the matter. If we had had that information today, we could have put the Executive's views to Elaine Smith. Could we take up the matter again with the Executive? If so, could we seek a clear statement on whether the Executive agrees in principle that that is something that it should do in future?
The information that we received from the Executive is the information that it provided to us. As Fergus Ewing described, following our consideration of Michael Matheson's bill, we agreed that we were of the view that it would be better for us to get a report from the Executive on members' bills. We also agreed that we would consider the matter in the context of our general approach to financial memoranda. A paper is under preparation, which will draw together a number of issues including that of members' bills. I propose that we deal with the matter in the way that we decided previously.
Briefly, I want to congratulate Elaine Smith on the introduction of her bill. I note from Malcolm Chisholm's response of 26 January to a question from Elaine Smith that the Executive will have spent around £954,000 over five years on the promotion of breastfeeding—it proposes to spend £230,000 this year. When the bill's provisions are implemented, the Executive could make a saving on those amounts. If breastfeeding becomes an accepted fact, the Executive will no longer have to spend those amounts. That could be a benefit of the bill.
We would always wish to see the promotion of breastfeeding, but if health savings can be made because more women are breastfeeding, that will be helpful for the whole of society.
Thank you.