Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 8, 2020

Official Report 967KB pdf

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Alcohol Foetal Spectrum Disorders

The final item today is a members’ business debate. I am delighted to welcome back members to these debates after a hiatus of some months. I know that their return has been eagerly awaited by many members across the chamber.

The debate is on motion S5M-21194, in the name of Kenneth Gibson, on recognising the impact of alcohol foetal spectrum disorders. The debate will be concluded without any question being put.

Motion debated,

That the Parliament recognises the prevalence and significant impact of Foetal Alcohol Spectrum Disorders (FASD) in Scotland, as discussed at the meeting of the parliamentary Cross Party Group on Improving Scotland’s Health: 2021 and Beyond on 26 February 2020; notes the presentation by Dr Sarah Brown of the Foetal Alcohol Advisory and Support Team at NHS Ayrshire and Arran, which highlighted that FASD results from alcohol exposure in the womb and is preventable, yet is the most common neurodevelopmental condition in Scotland; further notes data from Glasgow Royal Infirmary research, which showed that one-in-seven babies born there were at high risk of FASD, which suggests a much higher prevalence in Scotland than previously thought; understands that FASD affects neurodevelopment, attainment, physical and mental health and that, without adequate support, it reduces life expectancy to around 34 years of age; believes that 94% of people living with FASD experience mental health problems, 79% experience unemployment, and over a third struggle with addictions; acknowledges the vital work that is being carried out by FASD Hub Scotland in providing a national telephone helpline and range of support for parents/carers and those supporting families affected by FASD, as highlighted by the presentation to the group by Aliy Brown, FASD Project Lead at FASD Hub Scotland, which is run by Adoption UK Scotland; supports the “No Alcohol, No Risk” message, which makes clear that any alcohol consumed during pregnancy can be damaging to the unborn child, and acknowledges its calls for implementation of the new SIGN 156 clinical guideline for Prenatal Alcohol Exposure, and welcomes the development of the National Preconception Framework as a key opportunity to reduce risks to parents and children from alcohol and other health-harming products in Cunninghame North and across Scotland.

17:46  

First, I thank colleagues from across the chamber who signed my motion, which has allowed this debate on foetal alcohol spectrum disorders—FASD—to take place this evening. I also thank everyone who has managed to stay behind tonight after what went before.

The timing of the debate is welcome, because tomorrow is international FASD awareness day. For their invaluable briefings, I thank Alison Douglas and Simon Jones of Alcohol Focus Scotland; Dr Jonathan Sher of the Queen’s Nursing Institute Scotland; Fiona Aitken and Aliy Brown of Adoption UK; and Dr Sarah Brown, consultant paediatrician, and Dr Jennifer Shields, principal clinical psychologist, of the foetal alcohol advisory support team, NHS Ayrshire and Arran, which is funded by the Scottish Government. I know that it sounds like an Oscar speech so far, but I will soon move on.

On 26 February, Aliy Brown and Dr Sarah Brown together delivered an excellent and informative presentation on FASD to the cross-party group on improving Scotland’s health: 2021 and beyond, of which I am the co-convener, along with Brian Whittle and David Stewart.

FASD is a range of conditions caused by exposure to alcohol at any stage of pregnancy. It affects physical and mental health, and capacity to learn. It is the most common but unrecognised neurodevelopmental condition in Scotland.

The United Kingdom has the world’s fourth-highest rate of alcohol consumption in pregnancy, and Glasgow’s Queen Mother’s hospital found that 40 per cent of newborns had alcohol biomarkers in their systems. It is of particular concern that 15 per cent of babies had levels indicating frequent binge exposure, with one in seven inferring a significant risk of FASD.

There is currently no research on FASD prevalence in Scotland. International research estimates the rate to be 3.25 to 5.25 per cent, which is three to five times that of autism, equating to 165,000 to 275,000 affected individuals. The majority will never have been assessed or diagnosed with FASD, or understood as having a lifelong brain injury that requires support through adulthood, as such individuals rarely have a global learning disability. Their patchy cognitive profile masks difficulties until milestones are not reached. Paradoxically, those who are cognitively impaired to the degree of a formal learning disability have better outcomes, as their needs are identified earlier. The journey into adulthood of those who are unidentified as having FASD and are without support is often characterised by poor educational attainment, unemployment, chronic mental health, trauma and addiction.

FASD affects people throughout their lives. Early diagnosis and support are crucial to avoid a range of issues that are commonly encountered. Some 90 per cent of those affected were estimated to suffer mental health problems; 79 per cent had experienced unemployment; 60 per cent had disrupted school experiences; 43 per cent had educational problems; 35 per cent were imprisoned as adolescents; and 23 per cent needed in-patient psychiatric care. Misdiagnosis and inadequate support shorten the life expectancy of people with FASD to just 34 years, with many preventable deaths attributable to addiction, misadventure or suicide.

Of course, drinking during pregnancy does not happen in isolation; it is a symptom of Scotland’s continued unhealthy relationship with alcohol. One in four people regularly drink above the chief medical officer’s low-risk drinking guidelines. Alcohol consumption in women of childbearing age is common, and 45 per cent of pregnancies in Scotland are estimated to be unplanned. It is vital that we recognise the profound impact that FASD can have on someone’s health and wellbeing throughout their life.

That the prevalence of FASD in Scotland is much higher than was previously thought is cause for concern, and we must do more to ensure that the message “No alcohol, no risk” during pregnancy is well known and understood not just by prospective mothers but by partners, family and friends who can offer support.

I highlight the case of John, a 10-year-old who was referred by his GP for assessment of his neurocognitive function due to his parent reporting behavioural problems, emotional concerns and poor school performance. His mother, Mrs Smith, worries about John being held back at school and her inability to control him at home and around other children. Since he was a toddler, John has displayed aggressive behaviour and difficulty with emotional control. He often provokes fights with other children and can have tantrums that last over an hour—crying, screaming, destroying property and hurting others. Behavioural concerns also include impulsivity and difficulty in maintaining attention and following directions. John frequently steals his siblings’ toys, hides broken toys and lies about how they were broken. Mrs Smith reports that he is never invited to friends’ homes, and teachers report repeated difficulty with peer interactions. Generally, John gets along with children two or three years younger than he is.

John has been seen by several mental health professionals and continues to be engaged in both psychopharmacological interventions and behavioural therapy. Mrs Smith drank several times a day and binged at weekends before and during pregnancy. John was diagnosed as having a neurodevelopmental disorder associated with prenatal alcohol exposure, and given a personalised education programme that included particular focus on providing additional time and repeating new lessons until competence was achieved. He was also given behavioural reinforcement, for example, by getting a gold star sticker immediately after turning in his homework. Due to difficulties with concentration, John sits at the front of the class and is given extra time to complete tasks. It will be a long, hard road ahead for John and his family.

Dedicated resources and practical assistance for parents of children with FASD and early assistance from professionals who are expert in the condition and on how it can be supported can transform the prospects of younger people who are affected. Adoption UK’s FASD hub Scotland, which is funded by the Scottish Government, sets an example of best practice by offering telephone and online support for families living with the condition. However, people with FASD might struggle to access diagnosis due to a misdiagnosis or lack of identification. NHS Ayshire and Arran’s foetal alcohol advisory and support team aims to address those challenges by offering support to FASD practitioners.

The Scottish women’s alcohol framework includes a commitment to

“support the current system to be much more responsive to the needs of individuals, families and communities affected by FASD”.

The Scottish Government’s rights, respect and recovery strategy commits to implementing a “whole family approach” to reducing drug and alcohol harms, providing a platform for increased focus on that issue.

Work is also under way to develop Scotland’s first national preconception framework, to support women of childbearing age and their families to access reproductive health services and avoid unplanned pregnancy.

A dedicated national strategy for FASD treatment and prevention is vital to bring focus and to co-ordinate efforts and resources in order to reduce and ameliorate the condition’s impact. Such a strategy would enable experience and learning from services such as the FASD hub Scotland and NHS Ayshire and Arran’s foetal alcohol advisory and support team, as well as the use of international evidence to improve the life prospects of people with FASD and their families.

Inconsistent messaging on alcohol products remains a concern, with 28 per cent of women in the UK unaware of the current health advice. The chief medical officer’s guideline for pregnant women and women who might become pregnant is to avoid alcohol completely, as no safe amount of alcohol can be consumed during pregnancy. Providing pregnancy-related warnings on alcoholic drinks is an important way of informing consumers of risks that are associated with drinking during pregnancy, but, sadly, such labelling is usually only pictorial and of minimal detail, and 30 per cent of it is illegibly small.

Alcohol Focus Scotland and the Alcohol Health Alliance UK are urging the Scottish Government to mandate, monitor and enforce alcohol labelling standards in line with World Health Organization recommendations. I ask the minister to commit to doing so today, while the power to do so is still devolved.

For those who are affected by FASD, understanding the condition and getting assistance is fundamental for enabling the children to go on to lead healthy, happy lives. The work of FASD hub Scotland is a lifeline for the parents and carers who need that vital support.

17:55  

I thank Kenneth Gibson for bringing the debate to the chamber, and I congratulate him on having got time to discuss the subject in Parliament.

As he said, foetal alcohol spectrum disorders is a lifelong condition that affects the neurodevelopmental system, and is a result of prebirth exposure to alcohol. Estimates indicate that between 165,000 and 275,000 individuals in Scotland are living with FASD. That wide range in the estimate should tell us that the diagnostic rate for FASD is not great, in comparison with rates for other neurodevelopmental conditions. Nevertheless, the condition has wide-reaching implications not only for the individuals and their families, but for health and social care, education, criminal justice and the third sector.

The evidence shows that when FASD is not identified, people who have the condition are more likely to experience poor educational attainment and health difficulties, are more likely to be unemployed, and are more likely to have an addiction, to experience homelessness or to be involved with the criminal justice system. We also know that affected individuals are highly likely to experience trauma and poor physical health.

The condition is linked directly to alcohol consumption during pregnancy, so that is where we have to start. We have to accept that Scotland, within the United Kingdom as a whole, has the fourth-highest rate of drinking in pregnancy: 40 per cent of pregnancies in Scotland are exposed to alcohol, and one in seven babies are exposed to high-risk levels. Prevention is the key to tackling Scotland’s relationship with alcohol, and must be our starting point. Education on FASD across healthcare is being called for, because outcomes are drastically improved through early intervention, understanding and support.

I have to admit that my knowledge of the condition started only when I was asked to coach an athlete who has FASD. His foster parents were really keen that he would progress as an athlete. I have often wondered whether their idea was to give him to me in order to deplete his ever-growing energy reserves, because I would describe him as being enthusiastic in life. You would not be able to tell from looking at him that he has a condition; he is very enthusiastic and energetic. That young man is now a European medallist—he qualified for the world championships and has an eye on the Paralympics. He is even at college now.

When FASD is recognised, and access to organised activities is available, much can be achieved. Those are the pathways that we should be pursuing. Track and field athletics has given that young man purpose, structure and an opportunity to achieve through providing him with an outlet for his boundless energy.

Presiding Officer, you knew that somehow or other I would find that sport is the answer. However, I am in fact calling for investment in education on identifying FASD and investment in tackling Scotland’s relationship with alcohol. I have been given the following figure: when a person has FASD and the condition is not tackled early, the resulting cost could be upwards of £1 million during that person’s lifetime.

We talk about the preventative health agenda, which would be an ideal way of tackling the issue. That type of investment has been called for by FASD hub Scotland, and I whole-heartedly support that call.

I once again thank Kenneth Gibson for bringing the debate to the chamber, and for allowing me the opportunity to speak to the issue.

17:59  

I thank my colleague Kenneth Gibson for the opportunity to discuss this important subject.

Reading the motion, I was moved and saddened—in particular, by some of the statistics. For example, the average life expectancy of a child who is born with foetal alcohol syndrome disorders is a mere 34 years. In recent days, we have seen an outpouring of grief for a young actor who died at the age of 43, which is nearly 10 years older than the average life expectancy of a youngster who is affected by FASD.

Foetal alcohol spectrum disorders lead to quite variable outcomes, with some sufferers being affected more significantly than others. The presenting symptoms are not necessarily consistent among the cohort of people who are subject to the disorder—hence the difficulties that there often are in diagnosing the condition and in getting appropriate support in place.

What is shared, however, is that the syndrome is preventable. No parent—or very few parents—deliberately set out to harm their children. The syndrome is a side effect of an addiction to, or abuse of, one of our most widely available drugs of choice: alcohol. The danger with alcohol is that although it is an addictive drug it is not addictive for everybody, so people think that it is safe. For children in the womb, it is not safe. There is enough knowledge out there; people should know that they should not drink when they are pregnant.

However, not everyone is able to respond to the rational case for their stopping drinking. That is especially the case for an addict. It is our responsibility to support mothers during pregnancy and to support the children who suffer from foetal alcohol spectrum disorders. The championing of campaigns such as #NoAlcoholNoRisk is welcome.

I encountered issues to do with alcohol addiction when I was a nurse, 56 years ago, and one of our patients was an alcoholic who suffered extremely as a result of his addiction. My father was a general practitioner, and I used to provide some social support to addicts who were on his list. The issue is not far from a great many of us.

Children cannot look after themselves; they do not have the knowledge or the power to do anything about their situation. It is important that we identify the help that is required, and that people who suffer from FASD get everything that they require to lead as normal a life as possible.

I listened to Mr Whittle. I think that members can see the range of options that are available to support people, and to ensure that intervention comes early enough in a child’s life to ensure that they can get the maximum out of however long they have in this world. Early diagnosis, a loving and stable home and the absence of violence are rights that we all want for children in our society, and which we all have a duty to uphold. It is necessary to create a world in which people are supported. We will do all that we can to support future generations.

I very much welcome tonight’s debate. I hope that it brings the condition to the attention of a wider audience, and I hope that mothers and potential mothers are aware of the damage that alcohol can do to the precious child in the womb.

18:03  

I commend Kenny Gibson for shining a light on foetal alcohol spectrum disorders, and I thank Alcohol Focus Scotland, the foetal alcohol advisory and support team at NHS Ayrshire and Arran, and the FASD hub Scotland that is hosted by Adoption UK for their helpful briefings.

Alcohol harm in Scotland continues to be a serious public health challenge. More than 1,000 people die from alcohol-related illness every year. We have had positive measures in recent years, including minimum unit pricing, but problem drinking remains a widespread and stigmatised issue. For women who are struggling with drinking who become pregnant, the stigma and public judgment are magnified. However, prenatal alcohol exposure can have lifelong damaging impacts, so it is in everyone’s interests to reduce it as much as possible.

We think that FASD affects 3.2 per cent of Scotland’s young people, but the rate could be much higher, which is troubling. We need bolder public health policy and we need adequate and sustainable funding of treatment and recovery services. It is worrying that the number of publicly funded residential rehab beds in Scotland has plummeted in recent years, at the same time as there has been a rapid increase in alcohol-related and drug-related deaths.

Improving women’s access to rehab and other wraparound support is one measure that could help to prevent FASD. As the #NoAlcoholNoRisk message points out, FASD is preventable.

I want to focus on the needs of children who are affected by FASD. I was struck by an email that a mother sent me, ahead of the debate. With her permission, I will read out her words. She said:

“My daughter has just turned 8. She has probable FASD. I say probable because, despite starting the diagnosis process when she was in P1,”—

four years ago—

“we are still crawling our way through it ... There’s no joined up approach and parents are left to do everything themselves. We have been waiting for 2 years for the Cognitive Assessment through CAMHS. An assessment which would help identify areas where she needs support and would make it much easier to get her the right help at school ... FASD affects my daughter in lots of ways. It affects her memory, her sleep ... and her cognitive abilities. Some days are better than others—she can go from bright and bubbly, to not being able to dress herself because she just can’t remember what to do next.

FASD often goes alongside early trauma and attachment issues, because so many children are care-experienced”.

She continues:

“My daughter is a masker. She tries incredibly hard at school and holds herself together all day, then crumbles as soon as she’s out of the gates.

Masking is another challenge to diagnosis, she can see a Speech and Language Therapist for half an hour and push all her effort into that, leaving them with the impression that she’s ‘fine’, but emerge exhausted and unable to function for the rest of the day. In England, and in other countries like Norway, they take a different approach to assessment, where it’s a whole day, or in Norway two days, all in one place, making it impossible for a child to mask, so a more accurate picture of their difficulties emerges. It also means the child misses less school and doesn’t have to endure having their ‘faults’ listed to a never-ending series of professionals, who often have a very poor understanding of FASD.

We have accessed workshops through the FASD Hub that Adoption UK runs, but otherwise, we’ve been on our own. I feel my daughter has really been let down by both the Health Service and by Social Work, who have not provided any support, despite her care-experienced status. They say that early diagnosis is one of the best ways to avoid poor outcomes for children with FASD, but what chance do Scottish children have of that?”

She goes on to say:

“I’m an articulate, assertive parent with qualifications, and I know how hard I’ve found it to navigate the system. What chance is there for parents who haven’t had my advantages?”

We must do better than that. I hope that today’s debate leads to much-needed positive change, and I thank Kenny Gibson again for bringing it to the Parliament.

18:08  

I thank my colleague Kenny Gibson for bringing this important debate to the Parliament, just a day before international foetal alcohol spectrum disorder awareness day.

Monica Lennon’s speech was incredibly interesting and powerful. There was so much in it that I did not know.

This Government and this Parliament believe in giving children the best start in life. The Scottish Government has evidenced that with its introduction of the baby box, its planned expansion of early years education and much, much more.

Some children are denied the best start in life even before they are born. FASD is a family of complex conditions that arise from exposure to alcohol at any stage of pregnancy and affect a child’s physical and mental health and their capacity to learn. FASD is the most common unrecognised neurodevelopmental condition in Scotland. It is also entirely preventable.

During my time on the children’s panel, I attended a tutorial by a clinician who was originally from Canada—his name escapes me, sadly. It was about a decade ago, and he was one of the very few specialist researchers in FASD at the time. Back then, the message to pregnant women was that they should limit their alcohol intake. Women were told, “The odd glass of wine won’t do you any harm as long as you are sensible.”

The professor pointed out that alcohol affects everyone in different ways and that what might have an impact on one person might be devastating to another. His message was, “The only way to avoid giving your baby FASD is to drink no alcohol at all.” He also highlighted the fact that many children at children’s hearings may well have been affected by FASD and that they and we were unaware of that. We now know, of course, that many were also impacted by adverse childhood experiences. Thankfully, we know much more about that now.

As the helpful FASD briefing points out, early diagnosis and support for people with FASD is crucial to avoid a range of issues that they commonly encounter. It is estimated that 90 per cent experience mental health problems, 79 per cent experience unemployment, 60 per cent have disrupted school experiences, 35 per cent have been imprisoned as adolescents and 23 per cent have needed in-patient psychiatric care.

We heard Kenny Gibson say that it has been estimated that around 3.2 per cent of Scotland’s young people are living with FASD. However, a 2017 study in the west of Scotland found that as many as 40 per cent of babies showed signs of exposure to alcohol in the second trimester. That suggests that the figures are higher. I find that absolutely shocking.

Support for families that are affected by FASD and early diagnosis can transform the prospects of the young people who are affected. Adoption UK’s FASD hub Scotland provides telephone and online support for families that are living with FASD. It is funded by the Scottish Government, and it has reported that 55 per cent of children waited for two years or longer for their diagnosis and 78 per cent of parents whose children were diagnosed did not think that healthcare professionals were knowledgeable about the condition or its various presentations.

The Scottish Government’s alcohol framework includes a commitment

“to support the current system to be much more responsive to the needs of individuals, families and communities affected by FASD”

and a whole-family approach to reducing drug and alcohol harms. It provides a platform for increased national attention to the issue.

Drinking during pregnancy is a symptom of Scotland’s unhealthy relationship with alcohol. We are trying to address that by way of minimum unit pricing and improved public awareness of the dangers of drinking too much.

In conclusion, FASD is entirely preventable. It requires women not to drink for the entirety of their pregnancy, including avoiding alcohol while trying to conceive. In what we are facing today, with the scourge of the global pandemic still prevalent, surely that is not too much to ask to ensure that our children get the best start in life.

18:12  

It is fair to say that there has been a lot of agreement across the chamber on the issues for debate this afternoon. Undoubtedly, we all share a desire to see children who are born in Scotland healthy and happy.

Foetal alcohol spectrum disorders have a devastating effect on children who are born with them, as my colleague Kenneth Gibson illustrated in his motion, which I thank him for lodging. I, too, thank all those who have provided briefings and all those who have worked for a long time to raise awareness of these unacknowledged and misunderstood disorders. It is clear that we still have a way to go.

One of my colleagues described FASD as

“a side effect of an addiction”.

It is also a side effect of the health inequality that continues, in too many cases, to blight Scotland.

Like many issues, the problem cannot be tackled in isolation. If we pare it down, we could suggest that FASD is preventable by abstaining from alcohol during pregnancy, but a broader perspective would, of course, acknowledge that the relationship between alcohol and pregnancy is far more complex. It involves location, economics, education and much more. We need to look at the bigger picture of how society views alcohol, not least during lockdown. Some people have managed to cut down their consumption of alcohol, whereas others have perhaps found themselves drinking more than they did previously. There will be various reasons for that. It might be several years before we understand not just the impact of Covid-19, but the impact on our individual coping mechanisms.

The range of alcohol foetal spectrum disorders is serious and lifelong, so it is imperative that we do all that we can to provide the best healthcare, support and information to women and parents well before conception, particularly where dependencies are an issue. We need to look at any underlying causes, such as financial instability, domestic abuse, past trauma—Rona Mackay mentioned that—and unaddressed mental health issues.

Alongside that, it is imperative that we, as a nation, get better at dealing with alcohol. Minimum unit pricing appears, at this stage, to have had some success, but that alone does not mean that we have tackled problem drinking. Across Scotland, we have 16 times more licensed premises than we have GP surgeries, and we know how difficult it can be to access our GP surgery. There is an imbalance there.

From the moment a child starts to read, they see alcohol adverts. They see them when they watch sport with the rest of their family or when they are at the bus stop, on their way to school. We are yet to understand fully the impact that social media and influencers have on children and young people’s perceptions of alcohol.

We probably all agree that disease that results from a preventable cause can sometimes be the saddest and most heartbreaking to see. It can be frustrating, as we know that it is preventable. However, we know that choices are made in different contexts and that behaviour change is complex, as is pregnancy. It is not always a happy time, full of excitement, as adverts would have us believe; it can be very stressful, and women can feel under pressure and intense scrutiny from friends, family and even strangers, who feel that they know better than the women themselves and are often unafraid to offer unsolicited advice. That is just one of the challenges that women face during pregnancy.

Maternity discrimination in the workplace continues to be an issue, and taking a pregnancy to term while studying is a challenge. Kenny Gibson described John’s journey and spoke about all the challenges that that young person faces, although opportunities exist where support is available.

Monica Lennon described the situation of a constituent’s daughter. Masking can happen in specific situations if we break up the day into small chunks, and the young person can be somewhere where the situation does not bring on stress. If there are people in institutions or organisations who see the young person over a longer period, there is a far better chance of understanding what the condition is. There have been many interesting contributions to the debate.

I would love to see a Scotland in which no child is born with FASD, and I believe that that can be achieved with hard work. We can help to bring that about by creating a society in whic pregnant women and families are supported before, during and after conception and birth.

18:27  

I thank Kenny Gibson for securing the debate, and I welcome the opportunity to make these closing remarks. By happy coincidence, I note that I closed the last members’ business debate before Parliament paused this particular institution. It is a real privilege to come back to the chamber and continue our members’ business debates with another topic that is close to my heart.

The debate’s being had today is really great timing, because tomorrow is international FASD day, which marks an opportunity to raise awareness of the condition in countries around the world. The FASD hub Scotland plans to mark the day with the #IcanFASD campaign, which highlights what children and young people with the condition can do, rather than focusing on what they cannot do. We should all reflect on that message as we seek to improve the lives of children, young people and adults with FASD. What are we missing out on as a country and a nation by not providing the correct help and support to enable them to thrive?

As Mr Gibson correctly pointed out, 3.2 per cent of babies who are born in the UK are affected by foetal alcohol spectrum disorders. Knowing what support is needed is vital. In order to help health and social care professionals to support patients, Healthcare Improvement Scotland last year produced a Scottish intercollegiate guidelines network—SIGN—guideline, “Children and young people exposed prenatally to alcohol”. We expect that guideline to lead to more uniformity in practice, which will, in turn, enable patients to receive the best possible care. We hope that situations such as the one that Monica Lennon described her constituent’s daughter going through will be improved in the future.

I know that guidance is useful only when it is backed by support and training for those whom we expect to follow it, so we arranged for experts from Manitoba to lead, in June last year, a three-day training session with healthcare professionals. Representatives from all Scottish health boards had an opportunity to learn and to connect with each other, and to share their understanding and knowledge. In addition, an e-learning module is in production, which will reinforce the guidelines and raise awareness. It will be available in the coming months.

We know that FASD is caused by alcohol exposure in the womb and that the advice to women in Scotland is to avoid alcohol completely when they are pregnant or trying to conceive. In fact, for a number of years, Scotland was the only country in the UK that advised women not to drink at all during pregnancy or when they were trying to conceive. However, since 2016, the other UK chief medical officers have agreed to use the same message: no alcohol, no risk.

Improving health in the pre-conception period is vital; we are committed to helping families to understand the impact of poor health behaviours prior to pregnancy. Pre-conception and pregnancy are, arguably, the earliest stages at which services can work together effectively to offer guidance and support to families.

Women do not need to be alcohol dependent to have a child with FASD. It is much more common when that is the case, but a baby’s brain begins developing at the earliest stages after conception, and can be damaged at any point during pregnancy. That is the reason for the strong message of the #NoAlcoholNoRisk campaign. The physiological impacts occur at different stages, so the visible effects of FASD are present in only about 1 per cent of those who are affected—hence some of the complexity with diagnosis.

A pre-conception framework is in development. The plan will focus on mental and physical health, healthy weight and diet, vitamin supplementation and tobacco and alcohol use before becoming pregnant, and it will be out for consultation later this year. The Scottish Government’s plan for FASD is set out in “Alcohol Framework 2018: Preventing Harm”. Action 18 states:

“We will continue to prevent and reduce the harm caused by alcohol consumption in pregnancy through increased awareness of the risks, increased awareness of, and improved diagnosis and support for, Fetal Alcohol Spectrum Disorder.”

I am sure that Mr Gibson will be pleased to hear that we have continued our funding to the foetal alcohol advisory and support team to explore a different model for its work, and we will work with it to consider what next steps are needed. Our actions are set within the alcohol framework so that we can work right across policy areas. That places FASD firmly within all the other structures of policy development.

I am clear that all areas of Government have a part to play in supporting our understanding of the impact of FASD in policy initiatives. Work on FASD does not, and should not, sit in a silo; it is part of a much wider picture of decision making, in which we all need to play our part. Alison Johnstone brought that point to life very powerfully in her speech. The Minister for Public Health, Sport and Wellbeing and I met recently to agree that we will work together to provide leadership in that area.

The 2018 programme for government included a commitment to increase support for children and families who are affected by FASD. As part of that commitment, the FASD hub Scotland was launched. Before Covid, the Minister for Public Health, Sport and Wellbeing met families who have been supported by the hub, to hear their stories and to hear about the impact that the hub is having in supporting them in difficult times. We have invested £333,401—there is a funny figure—in the service to date, with highly positive results.

Mr Gibson noted the presentation by Dr Sarah Brown of the foetal alcohol advisory and support team. I am pleased to confirm that the Scottish Government has continued funding to that team to help it to explore new ways of working. Dr Brown and her colleague Jennifer Shields have played a pivotal role in improving our knowledge and supporting health colleagues. We have invested a bit more than £601,000 in that work to date, and we continue to support the sharing of learning much more widely across the clinical community.

Once again, I offer my thanks to members for their contributions. I reiterate our commitment to improving outcomes for people with FASD. I pay tribute to the children and young people with FASD—many of whom I have met in my role as Minister for Children and Young People—and wish them all the very best in their future journey.

Meeting closed at 18:24.