Hansard

I join other members in congratulating Gil Paterson on bringing a debate on this important topic to the chamber again. I have no negative feelings about the fact that we are debating it again, as it is important that we continue to consider such an important subject.

The context of the Scottish Cot Death Trust’s 30th anniversary is a good one, and I join Gil Paterson in saying thank you to the trust and offering it our gratitude for the very important work that it has done over the years. The high-quality support that the trust provides through counselling and education is extremely valuable. As David Stewart said, we commend the hard work and dedication of those involved, because that support has a profound effect on those families who have been affected by cot death.

As a doctor, I dealt with families experiencing cot death, and it was difficult. In the early days, in the 1970s and 1980s, cot death was managed by people coming forward from various silos. A health visitor provided some support, but the police and a pathologist were also involved, and the different elements were not connected up. The multidisciplinary approach that we have had—as David Stewart mentioned—from 2000 onwards is critical in managing such situations. The police are now infinitely better at dealing with cot death than they were, and that is very welcome.

Apart from dealing with patients, I have a family member who suffered sudden infant death syndrome—or sudden unexpected death, as it is now called.

Cot death is the form of unexplained death that we are discussing today, and it is critical that it is differentiated in the public mind from other things that may occur; the worst end of that spectrum is infanticide or Munchausen’s syndrome by proxy. There is sometimes suspicion about those things out there among the public when an infant death occurs. As Stewart Stevenson said, when families have that experience and have feelings of guilt and self-blame, the whole thing gets very confused.

The educational role that the trust provides is critical. The summit that it held to foster collaboration was important. It is important to get a range of health professionals to interact with the family, for example nursing during pregnancy, when it is a second pregnancy, but also bereavement and other counselling. The toolkit provided is helpful to professionals and families alike.

There is a lot of information. None of us forgets the back to sleep campaign, which members have mentioned. It was one of the nicest slogans because it was so simple and so welcome and it made a fundamental difference. It seems extraordinary that it took until the 1990s for medical researchers to discover such a simple thing that made such a huge difference.

However, that does not remove the fact that we still have one death every nine days. It is critical that research goes on, because we still do not understand cot death. There is a lot of research that indicates the factors involved, which other speakers have mentioned.

Smoking is still important. We still have too many people smoking in pregnancy. It is about 18 per cent now. It has come down, which is very welcome, but we need to go further. Groups such as the family nurse practitioners who are supporting families who are more likely to experience cot death are important. Teenage mothers are more likely to experience it. The numbers are very small, but it is still more likely to happen to them. The fact that families with lower socioeconomic status are overrepresented is important.

Breastfeeding is important. I was disappointed to hear that the family nurse practitioner programme, which we all support and think is good, has achieved only a 5 per cent level of breastfeeding. We need to question why a highly focused, low case load programme has achieved only 5 per cent, given how important it is to the group involved. Breastfeeding is another of the factors involved. We know that it protects against infection, but there is also an association with cot death rates.

The reduction in the number of teenage pregnancies, which the Health and Sport Committee produced a report on, is welcome. The trend is beginning to move in the right direction, but there is still substantial variation across the country in the levels of teenage pregnancy. It is critical that we follow up that report. It was not produced that long ago and it needs to be looked at. I feel that there should be school-level publication of teenage pregnancies. When I went to Oldham I found that that was instrumental in changing the approach to teenage pregnancy. Schools that did not believe they had a problem with it suddenly realised when the figures were given to them that they had a serious problem with it, which they then addressed.

There are other groups of mothers beyond the very limited tight group covered by the family nurse partnership who might also have problems. Drug and alcohol abuse is another factor involved. We need to make sure that those mothers are supported. Health visitors previously worked with those focused groups. We have now removed the most difficult people, or the ones most needing help or the most at risk. The ones who do not qualify for family nurse partnerships need to continue to be supported. In Fife, there was an excellent programme supporting 600 families, but that has now been somewhat damaged by the removal of resources into the FNP. Frankly, that is unacceptable and it needs to be looked at. I hope that the Government will do so.

I hear that the positive change programme in Glasgow has similarly had problems since the FNP was established, so that needs to be dealt with, too.

I am looking at the Presiding Officer to see whether I am still all right for time.