Hansard

No member in the chamber will argue against the principles of getting it right for every child—who can sensibly take an opposing view? However, it is one thing to support principles and quite another to work out what needs to be done to progress towards that agreed goal. It is even more difficult to put such plans into action and demonstrate how effective they have been in getting things right for more and more children.

I support strongly the research-based initiatives described by the minister. The progress that has been made is recorded in the evaluation of the Highland pathfinder approach. It is always satisfying to witness evidence-based policy being put into action. Nothing that I say today should be taken to minimise those achievements.

Getting it right for every child must start well before those initiatives. Events not only in very early life but even before birth can irrevocably shape a child's future. I will give some examples from my previous work as a general practitioner in Edinburgh. Repeated surveys of my former practice population, which largely covers an area of socioeconomic deprivation, regularly show a much higher perinatal mortality rate—the rate of deaths of babies either around childbirth or shortly after—than the more affluent parts of the city. That is certainly not getting it right for those children, but, to put it bluntly, a dead child gives no further problems of the kind dealt with in the "Getting it Right for Every Child" document.

The statistics show that the problem does not end there. A 2004 profile of south-west Edinburgh showed that the incidence of babies born with a low birth weight—babies whose birth weight is below the 10th centile for their gestational age—was 30 per cent higher than the Scottish average. Given that south-west Edinburgh includes several better-off districts, it is reasonable to conclude that the picture for my former area was even worse than that.

Why does that matter? It matters because lower-birth-weight babies are much more vulnerable than others. They are more prone to long-term ill health and retarded development, and they need more care in the neonatal period. They are frequently born to women who find it difficult to provide even basic care. Those mothers are often young—the rate for teenage pregnancies in the area is 90 per cent higher than the Scottish average—and unsupported, and they perhaps have physical and mental problems. The care of such babies as they grow up and into adult life demands a huge input from various agencies and is not always successful, so getting it right for those children involves doing what we can to remedy those issues before birth.

What can we do? I will not extend the debate into sex education in schools and the home, contraception for adolescents or similar controversial issues. I will say simply that any effective action that lowers the rate of unwanted pregnancies can only be beneficial. Poor diet, smoking or drinking alcohol in pregnancy and taking recreational drugs are all factors that predispose babies to poor birth outcomes, but all are remediable if vigorous action and support are offered.

Skilled and relevant antenatal care is a must. High blood pressure, vaginal infections and the development of anaemia are all conditions that are amenable to treatment but which threaten a baby's long-term health if they are left unchecked.

The effect of targeted interventions was shown spectacularly as long as 35 years ago in my practice. Public health specialists told us that, of the then 23 council wards in Edinburgh, our ward was fourth from the bottom of the league table for perinatal death; was fourth for the proportion of children with a physical handicap; was third for the incidence of congenital malformations; and had a higher than average rate of children who were taken into care. All our mothers had their babies in the hospital that most of the city used; the only difference was that a much higher proportion booked late and defaulted on their antenatal appointments.

I have no time to describe how a group of us altered the antenatal care system to suit our patient group's needs. I say simply that, after five years, our figures for neonatal mortality, admissions to the special care baby unit, premature birth and low birth weight had all fallen to below the Lothian average. The message is that careful tailoring of services can affect outcomes positively, to the benefit of children, mothers and society. It is unfortunate that the figures that I cited earlier in my speech show that the benefit has not been maintained. I have no time to give a detailed explanation, other than to say that it concerns a shift in focus in the delivery of maternity services away from prioritising safe pregnancies to satisfying more emotional or societal desires.

My message is that getting it right for every child means starting before birth, tailoring services exactly to meet the needs of the women in the communities that are served, and continuing that specific care and attention in the equally vital months after a baby has been born. In that way, the ambitions of GIRFEC might be more easily realised.