 Ysgol ddannustag yn ddesgan, yr cyflaesio sy'n cyflaesio ond unrhyw 1, 2, 7, 2, 3 o ffrind yng ngyngh aggressor dechrau McDougal ym unrhyw bryd i'r cyflaesieidllach Cocas. Yn gymhysgol ydi, mae gennym ni eisiau yn ddod. Byddwn ni, yn ddod yn cyflaesio'n cyfan o gyflaesio eich cyflaesio eich cyflaesio ar gyfer p torso o dechrau ei fod yn ddod, ac mae yn bryd o'r cyflaesio ar gweithiwr sy'n cyflaesio'n cyflaesio. Felly gennym mwy o'r ddefnyddio gyda ni i ddypa'r sydd yn ddymae, mae gennym hi fyddion yn gynticlesu i ddweud o'l yr oedd dweud o'n ddefnyddio sydd yn ddypa i ddymae. Rhywun o'r ddefnyddio ddymae mwy o ddymae eu ddymae fyddion yn ddymae i ddymae ar gyfer eich byd i'r ddymnt, mae gennym hi fyddion yn gweithio ei ddymae llawer i ddymae a dymae i ddymae i ddymae. Felly, gallwn i'n ddweud o derbyn o dduno i ddymae i grwp B Strep S targeted The campaign to introduce group B streptococas or GBS testing was first brought to my attention in 2013 through Jackie Watt from Cowinning, the grandmother of baby Lola, who tragically died after contracting strep B shortly after her birth at Crosshouse hospital. I'm delighted to say that Lola's parents Tracy and Stephen now have two beautiful daughters, Brooke and Ellie, who are both thriving. I'd like to congratulate Jackie Watt for her stoic campaign to raise awareness of GBS and to have testing offered in Scotland. Jackie's petition, awareness of strep B in pregnancy and infants, is currently being considered by the Scottish Parliament's petition committee. GBS is the most common cause of life-threatening infection in newborn babies, and it lives normally without causing symptoms in human intestines and genital tracts. But it can be passed from mother to baby at the delivery stage of labour, and unsurprisingly is the single biggest risk factor for a newborn baby. Given this, you might have thought that public awareness would be high. However, as my motion states, this is not the case, and there is a lack of public awareness regarding GBS and the effects that it can have on newborn babies. In the UK, it has been estimated that strep B infects over 500 babies a year. Sadly, 50 babies die as a result of contracting strep B, and around 30 suffer lifelong physical and mental disabilities. The charity Group B Strep Support has found that incidents of early-onset GBS are higher in Scotland than in the rest of the UK, and that the Scottish rate has increased from 12 in the year 2000 to 25 in 2014. That may seem like a small number, but in my view even one is too many when it is preventable and can be identified through a relatively simple and inexpensive test costing around £15 in the private sector. Indeed, 22 developed countries, including the USA, Canada, Germany and Spain, offer routine testing for GBS at 35 to 37 weeks of pregnancy. I have recently discovered that in the UK, around 60 per cent of obstetric units are offering testing to some or all pregnant women, while 76 per cent are carrying out tests at the mother's request. Despite that, the fact that the Royal College of Obstetricians and Gynaecologists does not recommend routine testing. However, the Scottish Government is not bound by this approach and is free to issue whatever guidance they may wish. Routine screening of GBS has proven to be effective. For example, in the US, where screening was introduced in 1996, rates fell from 1 to 0.24 per 1,000 live births in 2013. The University of Birmingham carried out studies into the cost of effectiveness of introducing routine screening for GBS. It found that £427,000 would be saved for every baby death avoided, and £32,000 would be saved per infection avoided. Those figures are, of course, estimates and will vary. However, other cost-benefit analyses have found screening as more cost-effective than risk-based approaches. Given the current financial pressures on the NHS, can I ask the minister to say in her summing up whether the Scottish Government will consider carrying out its own cost-benefit analysis to see how much could be saved by adopting routine testing? I do understand that there are some concerns around testing, such as the safety of using antibiotics during pregnancy, the willingness of patients to accept testing, and the enriched culture medium or ECM test not being reliable. However, the recommended antibiotic that is used is penicillin, which is narrow spectrum safe and effective against GBS. Most people know if they have a penicillin allergy and can be offered an alternative. On the criticism of the ECM test not being reliable, it is correct to state that it isn't 100 per cent accurate and, indeed, it won't identify which babies will develop early onset GBS infection. However, it is much better than relying on risk factors alone, which is the current guidance, and it is highly predictive of GBS carriage status when done properly within five weeks of delivery. Essentially, we must remember that ECM is a test to identify risk not to diagnose a condition. Trusts such as Guernsey and North West London hospitals offer universal screening, and that has been welcomed by patients and health professionals alike. Previous surveys on screening have also found that health professionals want to be able to offer anti-natal testing for group B stress using ECM tests, while women would like it to be offered and where universal screening has been introduced, infection rates have notably fallen. To conclude, I hope that today I have laid out a firm argument as to why routine GBS testing should be offered by the NHS in Scotland. It is, as studies have shown, cost effective, and on every piece of data, universal testing has been proven to dramatically reduce incidences, while risk-based testing seems to see an increase in incidences. In my view, the guidance from the Royal College of Obstetricians and Gynaecologists has been overtaken by events, with more and more maternity units offering testing regardless of the guidelines, or indeed, as I have said earlier, introduced universal screening. Given that the Scottish Government is not bound by this Government, I urge the Scottish Government to introduce updated guidelines so that there is no consistency and standardised care across all hospitals, and the expected mothers can be confident that they are receiving accurate information about GBS, and whether they can be offered routine testing or be given information on how testing can be assessed privately. I would also like to ask the Scottish Government if it will consider carrying out cost-benefit analysis to find out what the benefits of that would be, so that no other family will have to suffer the trauma experienced by the parents of baby Lola. I now call on Dennis Robertson to be followed by Rhoda Grant. I thank Margaret MacDougall for bringing this important debate to the chamber this evening. The death of any child, Presiding Officer, is very traumatic for the parent, especially at a time when we should be in a state of joy and celebration. I cannot imagine what it would be like to have a newborn or a small infant die when everyone else is hoping, as I say, to celebrate. It must have been a dreadful situation for the parents of Lola, and certainly it is something that, if preventable, then it is something that we should perhaps try to ensure that it is so. Margaret MacDougall says that the current evidence has suggested or has been overtaken, to some extent, from the Royal College of Obstructions and Gynaecologists. In looking at their website, I note that the Royal College had another evidence-based session to look at this whole aspect of GBS. It concluded, just in December 2014, that the situation should remain the same, that there should be no routine screening. It is strange, to some extent, given that they were updating the information. If it is felt, as Margaret MacDougall has said, that there is a benefit not just to the families who are expecting a lovely newborn, but to the baby who will suffer the consequences of strength being. The consequences for the newborn baby are not particularly nice. For some, it can lead to ameningitis, which can cause deafness, blindness and other symptoms. Sometimes they are short-lived, but I dare say for the parents with that young baby, they are going through a very traumatic and full of anxiety at the time, not knowing if their little baby is going to live or not. Presiding Officer, there is a risk. We have to be mindful of the risk. If the clinicians are stating that there is a risk to carrying out the process routinely, perhaps we should listen. However, they also state that, in the high-risk categories, there is not a problem with going ahead with the screening. We should be looking at the criteria of what is high risk and what is not. If parents have the information available to them, it is crucial that they need the information available to them so that parents can be informed and make that choice. I believe, Presiding Officer, that there are occasions when parents' choice is perhaps better than clinical choice. I think that if the expected parents believe that that is in their interest and the interest of their newborn baby, or the baby to be born, then that test should be carried out. I hope that, in conclusion, when the minister is summing up, that it may be taken to cognisance that parents' choice is against clinical choice. It is vital that we keep reassessing our approach to conditions like GBS and its prevention in order that Scottish patients receive the most appropriate treatment. In Scotland, patients are screened for GBS infection if they are deemed to be at risk. However, a number do fall through the net, and that can have terrible consequences. A child who contracts GBS is at risk of death or disability. That must be heartbreaking for the mother. Knowing that a bacterium that she carried, largely harmless to herself, has caused a problem for her child. That is why we need to continue to reassess how we deal with that condition. There is also an on-going cost to the state, estimated at £67 million by the 2007 health technology assessment study. Many more cases of GBS infection in newborn babies could be prevented by routine screening to identify all women who are actually carrying GBS, rather than using the current strategy of screening those with risk factors, but who might not actually be carrying GBS. The test itself does not carry a risk. However, there are concerns about its accuracy and the fear that routine testing could lead to many thousands of women being offered antibiotics that they do not need. The use of antibiotics in pregnancy and labour are the subject of increased concern, and current UK guidance recommends unnecessary use. Studies in the US have shown that antibiotics carry a risk in pregnancy only when they are broad-spectrum rather than the recommended narrow-spectrum antibiotics that are used here for GBS infection, as Margaret mentioned in her speech. There are concerns about antibiotics causing a negative effect on mother and baby, but those have mostly been disproven. More widely, there are concerns about growing antibiotic resistance due to their overuse, which rightly leads to reluctance to prescribe unless it is absolutely necessary, but that is said when lives are at stake. Surely, that should be used. There are concerns that the test can only tell if a woman is carrying GBS, not if their unborn baby will become unwell, and testing cannot completely predict which mothers will or will not have GBS by the time they go into labour. Up to 49,000 women per year, whose tests would say they have GBS, will actually be clear by the time they give birth. Conversely, up to 43,000 per year of those women whose tests came back clear might actually be carrying GBS by the time they go into labour. Therefore, those who needed no treatment could be unnecessarily treated, while those who tested clear could be given a false sense of security. That said, as a result of the screening programmes, a number of GBS infections in newborn babies has fallen significantly in other countries, in the USA by over 80 per cent, in Spain by over 86 per cent, Australia 82 per cent and France by nearly 72 per cent. However, in the UK, where routine screening for GBS is not offered, the incidence has increased, leaving more babies exposed to this life-threatening illness. Therefore, it may be that a number of approaches need to be taken in order to offer the greatest protection, possibly routine screening, combined with retesting, if risk factors are present. It is a complex issue, but at its heart is the safe delivery of healthy babies, and we cannot be complacent. We need to learn from other countries where they have succeeded in saving lives and preventing disability. I therefore urge the Scottish Government to look again at the issue to ensure that we are offering the best care for unborn babies. Many thanks. I now call Dr Nanette Milne to be forwarded by Margaret McCulloch. I, too, would like to commend Margaret MacDougall for bringing this important but difficult issue to the attention of Parliament and for gaining cross-party support for her motion. As we have heard, group B-stripped cockle infection is an uncommon, though potentially very serious and indeed life-threatening infection of neonates and young infants. In the first week of life for early-onset infection and up to around 90 days for late-onset. Streat B is a bacterium which lives in the gutter vagina and sometimes in the back of the nose and throat. It is usually harmless to the person carrying it, and of the 20 to 30 per cent of pregnant women estimated to be carriers, 99 per cent of their babies are born without any health complications. Very rarely, GBS infects a newborn baby through transmission from the vagina during labour, and this is symptomised by the baby being lethargic, not feeding well, being irritable, with abnormally high or low temperature, heart rate or respiratory rate, and the blood pressure may be low. Around 60 to 70 per cent of GBS infection is early-onset, developing within the first seven days of life. When the diagnosis is made, speedy treatment of antibiotics, usually penicillin, is very effective. Late-onset infection occurs after the first week and up to around 90 days, and it usually causes meningitis, which, again, may be treated very successfully when diagnosed. Sadly, there are a small number of babies who suffer very serious consequences, such as deafness, blindness or brain damage, and a few who will die of complications. GBS, although it rarely causes significant harm, has to be taken very seriously, and parents and the people looking after pregnant mums should keep it in the back of their mind in the later stages of gestation. As we know to this end, the Royal College of Obstetricians and Gynaecologists has drawn up guidelines on the prevention of early-onset neonatal GBS and has also produced educational material for patients and their care. NHS boards have also produced circulars detailing the main risk factors. I have seen, as an example, the information circulator to draw staff and managers involved in obstetrics by Forth Valley in 2013, and it is detailed in its guidance on the prevention of early-onset GBS and on the management of babies born to mothers with it. Nonetheless, the group B steps support charity has claimed that there is a poor understanding of GBS by midwives and other professionals, and they claim that countries with a national screening programme—and we know that there are several—have lowered the rate of infection, and their demands for routine screening are based on the experience of those other countries. That is why I said at the outset that we are this evening discussing a difficult issue, because the UK National Screening Committee, which gives expert advice on screening issues to the NHS and ministers in all four parts of the UK, advised in 2012 against a national GBS screening programme for pregnant women on the grounds that the benefits of such a programme would not outweigh harm. That advice was repeated again last year. Several reasons are given for the recommendations, and I think that it is worth repeating them. However, many women carry strip B, and most of their babies are born safely and without infection. Screening all women in late pregnancy cannot predict which babies will develop a GBS infection. Moreover, testing is not reliably accurate, and false negatives are possible, with carriers testing negative, and most babies who are severely affected by GBS infection are usually born prematurely before the suggested time for screening. Trying a large number of women carriers at very low risk would get unnecessary treatment, and the overuse of antibiotics may well lead to the development of antimicrobial resistance, which, as we know, is a serious problem for the modern NHS. I have a great deal of sympathy with the concerns of the people who are seeking screening for pregnant women, because to have a badly infected baby is one of the worst nightmares a mum can have. However, I also understand that Governments have to rely on their expert advisers to give them the right information before they embark on new regimes. Equally, I have no doubt that those who are lobbying for a change of heart will continue to make their very valid case, and that experts will revisit their decision and look at the facts again in future years to see if there are any new factors that might change their opinion. To me, the most important thing to be done at the present time is to ensure that all concerns are made aware of GBS and that steps are taken to reinforce that awareness on a regular basis by whatever is considered to be the most effective means in a 21st-century society. Thankfully, GBS infection is not common, but one serious complication or death is one to many, and I am sure that we will all agree with that. Many thanks. I now call on Margaret McCulloch, after which we move to the closing speech of the minister. In beginning my contribution this evening, I would like to congratulate my colleague Margaret McDougall for securing this debate on awareness of group B strep. Indeed, I want to commend all those members who have highlighted this issue in some way over the last four years, Margaret McDougall, Rhoda Grant, Annette Milne and Kenny Gibson. I also want to pay tribute to Jane Plumb, chief executive of group B strep support, and Jackie Watt for their passion and persistence in raising awareness about the bacterium and the risk that it poses to the youngest infants in Scotland and babies yet to be born. They have been pursuing this issue through the Public Petitions Committee, arguing the case for a more comprehensive screening and asking challenging but always fair and informed questions of the Scottish Government and the health professions. Equally, the committee has received some valuable and useful evidence from the Government and others highlighting the existing practice and the work that is already under way to address group B strep. There is an important debate under way as to how we prevent this bacteria leading to infection and illness in newborn, illnesses that can put precious young lives at risk. Why are so many mothers unaware of strep B? Is our approach to strep B out of kilter and out of kilter with some of our nearest neighbours like the Republic of Ireland? Why do we test and screen more women? Why do we test and are we testing them in the right way? Those are the issues that we need to grapple with. A brief intervention, obviously, making parents aware is paramount as well. Does the member agree with me that the Scottish Government is listening to the Petitions Committee and is revisiting the information on the ready-steady baby? That is to be welcomed. Well, if that is what the Government is doing, I welcome that. That is really important. There are also issues that women who are pregnant are not aware of strep B. They are also not aware that they can damage the babies seriously. If they cannot get it tested through NHS, they can go and do it privately as well. That information is on the Public Petitions Committee website, but not everybody actually accesses that information and knows that it is there. Group B strep can be present in many women and it can go unnoticed without causing any harm and without any symptoms manifesting at all. However, for pregnant women, strep B can be a cause of bacterial infection in their newborn babies. In the UK, around 340 babies develop an early-onset GBS infection. Most babies who are infected can be treated successfully. They will go on to make a full recovery and have a healthy and happy infancy. It says before, but for some, infection can be much more serious. It can lead to septocemia, pneumonia and meningitis and it can be life-threatening. Some of those babies will never fully recover. They could live for the rest of their lives with blindness or deafness, learning disabilities or cerebral palsy. Others will die. What concerns me about the level of early-onset GBS infections is that it has remained static in the rest of the UK but, as the motion sets out in Scotland, the rate has risen. That is not a huge number of cases but, as I have explained, the consequences can be devastating. It seems logical that the Scottish Government should therefore consider the merits of arguments being presented by people like Jackie Watt. Her concern is that cases are slipping through the net because our approach concentrates on women who are affected by certain risk factors. They might experience certain illnesses in their pregnancy or they might have their child prematurely. She would also advocate following the example of other developed countries where women are screened more generally and antibiotics are administered more widely. We do not want to provide intravenous strips to anyone if it can be avoided, but best practice from elsewhere suggests that administering antibiotics to more mothers helps to prevent early-onset infections. We want to follow the best medical advice from bodies such as the UK National Screening Committee, but equally we could test more women. It was suggested in evidence to the Public Petitions Committee that clinicians in Scotland could be ahead of the curve in supporting more women to be tested. However, questions were raised about whether testing is equally robust enough, given that we do not have a consistent set of guidelines to direct a more general approach to testing. I simply put it to the Government that the recorded increase in incidences of infection should focus minds and allow us to take a closer look at how we reduce the risk of GBS to the health of newborns. Margaret MacDougall and the Stretby campaigners have brought an issue of the utmost importance to this Parliament. We must hear the voices of those campaigners, we must interrogate the evidence before us and we must do all that we can to protect the next generation. I thank everyone in the chamber for their contribution to this debate and the points raised. Many members have raised very valid points, and in many cases, such as Rhoda Grant and Annette Milne answered the points that they raised. It is without doubt distressing that all involved—sorry, it is without doubt distressing—to all involved when a baby dies. I would like to express my deepest sympathies to the families affected by this infection. I would also like to reassure all in this Parliament today that the Scottish Government is absolutely committed to quality, safety and person-centred care of mother and babies in the NHS throughout Scotland. Care is based on best practice and guidelines underpinning use within the NHS. Those are not developed in isolation. They are as a result of consideration of the best available evidence. As many of you here tonight are aware, evidence on group B, Streptococcus, was extensively reviewed in November 2012 by the UK National Screening Committee. That independence expert advisory group used all the available medical evidence of the risks and benefits of screening all pregnant women. Indeed, the evidence base examined was the largest the NSC has been required to look at and also included extensive comments from interested groups and members of the public via a public consultation. This committee agreed that a national screening programme for group B, Streptococcus, should not be introduced, and the NHS in Scotland is following that advice. I am sure that members would agree that all work that we do should be evidence-based and we must listen to professionals. However, if the evidence change and the advice of the professional change, of course, Governments will respond to that. Many of you are aware of the reasons that have been stated for the position among which testing cannot completely predict which mothers will or will not have group B, Streptococcus, by the time they go into labour. As Anette Mill pointed out, it can have it at one point in time but not later on. Similarly, it can have it not later on and then develop it later. The estimates suggest that between 13,000 and 49,000 women each year who test would say that they have group B, Streptococcus, will actually be clear of the virus by the time they give birth. Just to clarify, 17,000 to 25,000 pregnant women in the UK would need to be treated with prophylactic antibiotics each year to prevent one death from group B, Streptoccus. That is approximately one in 30 pregnant women. I thank the minister for taking the intervention. Would you please agree with me that perhaps reducing the anxiety with the parents it may be better to test than the risk to the unborn child through high anxiety of the expectant mother? I will come on to the point that Dennis Robertson raises. We need to be absolutely clear that screening is not a risk-free option. There are implications that I am sure that you are all familiar with, including microbial resistance to antibiotics and the risk to some women of allergic reaction to antibiotics in pregnancy. I am sure that all women who have been pregnant will know that they do not want to take any drugs during pregnancy that they do not actually need. Another point that I would like to pick up on is the introduction to the chamber of various statistics around the rate of infection in Scotland. I would like to caution against that, given that infections are not notifiable under the terms of the Public Health Scotland Act 2008. Surveillance of Streptococcus B infection in Scotland is based on laboratory-confirmed reports that are received through the electronic reporting system called ECOSS, which stands for electronic communication of surveillance in Scotland. Although there are limitations with the data, particularly prior to 2009, when ECOS had not been fully implemented, the figures show that the number of laboratory-confirmed reports of group B streptococcal infections, including early and late-onsent infections, has not changed significantly in the past six years. Despite all that I have said, I can categorically state that I agree with everybody that a death even of one baby is one too many. That is why I am reassured that there is a programme of research under way to develop improved practices in the management of potential group B streptococcal infection. Those research studies include looking at appropriate rapid identification methods. As much of this research is due to be completed around the end of this year, it is hoped that the NSC will be in a position to evaluate the case for a screening programme with the most up-to-date evidence later this year or early next year. I am also reassured that we are developing better communications for pregnant women on the issue, as the net mill said in her valuable contribution and as Dennis Robertson has just indicated. An example is the ready-steady baby, which is an informative booklet, website and mobile phone app for expectant mothers. This source of information, which was funded by the Scottish Government and given to all expectant families in Scotland, has recently been updated to include two sections on group B streptococcus. I think that it is exactly this, Presiding Officer, about having the conversation between clinicians, midwives, maternity nurses and the families about the risks. There will be families where the risk is higher, for example in mothers who have previously given birth to a baby who has had the infection, women who have high temperatures or other symptoms of infection during labour, women who have had urinary tract or vaginal infections. We need to have that conversation. We need to make women more aware of the risks, especially if they have had those kind of symptoms and that they have the conversation about whether testing and medication is necessary. I would like to conclude by saying that, while I freely accept that progress and practice around this infection may not be moving fast enough for some, I would like to assure the chamber that progress is being made and that I will maintain a keen interest in ensuring that the best possible evidence is put into practice for the mothers and babies of Scotland.