Westminster Hall
Tuesday 15 May 2007
[Mr. Bill Olner in the Chair]
Alcohol Harm Reduction Strategy
Motion made, and Question proposed, That the sitting be now adjourned.—[Kevin Brennan.]
9.30 am
Mr. David Burrowes (Enfield, Southgate) (Con): It is a pleasure to have secured the debate under your chairmanship, Mr. Olner. It is timely and important. When the Government published the alcohol harm reduction strategy they also promised a review of the strategy in 2007, during which they would “take stock” against “clearly defined indicators”. The Department of Health and the Home Office will soon publish a revised draft. This is, then, an important opportunity to engage with the Government directly, before publication. However, that opportunity has not been afforded properly to interested groups and individuals, by way of a formal consultation.
The answer to my parliamentary question about consultation, which I tabled on 30 April, reveals the different ways in which the Government deal with their drug and alcohol strategies. The response on the drug strategy was:
“A consultation document is planned to be issued alongside details of the consultation process in May/June 2007. The intention is to consult interested groups and individuals, including service providers and those affected by drugs—users, families and local communities. Subject to cross-Government agreement, the new strategy is likely to be published in late 2007.”
Moving on to the question of alcohol, the response was:
“A series of detailed discussions have been held with key stakeholders from the health, police, young people’s sectors and the alcohol industry to inform the development of the new Alcohol Strategy. The new strategy is due to be launched in summer 2007. A formal consultation is not planned prior to launch, but consultation is likely to be required on implementation of key aspects of the strategy.”
—[Official Report, 2 May 2007; Vol. 459, c. 1771W.]
Why is there no intention formally to consult in the same manner on alcohol and drugs? Does the Minister recognise the concern from different interest groups, including Alcohol Concern and the Wine and Spirit Trade Association, that the Government
“needs to be much more proactive and confident in consulting”?
Have the detailed discussions with key stakeholders included service providers, alcohol addicts and their families, and the local communities that are most affected by alcohol misuse? Even before the launch of the new strategy, a fundamental criticism of the Government’s approach is exposed in its process of review. That is the fact that alcohol is the poor relation in drug and alcohol policy.
The debate is important because alcohol consumption and the harm arising from alcohol misuse affect all our constituencies. The debate is less about the millions of people who enjoy drinking responsibly
than about the millions who do not do that, and who devastate many lives and relationships around them. It is a debate about binge and chronic drinkers; but such drinkers should not be the only focus of debate. The Government strategy is too limited. It fails to tackle the need to reduce overall consumption and alcohol harms. Indeed, that attitude is supported in many ways by the media, which play to our voyeuristic tendency to be entertained by the antics of binge drinkers. Mr. Olner, you may have seen recent television productions of that kind. We can too easily stereotype the problem of alcohol misuse, and comfort ourselves that it is someone else’s problem. However, increased consumption and harm are everyone’s problem.
Alcohol consumption has grown and spread. Consumption has doubled in the past 50 years, and it is up 15 per cent. in the past five recorded years. It is estimated that 8.2 million adults have an alcohol use disorder and that up to 3 million are alcohol dependent. Young women have doubled their consumption in the past 10 years, and children have doubled consumption in the past 15 years. Six million under-25s binge drink and 60 per cent. of 15-year-old boys binge drink monthly.
Many of the figures relating to alcohol harm will be familiar to hon. Members who are present for the debate, but it is important to explain the harms at the outset. Alcohol damages the economy. The total loss to the economy from alcohol misuse is estimated to be some £6.4 billion a year. Alcohol damages mental health: 65 per cent. of suicides are linked to alcohol misuse. Anxiety and depression are very common among heavy drinkers. Alcohol damages health: 22,000 people are estimated to have died each year as a direct or indirect result of alcohol—more than the combined number of deaths from breast and cervical cancer and MRSA, which often make the headlines. Deaths from alcohol-related liver disease have doubled in the past 10 years.
Alcohol damages through violence. At least one in three reported instances of domestic violence are known to be linked to alcohol. The British crime survey’s figures show that 44 per cent. of victims of violent crime believe that their attackers were drunk or under the influence of alcohol at the time of their attack. Alcohol damages public services. Hospital admissions resulting from alcohol abuse have increased steadily between 1997 and 2004 from more than 19,000 to more than 25,000. More than 3,000 of those admissions were of children. At peak times seven out of 10 accident and emergency admissions stem from alcohol abuse and the Department of Health estimates that about £1 in every £3 spent in A and E is alcohol-related.
Alcohol damages the young. Home Office figures state that among 16 to 24-year-olds 63 per cent. of males and females who admitted to criminal and/or disorderly behaviour were drunk during or after the event. Alcohol and drug misuse is the cause of permanent exclusion from school for more than one in 16 children. More than three out of 100 babies born could have been damaged by their mothers’ drinking during pregnancy. Alcohol fundamentally damages families. It is estimated that 920,000 children in the United Kingdom currently live in a home where one or both parents misuse alcohol. Marriages in which one or both partners have a drink problem are twice as
likely to end in divorce as those that are not affected by alcohol. The list could go on.
The Government need to be more open about what they want to achieve by their strategy for alcohol. Do they seriously want to reduce overall consumption and alcohol harms? If so, a more strategic approach is needed, recognising the impact of price, regulation and availability; alcohol misuse should have the same public health status that tobacco and obesity currently have. The 2004 strategy, like many strategies emanating from the Prime Minister’s strategy unit, is strong on fine-sounding words but weak on delivery. To take one aim—improving health and treatment services—it is estimated that alcohol-related harm is at least six times worse than the harm related to drugs, but alcohol services continue to receive far less than drugs services.
It is extraordinary that the Government have developed a treatment policy with a pooled treatment budget, targets, monitoring and all the paraphernalia of bureaucracy that go hand in hand with the Government’s top-down initiatives, but that they have failed to include alcohol in that treatment policy, leaving it as the almost exclusive preserve of drugs. For a Government who pride themselves on their target-led approach to health and asserting their key health priorities, it is significant that the alcohol strategy discussed the importance of
“Setting goals and monitoring progress”
“There is no comprehensive target for reducing the harms caused by alcohol misuse”.
Guidance notes for primary care trusts have been published, including on programmes of improvements and models of care for alcohol misusers. The result of the strategy is much paperwork, but the impact in increased access to treatment has so far been limited, as local commissioners have determined their actions without national targets to guide them. The lack of dedicated funding and the absence of alcohol monitoring in the quality outcomes framework have meant that alcohol issues have not been prioritised by many PCTs. The alcohol strategy has failed to set out a framework of national, regional or local targets, or drivers to increase access to treatment for problem drinkers. That has left 17 out of 18 problem drinkers, on average, without access to the specialist support that they require. The Prime Minister’s constituency of Sedgefield suffers from being in the region with the highest incidence of problem drinkers and the lowest access to treatment, with barely one in 100 able to find any kind of treatment. I doubt that the other 99 would agree with the Prime Minister’s foreword to the strategy, in which he said that it would
“in time, bring benefits to us all in the form of a healthier and happier relationship with alcohol.”
In stark contrast to the 2002 drug strategy, there are no targets to increase the number of problem drinkers in treatment, or reduce alcohol misuse in general. Also, no funding is ring-fenced for alcohol treatment services, and it is unclear how much money goes to alcohol services. There are no centrally held figures beyond the global figures that the Minister gives in parliamentary answers, so I have conducted my own survey of primary care trusts across the country. It is
significant that of the 66 PCTs that have so far responded, only 39 know how much is spent on alcohol rather than being absorbed by the drugs budget. Most have responded that only a small proportion is given to alcohol treatment and that they do not think that the amount allocated to alcohol is sufficient.
In 2006-07, of the 39 PCTs that supplied separate figures for alcohol and drugs services, the average spent on alcohol was £424,500, compared with the average of £3,832,000 that is spent on drug treatment. So, alcohol treatment receives about 11 per cent. of the amount that is allocated to drug treatment. The survey shows that the 20 PCTs that were able to provide the relevant data for 2006-07 will spend an average of 0.72 per cent. of their total annual budget on drugs and 0.15 per cent. on alcohol.
The situation in Enfield illustrates the reality: the strategy has not made tackling alcohol misuse a priority. The answer to a parliamentary question in March revealed that £1.5 million had been identified
“to support various ‘Choosing Health’ White Paper initiatives including alcohol treatment services.”
But there was, as always, a caveat. The answer goes on:
“It is for PCTs to determine how to use the funding allocated to them to commission services to meet the healthcare needs of their local populations.”—[Official Report, 5 March 2007; Vol. 457, c. 1681W.]
The Minister might, in her response, be quick to extol the virtues of PCTs having self-determination, but managers at the cash-strapped and top-sliced Enfield PCT would say that they do not have a choice. It has a £13.1 million deficit and a priority to meet other central targets, which means that alcohol services inevitably lose out. There is no funding for any specialist alcohol treatment services in Enfield to support the good work that is being carried out by Rugby house and the service providers at Central and North West London NHS Foundation Trust mental health and substance abuse services.
Enfield has squeezed out of its drugs budget some support for alcohol addicts. Its focus on excluded and disadvantaged sections of our community is welcome and chimes with the words on page 5 of the alcohol harm reduction strategy, where it proposes
“better help for the most vulnerable—such as homeless people, drug addicts, the mentally ill, and young people. They...need clear pathways for treatment”.
However, that is not happening in Enfield or in many other places. It is madness that although patients might be addicted to both illicit substances and alcohol, there is a division between those services. One service might not treat illicit drug abuse until the patient is detoxed from alcohol, and the alcohol services might not detox a patient whilst they are addicted to illicit drugs, hence the patient does not get access to appropriate treatment. Drug action teams are encouraged to take the lead with alcohol strategy, but they refuse to do so in Enfield because they do not receive the funding.
The strategy speaks about piloting schemes to find out whether the earlier identification and treatment of people with alcohol problems can improve health and lead to longer-term savings. That all sounds good on paper, but the PCT in Enfield has cut the £82,000 allocation that was intended for alcohol screening in
the accident and emergency department. Will the Minister tell us how that decision fits in with the strategy?
The situation in Enfield is not due to a lack of effort on the ground. The alcohol strategy manager there is doing a fine job, and Enfield is one of only six London boroughs that has such a strategy management consultant. There have been significant results with crime and disorder in Enfield as a result of the dedicated support of a co-ordinator pushing up the alcohol agenda across services in Enfield and because of joint working with the police and probation, particularly on domestic violence. Despite the strong multidisciplinary approach and partnership to tackle alcohol misuse, however, the PCT is unable to allocate funds to plug the funding gap, especially with tier 3 alcohol treatment.
The lack of a serious and resourced strategy to deliver real progress on the ground means that alcohol treatment is left predominantly to small voluntary sector organisations such as local Alcoholics Anonymous groups and 1NE Beulah road, which are beacons in the desert of treatment. There is a highly effective and cost-effective abstinence-structured day care programme for alcohol at 1NE Beulah road, which has no direct or reliable source of funding despite the fact that most of the people who use the service there are referred from the statutory sector.
An area that the 2004 strategy avoids, which I would like the Minister to consider, is the control of supply and availability. Government policy has been to liberalise the main drivers of consumption—regulation and taxation—but where does that policy fit in with the strategy to reduce harm? The rising levels of alcohol misuse in recent years, the state’s power to sanction the manufacture and sale of alcohol and its potential power to control the availability and price of alcohol all inevitably give the Government the lead responsibility to minimise the harm that alcohol causes, not least because of the cost to the public purse. However, the 2004 strategy rejected tax as a means of tackling harm. In so doing, it rejected substantial scientific evidence that the price of alcohol is one of the principal influences on levels of alcohol consumption and harm, whether we like it or not. Will the Minister review the evidence that supports the idea that duties should be based on the alcohol content of the drink and should be used as a means of controlling alcohol problems?
I am not sure what the Minister’s career prospects will be in seven weeks’ time or whether she is feeling demob happy, but I invite her to boldly go where no Minister of Health has gone before in terms of alcohol policy. Professor Chris Cook, who is a consultant psychiatrist in alcohol misuse, has said:
“The enormous popularity of alcohol—our ‘favourite drug’ can make wise evidence based policies politically unattractive...It is not enough that debate about matters of production, distribution and consumption are conducted simply in terms of scientific opinion, political expediency and consumer choice. Alcohol policy should also be based on soundly reasoned ethical principles.”
I invite hon. Members and my hon. Friends to debate this matter, and urge the Minister that we should have an alcohol strategy based on such principles.
Mr. Bill Olner (in the Chair): I want all hon. Members present who want to speak in this very important debate to be able to do so, but we must give sufficient time for the Minister to answer all the questions that are put to her.
9.47 am
Mrs. Janet Dean (Burton) (Lab): I am pleased to take part in the debate, and I congratulate the hon. Member for Enfield, Southgate (Mr. Burrowes) on securing it and on raising serious issues of alcohol abuse.
A minority of people misuse alcohol, and most people enjoy it responsibly. Burton-on-Trent is the capital of brewing, so alcohol is important in my constituency for jobs in the brewing industry and pub companies present in the town. Like the industry, I believe that it is important that people drink responsibly. We can tackle the misuse of alcohol only if we all work together. That includes local and central Government, the industry and the police, where necessary. Of course, individuals must also be involved—they must be responsible for their own drinking habits.
We have made progress in the past few years. One example of progress is the “Challenge 21” initiative to tackle under-age sales. I do not know whether other hon. Members have been into retail establishments in their areas to promote “Challenge 21”, and encourage vendors not to sell alcohol to young people unless they appear to be over 21. That approach gives more leeway and makes it easy to identify people who should be challenged to produce proof of age cards if they do not look over 21. All sectors of the industry—both on-trade and off-trade—have been responsible in developing that policy.
The on-trade self-regulatory regime has been developed to eradicate irresponsible retailing, and there has been a great deal of progress there. Pubs, in general—this is certainly true of responsible pubs—try not to have happy hours or two-for-the-price-of-one offers, and do not encourage people to drink as much as possible in the first hour that they are in the pub. There has been movement on this, and we should thank the industry for developing and working with the on-trade.
Recently, the Drinkaware Trust was established. It is supported by the alcohol industry: producers and both the on-trade and the off-trade. I am trying to give credit to all those who have been involved. It is early days for the Drinkaware Trust, but I am sure that it will help to promote sensible drinking and to educate young people, in particular, about the importance of not abusing alcohol.
Ongoing discussions are taking place about labelling alcohol in respect of its strength. That is particularly important, because much stronger wines are now available and because although cider may not seem to be strong, it is tremendously strong. We need to know the exact strength of the alcohol that is on sale.
| Next Section | Index | Home Page |