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29 Jan 2008 : Column 50WH—continued
As the hon. Gentleman said, the pathways to work scheme has dramatically decreased the number of people taking up incapacity benefit, who as a result are able to return to work more quickly. We will invest £1 billion in that programme over the next three years so that
interventions will be available to as many people as possible, including support to help them manage impairments or health conditions.
We are also looking at new and innovative ways of delivering our services. For example, when I was last a Minister in the DWP a couple of years ago, we started placing Jobcentre Plus advisers in GP surgeries, through the pilot for our pathways advisory service. That initiative proved popular and has been well received by patients and GPs. The advisers have been supporting GPs or offering advice to their patients and, when appropriate, referring them to our wider range of provision. The pilots were on a small scale, but some strong local partnerships have been established. I am pleased to say that we are extending the pilots so that we can learn as much as possible and make the most of that new way of working. That point chimes well with the ten-minute Bill to which the hon. Gentleman referred, and which is promoted by my hon. Friend the Member for Glasgow, North-West (John Robertson) and will be debated in the House this afternoon. The Bill would ensure that, if people encountered disability or ill health, their chances of staying in work would be maximised and they would not needlessly have to leave their jobs.
Our wide variety of specialist disability employment services has opened up work options for many disabled people across the country. We have seen people develop their skills and confidence in open employment and in supported businesses. However, we need to go further still if we are to have a better, more consistent quality of service, and a clearer focus on the individual needs of every disabled person, recognising that there is a great variety of circumstances in which people need help. We are looking at how better to join up our services with those provided by others, including local authorities, and to improve the way in which our disabled customers can move from social services and education and to seek work that is appropriate to their interests and skills.
We launched a public consultation last month, outlining our proposals for improvements to our specialist disability employment services, and it will run until 10 March. I am pleased to hear that the hon. Gentleman will be responding to that consultation, and I hope that he will urge his constituents, including the organisations in his constituency to which he referred, and those of his colleagues who have an interest in the employment needs of disabled people, to consider and respond to the consultation.
We need to carry employers with us. The hon. Gentleman was right to say that they have a significant opportunity, because they are able to recruit from a large and diverse pool of possible staff. We should ensure that they can recruit from as wide a pool as possible, and not inadvertently limit the potential of their organisations by failing to tap into some of the potential of that pool of talent. Many businesses already employ disabled people and have good policies to support that work, and they are reaping the rewards.
However, research published by my Department last year highlighted the fact that although employer awareness of the Disability Discrimination Act 1995 and employer attitudes towards tackling discrimination have both improved over the past few years, there is still a long
way to go. I agree with the hon. Gentleman about that. We cannot simply hope that employers will change their perceptions of disability. We need to engage with employers and to support them. We need to work with them to open up more job opportunities to disabled people, and at the same time ensure that disabled people have the right support and the skills needed to apply for suitable jobs, to be successful in their applications and to be able subsequently to stay in those jobs. That will be a key focus of our future activities; for example, through our cross-Government health, work and well-being strategy and my Department’s EmployAbility campaign, we are working to engage employers, to explain the costs and benefits and to provide practical help to assist them in supporting their staff.
It is true that employers do not always understand the requirements placed upon them—the hon. Gentleman referred to data from the Employers’ Forum on Disability showing that employers do not always understand the needs of their customers or the support that might best help their employees to stay in work. We are committed to helping to improve that understanding and the support that is offered. Such support does not have to be difficult or expensive to introduce; it is often about making simple changes to workplace patterns and management practices rather than costly specialist equipment.
A practical example of our work with employers is the new jobs pledge, which aims to help 250,000 people currently on benefit to move into jobs through the new local employment partnerships. The Prime Minister, speaking yesterday at a major conference with employers at the Queen Elizabeth II conference centre over the road, reported on progress with those partnerships. More than 400 firms have now signed up for them, and negotiations are under way with a further 500.
I spoke yesterday to a number of employers, who were very positive about the help that they were receiving from Jobcentre Plus under the new partnership arrangements. I had the opportunity to sign a new partnership agreement with the chief executive of the fast-growing airline Flybe. I hope that many more partnership agreements will be put in place and that disabled people will be among those who benefit from the opportunities that result. We are building on the findings of the Leitch report on skills, working with the Department for Innovation, Universities and Skills and the Learning and Skills Council, both of which were involved in yesterday’s conference, to make the ambitions set out in that report at a reality.
The hon. Gentleman asked how we were getting on with the “In work, better off” programme. He will be aware that we have conducted a consultation on that topic, and I refer him to the document “Ready to Work”, our response to the consultation, which was published in December. We are also consulting on the future of our specialist disability programme.
I am grateful to the hon. Gentleman for giving me this early chance to set out our progress and our aims, which he shares. I welcome his interest in the subject, and I look forward to the opportunity to debate it further with him and others over the months ahead. I hope that I have made clear to the hon. Gentleman and to the House my commitment and the Government’s to equality for disabled people and to providing the employment support that they need and deserve, and to which they should rightly be entitled.
Alcohol Services and Rehabilitation Centres
1 pm
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) (Lab): It is always a delight, Mr. Marshall, to sit under your chairmanship, because, with your great experience and understanding, you know how important it is that Members of Parliament get the opportunity to raise individual but important questions in Westminster Hall.
On 8 March 1736, Mr. Pulteney rose to his feet in the House of Commons to speak against Sir Joseph Jekyll’s motion for a duty of 20 shillings per gallon to be laid on all spirituous liquors. He said:
“I believe it will be admitted by every Gentleman, that the constant and excessive Use of spirituous Liquors among the inferior Rank of our People, is a Practice which has of late Years grown to a monstrous Height, and it will be as generally and as readily admitted, that this Practice is dangerous and mischievous to the Health, Strength, Peace, and Morals of the People; and that it tends greatly to diminishing the Labour and Industry of his Majesty’s Subjects; therefore I believe we shall all agree in this, that some Method ought to be taken for putting a Stop to this Practice...The Distilling Trade is a Business which has been earned on by Royal Authority for about an hundred Years, and that it has been not only highly approved, but very much encouraged by several Acts of Parliament passed since the Revolution...There is not now an Inn, an Alehouse, or a Coffeehouse in the Kingdom, but what owes a great Part of its Profits to the Retail of such Liquors: By which Means there are now such Multitudes of Families in the Kingdom who owe their chief, if not their only Support to the distilling, or to the retailing such Liquors, that they very well deserve the Care and the Consideration of a British House of Commons.”
In other words, not a great deal has changed and the liquor industry still has an extraordinary powerful lobby in the House of Commons.
Some time ago, the Cheshire coroner, who is a most caring and considerate man, became so concerned by the rise in alcohol deaths within the county that he commented publicly. He made it very clear that, in his view, the doubling of deaths from alcohol, particularly among women, was not only a public health matter of great concern but something that should concern us all. He linked that doubling of deaths specifically to the numbers of cases that he was being required to deal with among young people, as well as among those who might be said to have reached the age where their abuse of themselves was somehow inevitable. Not only should his views be taken extraordinarily seriously but we ought to think about the impact of what we have been doing in this area.
Addiction is never easy to deal with. When I was a young and impressionable doctor’s wife, I had a rather sad feeling that, if one gave people support, that support would automatically lead to their ceasing to be addicted to particular substances, and of course alcohol is even more addictive than some drugs. However, the reality is, of course, that those who need a particular support or crutch and have become wholly dependent on alcohol need a lot more than encouragement. They need specialist services and consistent support in their homes, and then, over a period of time, if they are lucky, they will hit that moment when they can at least be weaned away to the point where they are no longer destroying themselves. That is not an easy moment to find, but it will never be found if, as a nation, we are not capable of producing those support services that are absolutely essential.
We accept that we have a very real problem with drugs and the Government not only discuss that problem quite consistently and openly but seek, with great vigour, to make it plain to the general public what the implications of drug addiction are. However, somehow or other—I believe that it perhaps began with my generation—alcohol is not regarded in the same way as a deadly poison.
Please do not misunderstand me; I like a drink. I like good wines, good brandies and good whiskies, although they do not always like me. Perhaps the advantage of living long enough is that one’s constitution begins to deal with things that one’s brain ought to have dealt with but has not.
However, the reality nowadays is that people not only routinely drink much more heavily than people did when I was young but they indulge in specific, targeted and I would have thought enormously boring bouts of binge drinking. One no longer needs to look too harshly at what is going on in Crewe and Nantwich to wonder about the changing social ethos and habits of people. It is almost impossible to walk from my office to the station in Crewe without passing 50 bars and pubs and they are all, of course, open for many more hours than they were originally.
One of my constituents came to me because, very sadly, she had lost a dearly loved son in a very sad set of circumstances; his death was due, of course, to alcohol abuse. He was young and she felt, rightly, that if there had been support services at the moment that he desperately needed them, he would have had at least a fighting chance of surviving. She then began to ask me what we were doing about the coroner’s remarks; what attitude the Government were taking to the provision of support services, and what was happening in my local health services. After all, the Government will not escape responsibility; if the Government are responsible for lowering the taxes on alcohol and for making it easier for people to drink, they must also seriously consider the downside of those policies.
How much are we spending in the education services for young people to encourage them to understand the damage and the very real destruction that alcohol can bring to individual families? How many beds are available, for use by consultant psychiatrists and by others within the hospital service who are specifically trying to deal with alcohol as a problem? Is it possible to admit people from accident and emergency departments into particular beds?
In parentheses, I would say that it is not just in Crewe and Nantwich that we have this problem. While dealing with someone in the London system within the last 12 months, I was told that the advice that he was given—in this case, it was from a consultant physician—was, “If you have sufficient money, admit yourself to this private unit, because there is no mental health or alcohol service available within the London region.” I must say that I would not admit a dog that I was fond of into the private unit that that doctor recommended, so I have very grave reservations about whether we are dealing with this problem on the best possible basis.
In Crewe and Nantwich, we have, with the agreement of the local county council and the local health services, very specialised assistance. It is, of course, provided on a voluntary basis. Central Cheshire Alcohol Services derives its money both from the local county council, which is soon to be dissolved, and from the health
service partnerships. Because of the Cheshire and Wirral Partnership NHS Trust, there are two nurses who are paid directly by the trust but who are managed on a day-to-day basis by the charity.
Those nurses cover a very large area and they have a lot of experience of providing support services. They also try very hard to work in partnership with the health service, the local authorities and the third sector organisations. However, the rise in the number of referrals to them paints a very alarming picture. In 1991-92, they had 182 referrals; that rose by 2003 to 590 referrals; it rose further in subsequent years, first to 687, then 807, and by 2006-07, the number of referrals had risen to 905. Furthermore, those referrals are just the smallest percentage of the cases that the nurses have to deal with.
It is clear that the demand for services totally outweighs the resources. There are 70-plus people on the Central Cheshire Alcohol Services waiting list for support. Although the organisation receives uplift money from the health service, there has even been some debate about whether it should still have access to the same number of beds.
There is clear evidence that binge drinking is on the increase, but there is no consistent education programme in the schools in my area. Furthermore, the mental health issues created by alcohol mean that mental health services are constantly being called on, but they will intervene only if the client has a severe and enduring mental health problem. Yet, alcoholism can result in real mental problems.
There appear to be no national targets for alcohol, and nor does there appear to consistent funding to support such targets. What is more, the Government have made it easy to access cheap alcohol. In Crewe and Nantwich, there are now many superstores where it is easy to buy not only beer and spirits, but any kind of alcohol, no matter how damaging it is. We are told that the supermarkets do their best to monitor trade, but only last week, a gang of youths, including several small children as young as 10, endeavoured to knock down the back door of my constituency office—luckily, it is made of steel—and all of them were drinking vast amounts of alcohol. Whatever safeguards we have in place, therefore, they are clearly not working.
Staffing numbers have not kept pace with the demand for services, and large numbers of volunteers are being used. When I raised the issue of alcohol services with the PCT, it was concerned. It has just opened a health centre in the middle of Crewe, so it is aware of the need to respond with all sorts of services. However, when people say, for example, that an alcohol liaison service is available in accident and emergency, we have to ask what it is doing. Does it have the right routinely to refer people to beds after triage? Does it accept that people have a long-term problem and will need specific detoxification and residential provision? Is such provision available? Have we looked at the need for services or at the commitment of the various partners to address alcohol harm across Cheshire? Are we convinced that services are co-ordinated? Unless there is a specific, targeted and well-understood commitment to provide highly specialised services, we shall allow large numbers of people to destroy themselves without having attempted to rescue them when that was still possible.
This is not a new problem, as the House of Commons record shows, and nor is it not understood. There is a powerful drinks lobby in this country, which has persuaded this Government and previous Governments that the extension of licensing laws and the availability of cheap alcohol are not only acceptable, but that they are the way forward, if we are not to be overtaken by events. The industry spends a fortune on advertising its wares, so it is aware of the need to recruit more drinkers.
Above all, the industry has created problems in many of our small towns and cities on Friday and Saturday nights, when groups of people—they are not only young people—inevitably become involved in all sorts of public disorder. We are familiar with the sight of young girls and young men who are virtually insensible. There are constant problems for the police, and there are the difficulties faced by those who want to use their town centres without experiencing the atmosphere created by drinking. Many of my constituents experience problems simply because of the general disorder that drinking creates, and that should not be acceptable in this day and age.
I am not saying that we should nanny people or organise their lives, but we must accept that the cost to this country’s economy and social ease and the effect on the quality of our constituents’ lives is largely determined by social problems to which we have contributed. We desperately need to accept—certainly in my area—that more money must be spent on alcohol services and that more problems must be confronted. Above all, Her Majesty’s Government must take responsibility. There is a direct link between the decisions taken by the House of Commons on fiscal and national health service matters and on the provision of services and what happens on the Crewe road on a Friday night. However, I know that this very intelligent and helpful Minister is going to say that she will solve some of those problems for me immediately.
1.16 pm
The Minister of State, Department of Health (Dawn Primarolo): I wish that I could give such absolute commitments to my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody). However, let me congratulate her on securing this important debate.
I want first to look at what is happening locally and to set that in the context of regional and national plans. I also want to look at each of the levels that my hon. Friend rightly identified: discouraging excessive drinking and ensuring that services are available in the community, that interventions take place to discourage drinking where it occurs and that the appropriate treatment is available in the complex and often tragic cases that my hon. Friend mentioned.
I am aware that Her Majesty’s coroner for Cheshire has raised concerns about the number of cases with which he has dealt involving alcoholic liver disease or alcohol as the primary cause of death. His experience contributed to his critical view of the services being provided, and he urged Cheshire county council to ensure that there was appropriate funding.
It might be helpful if I quickly describe the services that exist and say what will happen next, before moving on to the wider issues. Services based in the community receive referrals from GPs and others, and staff see clients at the service or in the client’s home, depending on the circumstances.
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