The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)
My Lords, I congratulate the noble Lord, Lord Brooke, on securing this important debate and on his obvious tenacity in pursuing this issue. I am sure that this will be the first of many occasions we will have to discuss this matter. I also thank all noble Lords for a wide-ranging, well-informed and informative debate.
I think all noble Lords accept that the vast majority of people who consume alcohol—whether in my noble friend Lord Smith’s clubs or elsewhere—do so as a pleasurable and indeed even positive part of their social lives. However, we also know there are very serious harms and health costs associated with alcohol misuse, which is estimated, as the noble Lord, Lord Brooke, and other noble Lords have pointed out, to cost the NHS around £3.5 billion a year. The recent Public Health England evidence review tells us that alcohol is now the leading risk factor for ill-health, early mortality and disability among 15 to 49 year-olds in England, causing 169,000 years of working life lost. That is more than the 10 most frequent cancer types combined—a truly alarming figure. As the noble Lord, Lord Colwyn, pointed out, that is having an effect in specific areas such as increases in oral cancers.
Alcohol misuse is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, a number of cancers, as has been said, and depression. Alcohol-related deaths have increased in recent history, particularly deaths due to liver disease, which saw a 400% increase between 1970 and 2008. As several noble Lords have pointed out, that is in contrast to trends seen across much of western Europe and, as my noble friend Lady Berridge pointed out, it is also in contrast to outcomes in many minorities in the UK. It is not so much a British problem as a problem of certain communities within Britain.
In the UK, there are currently more than 10 million people drinking at levels that increase risk to their health. Those health risks, as the noble Baroness, Lady Walmsley, pointed out, are both mental and physical. They lead to more than 1 million hospital admissions annually, half of which occur in the most deprived communities, so this is also an issue of social justice. My noble friend Lord Smith was right to point out the work that the police, the ambulance service and other public services do to deal with—mopping up, sometimes physically as well as figuratively—the results of alcohol misuse. I take this opportunity to pay tribute to their work; they often have to deal with both physical and verbal violence in doing so.
We also know the tragedies that can occur from mothers drinking alcohol during pregnancy, leading to problems after birth. This is not just a UK but a global issue. To address the challenges of the prevalence of fetal alcohol syndrome disorders, the WHO is starting a global prevalence study. We will consider lessons from this for further work in the UK.
It is also important to recognise the devastating impact that addiction has on individuals and their families. It is unacceptable that children have to bear the brunt of their parents’ conditions. I was shocked to learn that, according to Alcohol Concern, 93,500 babies under the age of one, which I make to be about a sixth or seventh of the cohort, live in a family where a parent is a problem drinker. As the noble Baroness, Lady Walmsley, pointed out, there is a link to domestic violence which affects not just children but also partners. My colleague, the Minister for Public Health and Innovation, recently met with members of the All-Party Parliamentary Group on Children of Alcoholics to set out our plans to work with MPs, health professionals and those affected to reduce the harms of addiction and support those who need it. I am sure that noble Lords will agree that that is an important mission.
However, I am glad to say that we can also observe some promising trends regarding alcohol. As my noble friend Lord Smith pointed out, the figures for alcohol crimes and deaths are down, although there are other problems which we have talked about. People aged under 18 are drinking less, which stands in stark contrast to the data for the over-65s who are drinking more—I am not looking at anyone here—and there has been a huge increase in the number of hospital admissions for the over 65s in recent years of more than 130%. Nevertheless, there has also been a steady reduction in alcohol-related road traffic accidents.
We also have social action campaigns, such as Alcohol Concern’s dry January, in which I have taken part over the past few years, as I am sure other noble Lords have too, which are starting to change attitudes. The point that my noble friend Lady Berridge made about minority and religious groups leading the way was incredibly important. I accept her point about the need for appropriate analysis of how to communicate with those communities. We were unable to get the information, admittedly at short order, that she wanted, but I shall certainly write to her and put a copy of the letter in the Library for noble Lords. She makes an important point and she may have highlighted a weakness in the current strategy.
We have also seen real progress through working in partnership with industry: 1.3 billion units of alcohol have been removed from the market by improving the choice of lower alcohol products; nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels; and we have published guidance on updating the health information contained on labels better to reflect the latest advice on alcohol published by the UK Chief Medical Officer.
Several noble Lords asked about calories and labelling. This is an area where the European Commission is looking at legislation. It is not always the fastest moving institution in the world, and we have of course just signalled our intention to leave the European Union, but we will certainly look at that legislation as it comes through. It is fair to say—although I am not in a position to make a commitment at this point—that the UK has been a leader in this kind of area, not just on drink but on smoking as well, and I hope that, looking ahead, we would continue that leadership position.
An essential part of our strategy to tackle alcohol harms is the provision of high-quality, evidence-based treatment services. Local government now has the responsibility to improve people’s health, in particular on the public health side. This includes tackling problem drinking and commissioning appropriate prevention and treatment services for the local population’s needs. Several noble Lords asked about addiction and spending on cessation services, which increased from 2014-15 to 2015-16, even within the context of challenging budgets for public health. I see this as a positive move, but it is something to be kept under review.
The NHS remains critical to preventing alcohol harms. There is a new scheme to incentivise investment in alcohol interventions. The national Commissioning for Quality and Innovation indicator has been developed, and in the way beloved of the NHS, it has been given the acronym CQUIN. It links a proportion of service providers’ income to the achievement of national and local quality improvement goals. The practical effect of that is that every in-patient in community, mental health and from 2018-19 to acute hospitals, will be asked about their alcohol consumption and, where appropriate, will receive an evidence-based brief intervention or a referral to specialist services. The noble Baroness, Lady Walmsley, pointed out that the evidence shows that people who receive a brief intervention are twice as likely to have moderated their drinking six to 12 months after the intervention when compared to drinkers receiving no intervention, so it is obviously a low-cost but highly effective action.
In addition, as my noble friend Lady Chisholm mentioned, by 2018, around 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated problems. My noble friend Lord Colwyn pointed out that dentists have a vital role in prevention and spotting early problems. The new dental contract means that there has been an increasing number of patient episodes, and Public Health England has developed an alcohol training resource for dental teams. I would be interested, as a follow-up, to find out if that has been successfully adopted within the profession that he represents.
Furthermore, the inclusion of alcohol assessment and advice in the NHS health check, which is offered to all adults in England aged 40 to 74, means that GPs and other healthcare professionals can offer advice to promote a healthier lifestyle. Since we mandated the alcohol assessment and advice component, nearly 5 million people have had a check. Referral to alcohol services following an NHS health check is around three times higher than among those receiving standard care, which is yet another example of how a small nudge in the right direction can make a great impact.
Several noble Lords talked about providing people with the right information so that they can make informed choices. Last year, Public Health England launched the One You campaign to help motivate people to improve their health through action on the main risk factors. This includes a drinks tracker app to help drinkers identify risky behaviour and lower their alcohol consumption and a new “days off” app to encourage people not to drink alcohol for a number of days a week, in line with the CMO’s recommendations.
My noble friend Lady Chisholm and the noble Baroness, Lady Walmsley, asked about education. PSHE is obviously a critical part of making sure that young people are informed about their choices. There has been a review of the PSHE curriculum—we have seen a strengthening of PSHE in recent announcements by the Secretary of State for Education. There must be, at least in part I think, some impact on the positive trends that we are seeing among young people in lower drinking, although it is of course hard to isolate what exactly causes that. We know, however, from the smoking environment that constant public health campaigns do have that impact, particularly for younger people. It is also notable that while the incidence of mental illness has unfortunately and sadly increased among young people, there has not been the same increase in drinking. That is an interesting inverse correlation that is worthy of further investigation.
Several noble Lords asked about the affordability of alcohol. In this context you think of Hogarth’s “Gin Lane” and “Beer Street”, and the important role that taxation has historically played in changing drinking habits. The UK currently has the fourth highest duty on spirits among EU member states, and higher-strength beer and cider are already taxed more than equivalent lower-strength products. In relation to a move in the direction that the noble Lord, Lord Brooke, pointed to, noble Lords may know that it was announced in the Budget that duty rates on beer, cider, wine and spirits will increase by RPI inflation. In addition, a consultation is currently seeking views on the introduction of a new band to target cheap, high-strength white ciders which are a particular problem among young people. It is also seeking views on the impact of a new lower-strength still wine band to encourage production and consumption of lower-strength wine—another point talked about by the noble Lord, Lord Brooke. It is worth touching briefly on minimum pricing. I am afraid that my answers are entirely predictable on this issue. We await the conclusion of the court case. I will, however, look at the IFS report that was mentioned and we will keep a close eye on that issue going forward.
The noble Baroness, Lady Walmsley, asked about advertising, as, I believe, did the noble Lord, Lord Hunt. The Advertising Standards Authority has a vigorous approach to preventing advertising to children and young people, but I am assured that it is kept under review to make sure that it is having an impact. Again, it is worth investigating whether that has had an impact on the lower instances of drinking among young people.
It would be wrong for Ministers to restrict the treatments offered to young people. That is a clinical decision, although I know that clinicians are increasingly trying to change the behaviours of smokers and drinkers before providing significant treatments. There is also a link between drinking and depression, as the noble Lord rightly pointed out.
I close by again congratulating the noble Lord, Lord Brooke, on securing this debate on such an important subject. Alcohol misuse has a significant impact on people’s health, the NHS, the wider care system and society in general. I also believe, however, that progress is being made. The Government remain deeply committed to ensuring that people are given the information and support—and if necessary the treatment—that they need to reduce harms from alcohol. I look forward to working with the noble Lord and all noble Lords to reduce alcohol misuse in the years ahead.