Government Alcohol Strategy 2012

Wednesday 18th January 2023 Westminster Hall

16:00

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered the 2012 Alcohol Strategy.

It is a pleasure to serve under your chairmanship, Mr Bone. I refer Members to my entry in the Register of Members’ Financial Interests.

The Government’s alcohol strategy 2012 was an ambitious attempt to reduce the harms of alcohol. In its introduction, it states:

“alcohol is one of the three biggest lifestyle risk factors for disease and death…It has become acceptable to use alcohol for stress relief, putting many people at real risk of chronic diseases. Society is paying the costs—alcohol-related harm is now estimated to cost society £21 billion annually.”

Despite the ambition, 10 years on, the harms of alcohol have not decreased; they have spiralled. We are at crisis point.

[Jim Shannon (Strangford) (DUP)]

It is not just about the fact that alcohol is more used today; it is also about the effect it has on lives. The hon. Gentleman will be aware that 70 people die every day due to alcohol. Deaths from alcohol had already increased prior to the pandemic: between 2001 and 2018, across the UK deaths increased by 13%. In Northern Ireland, deaths rose by 40% between 2012 and 2017—more than anywhere else in the United Kingdom. Does he agree that the Government must begin to deal with this in a standalone manner, rather than under the general umbrella of health?

[Dan Carden]

The hon. Gentleman hits the nail on the head. The point of this debate is that the Government had a very good strategy in 2012 and unfortunately failed to deliver on it.

Alcohol is now the leading risk factor for death, ill health and disability among 15 to 49-year-olds. In 10 years, deaths caused by alcoholic liver disease are up by a third, and the estimated cost of alcohol harm is upwards of £27 billion—£6 billion higher than back in 2012. Alcohol-specific deaths have risen by 27% in the last two years alone, and since 2012 there have been more than 66,500 deaths from alcohol across the UK. Alcohol-related hospital admissions in England are upwards of 980,000 annually, and one in five children is living in a household with one parent with an alcohol use disorder.

The wider impact on families and communities is incalculable, but it is often plain to see. The crisis we are facing is the consequence of a decade of inaction. Sir Ian Gilmore, chair of the Alcohol Health Alliance and a great advocate of alcohol policy reform, said:

“The ten years since the last Government UK strategy is a decade of missed opportunities to reduce preventable hospitalisations, deaths, violence, child neglect and antisocial behaviour. A failure to deliver on promised initiatives has contributed to the rising levels of alcohol harm we are seeing today. This cannot continue.”

I want to mention a couple of the milestones of the last decade. In 2011, the Government alcohol strategy was introduced. In 2013, key evidence-based measures in the strategy were scrapped. In 2018, the Government promised another alcohol strategy, which was later scrapped. In 2019, it was announced that alcohol care teams were to be put in hospitals in the top 25% of most-in-need areas; that is still uncertain. In 2021, an alcohol and health calorie labelling consultation was agreed, yet it has still not begun. In 2021, the Government’s health disparities White Paper was due to be published, and yet still no decisions have been taken.

The Government’s record on alcohol policy is one of policies scrapped and promises broken. The Health Foundation’s 2022 review of Government policies tackling smoking, poor diet, physical inactivity and harmful alcohol use in England made for uncomfortable reading. It observed that there are “no national targets” for alcohol and that the Government have a dismal track record in implementing commitments, not only from the 2012 alcohol strategy but beyond. The report delivers a blistering assessment of the many alcohol policy initiatives that have not been introduced, or that are of unclear status or partially implemented.

The measures set out in the 2012 strategy were, and remain, effective, evidence-led health policies that are shown to prevent deaths and alleviate pressures on the NHS. Back then, the Government’s stated outcomes were:

“A change in behaviour so that people think it is not acceptable to drink in ways that could cause harm to themselves or others; a reduction in the amount of alcohol-fuelled violent crime; a reduction in the number of adults drinking above the NHS guidelines; a reduction in the number of people ‘binge drinking’; a reduction in the number of alcohol-related deaths; and a sustained reduction in both the numbers of 11-15 year olds drinking alcohol and the amounts consumed.”

We were told the 2012 strategy would

“radically reshape the approach to alcohol and reduce the number of people drinking to excess”,

through 30 commitments or actions covering various areas. The flagship policies included minimum unit pricing, banning multi-buy alcohol promotions in shops and regulating to ensure that public health is considered as an objective by local authorities when making alcohol licensing decisions. The former Prime Minister, David Cameron, promised that there would be 50,000 fewer crimes each year and 900 fewer alcohol-related deaths a year by the end of the decade.

The only conclusion that I can reach is that the decision to scrap the 2012 strategy is a major factor in alcohol-related crime, which now costs us £11.4 billion each year, and in the fact that deaths from alcohol have reached record levels, because soon after its publication, the Government backtracked on all the flagship policies, despite the evidence. Based on David Cameron’s figures, 9,000 lives would have been saved.

Many of us who care deeply about the impact of alcohol and addiction across society fear that the influence of the alcohol industry on Whitehall and Westminster is to blame. When minimum unit pricing is mentioned, uproar ensues and misinformation spreads—namely, that introducing a minimum unit price would hit the pub trade or punish moderate drinkers. As the right hon. Member for Maidenhead (Mrs May), the former Home Secretary who introduced the strategy, said:

“Most drinks will not be affected by minimum unit pricing, but the cheap vodka, super-strength cider and special brew lagers will go up in price.”

She went on:

“Pubs have nothing to fear from the minimum unit price that is being introduced today. That will not have an impact on them.”—[Official Report, 23 March 2012; Vol. 542, c. 1072-1078.]

The not-so-snappily titled “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies” states:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement.”

The 2012 strategy agrees with that. Minimum unit pricing is no silver bullet, but it is an evidence-based policy that works.

I welcome the alcohol duty reforms that will come into effect in August this year. Alcohol should be taxed according to its strength. That is an effective starting point that makes it possible to use duty reforms to improve public health. The reality of the last decade is that cuts and freezes to alcohol duty have cost the Treasury £8.6 billion since 2012.

Advertising was another key component of the 2012 strategy. In July 2013, “Next steps following the consultation on delivering the Government’s alcohol strategy” promised to challenge and engage with the industry and sellers to promote responsible drinking, and I want to read a little excerpt from the strategy:

“The alcohol industry has a direct and powerful connection and influence on consumer behaviours. We know that people consume more when prices are lower; marketing and advertising affect drinking behaviour; and store layout and product location affect the type and volume of sales.”

The “Next steps” document promised to challenge and engage with the industry and sellers to promote responsible drinking, saying:

“Alcohol offers are too often prominently displayed in shop foyers or at the end of aisles. Some in the industry recognise such promotions, and the high visibility of these within shops, can unduly encourage harmful levels of drinking.”

The strategy cites as one potential example for action the voluntary agreement between retailers and the Government in the Republic of Ireland. There is no evidence of any progress here in the UK, and alcohol marketing is more invasive than ever. Anyone who has set foot in a large supermarket will know that alcohol promotions are unavoidable, whether that is in the foyer, at the end of the aisles or at the checkout. The sales campaign is aggressive, unnecessary and irresponsible. In the Republic of Ireland, thanks to the voluntary agreement, alcohol is reserved to one area, with the exception of smaller stores. Why have Ministers not implemented a voluntary agreement between retailers and Government?

It is worth remembering that, in the same year the alcohol strategy was introduced, this place legislated to cover up cigarettes and hide tobacco products from public view. Last year, I met ASDA and other large supermarkets to discuss online marketing practices and giving customers an opt-out from online marketing. I hope we will see progress in that area.

There are tragic consequences for individuals, their families and communities from the failure of this strategy. It is not just the person drinking who is at risk from alcohol harm; the harms affect us all, and they cause the most damage in the most deprived communities. Nobody chooses to be alcohol-dependent—it is not a life that anyone would aspire to lead. Trauma and poor mental health are often the root cause.

Anyone who has tried to access support in the last 10 years will have faced an underfunded service with staff who are overworked and undervalued. Since 2012, billions of pounds have been hollowed out of drug and alcohol treatment. NHS in-patient detox provision in England is at breaking point. There are seven in-patient detox clinics across the country, with just over 100 beds, supporting a population of 56 million.

I want to share the experience of a father trying to support his daughter, who wishes to remain anonymous. He said:

“I did everything I could to stop her from drinking. I didn’t know where to go, no one seemed to help or care. Her drinking was out of control—she always had mental health difficulties and I know she thought the alcohol would help. I took her to A&E so many times and was told the same thing—‘we have no space for her’. I was broken, I still am. I’m not a doctor or a nurse, I didn’t know how to monitor an alcohol detox. Eventually I raised the funds to go private, she’s on the mend and slowly returning but I’m angry—I’ve worked my entire life, my daughter worked, we paid into the pot. How can there be no NHS beds for my daughter?”

As the Minister knows, alcohol care teams provide specialist expertise and interventions for alcohol-dependent patients and those presenting with acute intoxication or other alcohol-related complications. They are proven to be successful and help reduce avoidable bed days and readmissions. The seven-day-a-week service in the Royal Bolton Hospital saved 2,000 bed days in its first year, and modelling suggests that an alcohol care team in every non-specialist acute hospital would save 254,000 bed days and 78,000 admissions each year by year 3.

I have spent some time with the alcohol care team at the Royal Liverpool University Hospital, and I pay tribute to Dr Lynn Owens and her team for everything they do. In 2019 the Government promised to establish alcohol care teams in the 25% of hospitals with the highest need. Three years have now passed since that promise, and I hope the Minister will update us on the roll-out. Does he agree that alcohol care teams should be in every hospital?

As of December 2020, the Government have begun to replenish the budget for addiction treatment services, but it will take time to recover after a decade of cuts. This new funding forms part of the 10-year drug plan, “From harm to hope”, which adopts all the key recommendations from Dame Carol Black’s independent review of drugs. Dame Carol’s review was groundbreaking. However, the legal and most harmful drug—alcohol—was out of scope. Her review, if implemented properly, will see system change in reducing the harms of drugs. I commend the Government for commissioning the strategy and beginning its implementation, but now I want an independent review of alcohol, and so does Dame Carol Black. I am delighted that she supports that call.

In November, Alcohol Health Alliance UK and I, with the support of 42 cross-party colleagues from both Houses and over 50 leading health organisations, wrote to the Prime Minister calling for an independent review of alcohol that would lead to an alcohol strategy. The focus of that review should be evidence-based interventions to reduce the harms felt across society. There is already strong evidence for the effectiveness of measures to reduce the affordability, promotion and availability of alcohol, such as alcohol taxes and a comprehensive restriction on alcohol advertising. So far, the Government have responded to calls for an independent review by signposting the recent increase in spending on addiction treatment services. Increased funding for treatment is a start, but improved drug and alcohol services are a separate matter from the wider public health measures that we need.

In recent years, we have heard a lot about the action needed to tackle tobacco use, gambling-related harm, the use of illicit drugs and obesity, but we hear little about what is needed to tackle the harms of alcohol. With so little to show from the Government’s excellent 2012 alcohol strategy, is it any wonder that deaths from alcohol across England are about to top 10,000 annually? As the social and economic pressures continue to mount, more and more people will use alcohol to escape their often difficult reality. We cannot afford to wait another 10 years. The time to act is now.

In his foreword to the 2012 alcohol strategy, the former Prime Minister, David Cameron, said:

“the responsibility of being in government isn’t always about doing the popular thing. It’s about doing the right thing.”

I hope the Government will take heed of his words and conduct an independent review of alcohol that informs an alcohol strategy for the future, because it is the right thing to do.

16:17

[The Minister for Crime, Policing and Fire (Chris Philp)]

It is, as always, a pleasure to serve under your chairmanship, Mr Bone. I start by thanking the hon. Member for Liverpool, Walton (Dan Carden) for securing the debate and for his thoroughly prepared, thoughtful and considered remarks. In the past, he has spoken about his personal experience of this topic, so I thank him for bringing it to the attention of the Government and, through these proceedings, to the attention of the House.

The hon. Member made reference to the 2012 alcohol strategy, which sought to reduce the harms caused by excessive drinking without disproportionately affecting moderate drinkers. It is important to say that, although not all the measures set out in the strategy were introduced, many have been, including creating more powers to deal with problem premises; doubling the fine for persistent under-age sales; strengthening the mandatory licensing conditions; tightening the law on irresponsible promotions; enabling local councils to collect a late-night levy to contribute to the cost of policing; and introducing new powers to tackle alcohol-related issues, including closure and dispersal powers. All those were in the 2012 strategy, which the hon. welcomed, and they were delivered.

Some measures have not been taken forward, and the hon. Member mentioned some of those. One is minimum unit pricing for alcohol in England, where there was a feeling that the evidence base was not sufficiently strong. Minimum unit pricing was introduced elsewhere, including in Scotland. A report will shortly be published that assesses the impact of the minimum unit price for alcohol in Scotland, and we will study it extremely carefully to find out what lessons can be learned. If there is clear evidence on the effectiveness of minimum unit pricing in Scotland, we stand ready to respond to it. We are open-minded on the question, but we do want to see the evidence.

It is worth setting out some of the facts and figures around alcohol-related problems, because the picture is perhaps not as unrelentingly bleak as may have been suggested. In terms of violent criminality and incidents relating to alcohol, back in 2009-10 the crime survey for England and Wales said there were just over 1 million alcohol-related violent incidents. By 2019-20—just before covid—that number had fallen to 525,000—it had dropped by roughly half from 2009-10 to 2019-20.

The percentage of adults consuming alcohol within the last week stood at 64% in 2009; by 2019 that number had dropped to 54%, so there was a 10 percentage point reduction, from 64% to 54%. Binge drinking—defined as drinking at least twice the recommended limit on a given day—stood at 20% in 2009, which is quite a high proportion, but by 2014 it had dropped to 15%. The proportion of under-18s consuming alcohol and suffering alcohol-related harm has also decreased significantly in the last 20 years. All those things are worth putting on record.

The Office for National Statistics publishes numbers for alcohol-specific deaths. There was a slight decrease from 2008 to 2012, but the numbers were fairly stable; they were pretty much constant through to about 2019. There was then an increase in 2020 and 2021—just in those last two years, as the hon. Member for Liverpool, Walton mentioned—and that is of concern. However, there is a feeling—perhaps more work needs to be done on this—that that was connected with increased alcohol consumption during the covid lockdown by people who were already at risk. We probably need to look at that more carefully. I am looking at the graph now, which is available on the ONS website, and it is striking that the mortality rates are flat over the last eight or nine years until the last two years, when they go up considerably.

I will mention one or two other important initiatives. One relates to the criminal justice system; sadly, having problems with alcohol is one of the things that leads to offending. It is not the principal driver of offending, but it is one of the drivers. Changes brought in recently—a year or two ago—introduced alcohol monitoring and abstinence licence conditions for prison leavers. They became effective just a year or two ago, and since November 2021 over 900 such conditions have been imposed.

Community sentence alcohol abstinence monitoring requirements ban offenders from drinking alcohol for up to 120 days, with tags used to monitor compliance. Over 5,000 orders have been imposed, and offenders have complied with the tag 97% of the time. Those licence conditions and abstinence monitoring requirements are quite significant and are clearly having a positive effect, and we can do more in that area.

The other important area the hon. Member mentioned was treatment, and he rightly made quite a few remarks about it. As he said, the drug strategy was published in December 2021, and it was backed by record funding. The focus of that strategy was on drugs, but the commissioning and delivery of drug and alcohol treatment services are integrated in England. In practical terms, that means that the implementation of the drug strategy and, critically, the funding that goes into treatment will also benefit people seeking alcohol treatment through mechanisms such as the new commissioning standards, the plan to build back the workforce—which the hon. Member also mentioned—and new investment to rebuild local authority-commissioned substance misuse treatment services in England. As I said, those are integrated, so they cover alcohol as well as drugs.

This current year—2022-23—we have made £86 million of funding available to local authorities to invest in treatment and recovery services, with a further £10 million to increase the availability of in-patient detox beds, to help those requiring medically assisted withdrawal. In addition, as part of the NHS long-term plan, we are investing £27 million of national funding in an ambitious programme to establish specialist alcohol care teams in the 25% of hospitals with the highest rates of alcohol harm and socioeconomic deprivation. We think that those fully optimised alcohol care teams can significantly reduce accident and emergency attendances, bed days, readmissions and ambulance call-outs. It is estimated that that NHS programme will prevent 50,000 hospital admissions over five years. As the hon. Member alluded to, there has been a significantly increased focus on treatment in general over the last couple of years.

I am concerned that we should do even more to get people with alcohol problems into treatment, especially where that gets them into criminal offending. In that regard, the three kinds of medical challenges that often present are drug addiction, alcohol addiction and mental health problems. Estimates vary, but somewhere in the region of 50% of offenders, or possibly more, have one or more of those challenges. However, only about 2% or 3% of sentences, or maybe less, contain community treatment requirements, which might be a drug treatment requirement, an alcohol treatment requirement or a mental health treatment requirement. There is a huge opportunity to work with the Crown Prosecution Service, the probation service, which prepares pre-sentence reports, and the judiciary to get a lot more people referred into mental health, drug or alcohol treatment as an alternative.

[Dan Carden]

I am grateful to the Minister for his response. He has covered every part of government and society, from the health service to criminal justice. I think alcohol takes up around half of all police time. What I am asking for is a strategy and an independent review. The Government have taken their eye off the ball over the last 12 years. They published the strategy, but it was never fully implemented. What we need is something that looks across Government at alcohol, in the way Dame Carol was able to do with illicit drugs. Our constituents know that this is a problem up and down the country. It costs society tens of billions of pounds, and the money that the alcohol industry pays in taxes does not cover the cost of alcohol harm.

[Chris Philp]

I am not going to make a commitment in this debate to initiate a review, for reasons that the hon. Member will understand, but I will give the issue some consideration and careful thought since he raised it.

In concluding, I reiterate that there has been a significant increase in investment in drug and alcohol treatment in the last one or two years. We have the new alcohol abstinence monitoring provisions in place, and we have seen the consumption of alcohol decline. We have also seen the number of alcohol-related violent incidents halve over the last 10 years or so, and much of the 2012 strategy has been implemented, so there is a lot to be pleased about. I will give some thought to the suggestion the hon. Member made, and I will of course happy to work with him going forward, given his obvious expertise and interest in this area.

Question put and agreed to.