Alcohol Consumption Guidelines

Andrew Griffiths Excerpts

Tuesday 28th June 2016 Westminster Hall

[Andrew Griffiths (Burton) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Alan, and to address the issues raised by my hon. Friend the Member for Gower (Byron Davies). They are hugely important issues and he got into the detail of them.

I am also pleased to take part in a debate with the Minister, because she has worked really constructively with the industry during her time in office. The work that she has done in lowering the alcohol by volume in drinks, as a result of working closely with the industry, has taken a billion units out of consumption. That shows that constructive working can have a huge impact on the nation’s health and the nation’s drinking habits.

I should declare an interest as the chairman of the all-party group on beer, and colleagues should see my entry in the Register of Members’ Financial Interests; I am also the patron of a drug and alcohol rehabilitation centre in my constituency. I want to see a healthy drinks industry and a healthy population, and those two things are not mutually exclusive.

In Government, we used to have something called “the nudge unit”, to try to persuade people and help them to make the right choices. However, we are seeing “Project Fear” in this approach and we saw in the referendum that that approach simply does not work. At a stroke, we have made 2.5 million people problem drinkers. Let me tell the tale of my auntie, Irene. She died at the age of 88. Before she died, she used to enjoy a bottle of Mackeson Stout every evening. According to these guidelines, she was a problem drinker. That is what we have done. These guidelines are so against the grain of the way that people live their lives that we risk people ignoring them and ignoring other advice, and going on regardless, so that the guidelines become absolutely pointless.

For instance, Sir Alan, you will be surprised to know that according to these guidelines the Minister can drink exactly the same amount of alcohol as my right hon. Friend the Member for Brentwood and Ongar (Sir Eric Pickles). I have never been drinking with the Minister, but that does not seem to make any sense at all. Size, and the way in which men and women absorb alcohol at different rates—none of that is being taken into consideration.

It is interesting that in a written answer to my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) the Minister said that, although we have specific guidelines on calorie intake for men and for women—that guidance is differentiated—we do not have them for the intake of alcohol. That just shows that there is absolutely no sense in the way this guidance is being proposed.

My hon. Friend the Member for Gower referred to the concerns that exist about the way this report was drawn up and about the organisations that took part in the research, including those involved in the temperance movement. I am also concerned that in a written answer to my hon. Friend the Minister wrote that

“The National Institute for Health Research has awarded funding to The University of Sheffield… to evaluate the new drinking guidelines.”

That is a case of people marking their own homework, and we should all be very concerned about that. There are real concerns about the rigour with which this information has been compiled and we risk people turning off and not taking any notice, which could damage the health of the nation.

I realise that other Members wish to speak and that time is pressing. I appreciate the efforts that the Minister has made to work with the drinks industry, but this guidance came as a bolt from the blue. The industry knew nothing about it. There was no consultation. Nobody from the alcohol industry was involved in peer-reviewing the evidence, so I hope that we will reconsider. I realise that it is an independent report, but I urge the Minister to reconsider the validity of the evidence, because it just does not stack up.

[Sir Alan Meale (in the Chair)]

Before I call the last two speakers, I should inform you that, as I said before, we will have to start the winding-up speeches at five minutes past 6, so if you can, please share the time remaining.

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[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to be able to speak in this debate. I congratulate the hon. Member for Gower (Byron Davies) on securing it.

This debate has highlighted the fact that statistics can be used to prove just about anything. It is important that people out there have confidence in the statistics and the guidance that they are given, and I am concerned that the Royal Statistical Society seems to have a bit of a worry about the guidance that has been put forward—particularly on the issue to do with intake for women and men. There is evidence to suggest that women’s and men’s bodies absorb alcohol slightly differently, and that really ought to be acknowledged so that each individual gets the best advice possible.

The hon. Member for Burton (Andrew Griffiths) talked about the differences between people. My brother is 6 feet 4 inches and his girlfriend is about 5 feet 2 inches, and there are obviously stark differences between them. Having said that, unless people are going to have a personalised alcohol prescription, it is quite difficult to be specific. We have to have general guidelines that give people an idea of what they can expect. People have to know their limits, as the hon. Member for Strangford (Jim Shannon) said. He also said that 60% of alcohol sales are to problem drinkers, which is an issue that we have had in Glasgow and the west of Scotland. As my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) said, alcohol consumption significantly blights families.

Organisations such as the Glasgow Council on Alcohol, through their community work, seek to get people talking about the impact that alcohol has on communities. As the Glasgow Centre for Population Health has found, inequality has a significant effect. In Glasgow, the most deprived communities have five times more of a problem with alcohol than the least deprived communities.

Alcohol guidelines are not just about pubs, as the hon. Member for Gower seemed to be suggesting. I very much support the real ale industry, and CAMRA does really good work and has transformed the way people look at alcohol—they go for quality rather than quantity in some cases—but the fact remains that many people, particularly in deprived communities, are not going to a nice, cosy real ale pub; they are going to the local shop on the high street and buying large volumes of alcohol, which will do them significant damage.

[Andrew Griffiths]

I agree with much of what the hon. Lady is saying. Does she share my concern about telling people that alcohol can cause them to misjudge risky situations, cause accidents and cause them to lose self-control, and giving them advice about drinking alcohol before going up a ladder? That is not the kind of advice about alcohol that people expect, and the risk is that the general public will have no confidence in the guidelines.

[Alison Thewliss]

We need to be aware of the impact of alcohol generally. The hon. Member for Henley (John Howell) spoke earlier about alcohol in the House of Commons, which is still a concern for me. I was at an event earlier celebrating tennis—a nice, healthy activity—and there was booze. I could get a drink at lunchtime. I do not think that is acceptable. The House of Commons should consider whether it is appropriate for people to have a drink with their lunch at events that take place during a working day. I am not convinced that it is.

The Scottish Government have a framework for action on alcohol. We pursued the Alcohol (Minimum Pricing) (Scotland) Act 2012, which, due to the alcohol industry, has been bogged down in a legal dispute. Importantly, it is about trying to cut down the number of people buying large volumes of alcohol. We are trying to change that behaviour and get people to think about how their drinking is affecting their health.

Evidence that organisations such as the Glasgow Centre for Population Health have looked at suggests that we need a change in attitude. There are people who are damaging their health severely every day. This is not about an auntie who drinks a wee drink before she goes to bed or anything like that. It is about people who are drinking more than they should and drinking in unhealthy ways, which has an impact on their health and their ability to go about their business safely.

I saw a study from the Glasgow Centre for Population Health a few years ago that suggested that, in the most deprived areas of Glasgow, people who drink quite a lot end up in hospital more than people who drink an equivalent amount in better-off areas, because their lifestyles and the things around them do not keep them safe. Someone in a well-off area might be having a bottle of wine every night, whereas someone in a poorer area having something else is far more likely to come to harm. There are serious considerations not only about public health but about how we think about alcohol in general, and about the guidelines that are put in place to get people to think about how much they are drinking and what they can do to reduce their intake, be healthy and happy and have a good role in their families and communities.

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[Andrew Griffiths]

Can the hon. Lady tell me of just one sentence today in which any Member has said that they are not concerned about the effects on health, or about domestic violence or alcoholism? This is a ridiculous speech—I realise that she is new in her position, but I suggest that in future she does a little more research before she comes to the Chamber.

[Ms Abbott]

I have to advise the hon. Gentleman that I was a spokesperson on public health for three years for the Labour party. Not only did I do research on the health issues around alcohol, but I visited other countries—notably Scandinavian countries—to see what they had done. My point is that if hon. Members are willing to come here without spelling out the issues that I am describing, it must suggest to anybody listening to or reading the debate that they put them below the interests of the pub trade.

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[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank colleagues for bearing with our rather interrupted debate. I am fairly confident that I will not have time to discuss all the issues in my response, but as some colleagues are aware, my door is always open, and I have a proposal towards the end of my speech for how we might continue the discussion.

First, I congratulate my hon. Friend the Member for Gower (Byron Davies) on securing this debate and on opening it so authoritatively. We are all aware of the impact of alcohol misuse, which was well summed up by the shadow Minister, who is knowledgeable about that. She reminded us of some of the pressure it puts on our vital public services. It is right that we give this issue our attention.

I know that people have asked why we need new guidelines when alcohol consumption is falling. My hon. Friend, in introducing the debate, talked about some of the areas in which we have had welcome improvements in the statistics. The majority of people drink alcohol in an entirely responsible way. In 2014, 59%—just over 25 million adults—drank within the new guidelines, so it is important to stress that quite a lot of people drink that amount or less at the moment.

As a Government who believe in informed and empowered consumers, we have a responsibility to provide clear information to help people make informed choices about their drinking. The guidelines are not about preventing those who want to enjoy a drink from doing so. Goodness knows, as a passionate remainer, I can certainly say that guidelines of all sorts have been suspended in my household for the past week or so. This is about ensuring that people get common-sense advice and practical information, and some of that will be about things like taking days off from drinking. There is an appetite for that; we know that from the research we have done with people.

The new low-risk drinking guidelines are the means by which the four UK chief medical officers, working together, provide the public with the latest and most up-to-date information about the health risks of different levels and patterns of drinking. Let me clarify at the outset, in case I run out of time, what the guidelines are not. Nobody has said that more than 14 units is considered harmful or problem drinking. It is just not recommended as low risk. To be clear, there is no public policy on abstinence. The guidelines are not about the rate at which alcohol affects men and women in terms of intoxication, but how it affects their long-term health.

[Andrew Griffiths]

Will the Minister give way?

[Jane Ellison]

If colleagues will forgive me, I have very little time. I will not even have 10 minutes. I will give way, but it means I will not get through my speech.

[Andrew Griffiths]

I have a very simple question. Does the Minister think there is no such thing as safe drinking?

[Jane Ellison]

I will come on to deal with some of the issues, but I will also make a suggestion for how we take this discussion forward. The issue outlined was about the extent to which alcohol affects people. The second part of the consultation, to which a response has not yet been published—I will come on to talk about that—is about how we express and communicate the new guidelines. That is slightly different from the science that sits behind them. I want to try to pull those two things apart. Clearly we have a job of communication to do, because we want to be helpful to the public.

Perhaps it would be useful to remind Members how we arrived at this review. It was not Ministers who asked the chief medical officers to do it but Parliament. The previous guidelines came out in 1995, and in 2012 the Science and Technology Committee recommended that they should be reviewed because they had not been for so long. It is fair to say that there are a lot of places around the world where such guidelines have not been looked at for a long time, so the evidence base is not as up to date as it could be. There was a lot of parliamentary interest, especially in the previous Parliament, in guidelines—for example, in the harmonisation of the pregnancy guidelines when we had debates about foetal alcohol syndrome.

At the request of the four UK chief medical officers, three independent groups of experts have met since 2013 to look at both the scientific and the behavioural evidence of the health effects of alcohol. Those groups were made up of international experts in the field of epidemiology, public health, liver disease, behavioural science, science communications and evidence-based alcohol policy. None of those people were members of the temperance movement.

To ensure that the guidelines are as practical as possible, after their publication the Government held a public consultation to gather views on their clarity, expression and usefulness. I should clarify something that is important: the Royal Statistical Society supported the evidence review and the conclusions. It was very specific in its challenge about how the Department of Health presented it in the launch. That is exactly why there was then a consultation about how we express and discuss the guidelines. To be clear, though, the RSS did not question the evidence review or its conclusions.

As part of the consultation process, Public Health England has undertaken market research to test understanding and acceptance of the guidelines—just the points that colleagues have asked about. Overall, the results were positive, showing that the language was understood and accepted and the tone appropriately informational. That is the tone we are trying to achieve: informational, not hectoring or nannying. The expert group has now reviewed the consultation responses and market research and has put its final recommendations to the four CMOs for their consideration. We intend to publish the final guidelines and the Government response to the consultation as soon as possible.

We of course recognise that industry has a key role in communicating the new information to consumers, particularly through labelling. I thank my hon. Friend the Member for Burton (Andrew Griffiths) for his remarks. As he knows, as a Back Bencher in the previous Parliament I was an active member of the all-party groups on pubs and beer. I had the honour of being the guest judge of the pale ale category at the Battersea beer festival on more than one occasion. To declare an interest, I am a member of the Campaign for Real Ale. I could not agree more that a well-run pub or bar can be a great way to help people to drink responsibly while maintaining social contact.

Nevertheless, the industry needs to enable those who want to moderate what they drink to do so. It has done some really good work on that. The work with the industry in the previous Parliament on alcohol units was very useful. I always have a further challenge for the industry. One thing we can do to reduce the number of units people consume and to develop that wider choice is to put more emphasis on lower-alcohol products. When I have spoken to them, I have always been very honest with industry spokesmen that greater promotion of lower-alcohol drinks can help people to get into healthier habits. Simple switches can help. I want to put on the record that just by swapping from a pint of beer or lager at 6% strength to a pint at 4% strength, people could cut their units by a third—that is, they could take out 1.1 units. They could still enjoy their pint but cut their alcohol intake by a third.

The chief medical officer had a successful meeting with the Portman Group yesterday, confirming willingness on both sides to continue to work constructively together and to deliver benefits to the public and good information to our constituents. There are reasons for optimism in some of the alcohol statistics, but the shadow Minister is right that there are some significant and often highly concentrated problems. We need to give people the best and most up-to-date advice. We recognise that it is not for the Government to tell adults what to do in their private lives, but we do have a role in enabling the public to make informed decisions about their health based on up-to-date guidelines and the best science.

I am grateful to the chief medical officer, who has confirmed that she is happy to hold a parliamentary drop-in briefing for colleagues to discuss the matter further. It simply is not possible to pick up many of the detailed points that have been made on the various international studies in the time available. For the record, the review scrutinised all the available high-quality evidence and covered the findings of 63 systematic reviews from the evidence worldwide. It was a major undertaking. I think it would be useful for colleagues to be able to come along and discuss some of the studies that have been cited. Some of them are in different countries and some, it must be said, are based on different situations in terms of the nature of the national health service and the health support in those countries. I do not have time to go into that factor, but it is relevant for some of the comparative remarks that were made.

I hope I have reassured colleagues that we want to move forward in a sensible way. We want to give people the best information and we want to communicate it with clarity. Change will not happen overnight, but we want to raise awareness of the health risks, particularly around some of the links, such as between breast cancer and alcohol. We have a vastly better understanding of that than we did in 1995, and that has come through in recent years. It is important that we reflect that and continue to communicate it. I hope we can move forward constructively from here. I will set up the meeting that I offered. I sense from the Chamber that there is an interest in having further constructive dialogue. I leave a couple of minutes to my hon. Friend the Member for Gower to close the debate.

Health Services in Staffordshire

Andrew Griffiths Excerpts

Wednesday 3rd June 2015 Commons Chamber

[Jeremy Lefroy]

I thank my hon. Friend. He has been a huge support in all these matters, which have at times been extremely difficult. He is absolutely right. I have come across cases of agency workers charging absolutely extortionate fees. I could give the Minister in private—he would be shocked to hear them—one or two examples of what I consider to be close to blackmail.

Another question is raised: if these important services are moving, without mention in the information to my constituents, are other moves planned of which we have no information? The loss of emergency surgery, consultant-led maternity, full level 3 critical care and in-patient paediatrics was—even if most were the wrong decisions—at least clearly set out and communicated with my constituents. These acute in-patient services were not. What we therefore need, and what I have been asking for since last summer, is a clear summary of exactly what services will be available and where.

Of course, this is primarily the responsibility of the UHNM Trust. However, it is grossly unfair to place this burden entirely on it. It has been asked to do a huge job in bringing together two acute hospitals, one of which has been the subject of a major public inquiry. It needs the full support of the NHS through the NHS Trust Development Authority and NHS England. I am asking the Minister to make it his responsibility to do precisely that.

I will now turn to the tender for cancer and end-of-life services throughout the west of Staffordshire and Stoke-on-Trent. The proposal has been developed by NHS England, the four clinical commissioning groups covering North Staffordshire, Stoke-on-Trent, Stafford and surrounds, and Cannock Chase, and Macmillan Cancer Care. The objective is clear: to improve cancer outcomes, which are currently below the average for England and well below the European best, so that survival rates are among the best in England by 2025 and subsequently among the best in Europe.

[Andrew Griffiths (Burton) (Con)]

I commend my hon. Friend for securing this debate and for the fantastic work he has done over the last five years, both for his constituents and for people across Staffordshire. We welcome the work he does, and I am sure he would join me in thanking the doctors, nurses and clinical staff across Staffordshire who have worked so hard to get improved care across our county. Does he agree that we still have a fragile healthcare economy in Staffordshire? I managed to secure £8 million for East Staffordshire CCG thanks to the help of the previous Health Minister, but that is for just one year, so does my hon. Friend agree that we need to move towards fairer funding in Staffordshire?

[Jeremy Lefroy]

I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.

To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:

“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”

My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.

Macmillan says about the first two years of the contract:

“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”

That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.

According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to

“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”

That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.

I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.

The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.