Health and Social Care Bill

Lord Brooke of Alverthorpe Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Wigley]

My Lords, I rise with some trepidation as this Bill applies to England only, although there are some consequential effects on Wales. As I was speaking in Grand Committee on the Welfare Reform Bill upstairs a moment ago on initiatives in Wales which should be copied in England, I hope that initiatives in this area will be copied by the National Assembly for Wales and I very much hope that the spirit of the amendments, some of which I have my name alongside, can be taken on board by the Government, even if the wording is not perfect.

I welcome the address made by the noble Baroness, Lady Finlay, in opening this debate and pay tribute to the work that she has undertaken in this context, which is recognised all round. I come from a generation in Wales where we used to have to smuggle ourselves out to the pubs because of the general ban on alcohol that used to exist. In previous generations, understandably and rightly, there had been a clamping down on alcohol use in Wales. My parents’ generation referred to whisky, for example, as medicine and very rarely used it. In fact, the pledge was a general feature of society there. My generation was responsible for a movement in another direction. The pendulum swung and is still swinging in that direction and it is time to start it swinging back.

I have no doubt at all that alcohol is one of the greatest problems that we have in our society today. I say that not as a teetotaller although I restrict myself two months of the year to not touching the stuff because it is so important that we have self-discipline as well as discipline that may come from the statute book. But in terms of violence, the break-up of families, poor performance at work—one remembers David Lloyd George’s initiatives in the First World War to try and clamp down on alcohol because of the effect on the war effort—criminality, injuries and the pressure on accident and emergency departments in hospitals, and the social disruption that arises from it, we can see the effect all around. The effect seems to be hitting people younger and younger. Children at the ages of 11, 12 and 13 are showing the effects of alcohol. That cannot be acceptable.

I realise that in an area of social responsibility such as this it is sometimes difficult to legislate. However, there must be pressure to turn the tide in another direction. Amendment 202 refers to establishing a duty to reduce alcohol harm. Amendment 328 covers the assessment of alcohol damage in local communities. Amendment 329 would provide appropriate places for representatives of alcohol services. These modest steps, taken together, would add up to a message that would come across. I implore the Minister, even if he cannot accept the amendments, to accept the thrust of the argument that lies behind them, because we have to do something about this great scourge of our society today.

[Lord Brooke of Alverthorpe]

My Lords, I hope that the noble Earl will accept these amendments. In many respects they are very modest. I have grave doubts about the extent to which we will be able to influence the course of events in this arena with the changes that we have before us. I am grateful to him for responding in his long letter of 20 October to all of us who raised a variety of questions at Second Reading. He endeavoured to address some of the topics that I had raised on alcohol, labelling, licensing and so on. However, I still believe that ultimately the major issues on alcohol policy will need to be addressed at the centre.

One can do nothing about the cost of alcohol at local level. It must be done centrally. That is being addressed—but inadequately. The marketing of alcohol is something over which local authorities and well-being boards will have no control whatever. The drinks industry is increasingly marketing on the internet and targeting youngsters, particularly in the social networking sphere. I heard recently that one-third of young girls aged 13 to 16 surveyed in Essex are suffering blackouts from excessive drinking. If they continue to drink like that, they will not be ill immediately—they will have good fun and games—but within 10 years, when they get to their late 20s, they will have real problems. What will health and well-being boards be able to do about that? I have been pestering the noble Earl on the labelling issue for quite some time. Nothing can be done about that at local level.

There is one issue that we could have done something about at local level, but we missed our chance. The noble Lord, Lord Clement-Jones, will recall that when we debated the Police and Social Responsibility Bill, we addressed the freedom that people now have to issue licences on a much more liberal basis than used to be the case—we now have a proliferation of off-licences everywhere—but were unable to effect any changes that would have given local authorities greater powers to limit the way in which licences are granted locally. Again, nothing can be done by health and well-being boards.

These are major topics and I wonder how much power there will be to change the course of events. These issues all link to related topics such as obesity and diabetes. It is important that we do not delude ourselves into believing that there will be massive changes without a strong drive from the centre. The nudge-nudge approach will not work with the big drinks industry. Neither, as the noble Baroness, Lady Williams, mentioned this morning, will it work in the context of food, with salt, fats and sugar. These are real problems for people and very little change will be effected at local level; it must all be done centrally.

I come back to the amendments before us. They are very modest and I see no reason why they cannot be accepted. In particular, I will look at the endeavour to achieve change at GP level. Many GPs have been very innovative. Initiatives have been offered to them to effect changes and a number of them have taken up the cudgels and worked adventurously to identify the problems at local level in their communities. Many more have not been doing anything like what should have been done. The Government have declined to accept the screening possibility that was mentioned. Again, I hope that they will be prepared to review their position on that.

Overall, I urge the Government not to reject the modest changes here, but to accept the amendments.

[Lord Turnberg]

My Lords, I should like to speak to the amendments in the name of the noble Baroness, Lady Finlay of Llandaff, and others. I do not think that it is necessary for me to reiterate the dangers of excessive alcohol consumption. The damage done by alcohol is obvious to anyone who visits an A&E department on a Friday or Saturday evening—and indeed, now, almost every evening during the week. It is the cause of more than 1 million admissions a year to hospitals—that is, admissions to hospital beds, not to the A&E department. Liver disease is spiralling out of control. All of this has been described very eloquently by the noble Baronesses, Lady Finlay of Llandaff and Lady Hollins, and other noble Lords.

I want to concentrate on the sort of things that we might be doing—in addition to the things suggested, very modestly, in these amendments—with regard to two aspects, prevention and treatment. It is pretty obvious that the system of voluntary pledges with the alcohol industry does not work. It has not yet worked, and does not look like it ever will. The drinks industry is not in the business of reducing alcohol consumption. We cannot suggest that it is. We have tried the voluntary pledges system, and it is obviously not having an impact.

I agree entirely with my noble friend Lord Brooke of Alverthorpe that we need a national strategy. We cannot rely on local authorities alone. In any national strategy, I fear that we have to focus on the price of alcohol. Our history has shown that every time the price of alcohol goes up, the incidence of liver disease and death from liver death goes down. It is the most effective measure. The Government have suggested that we should look at the minimal unit price, which is the price based on VAT and duty, as the minimal level. That is a pretty pathetic level and it does not work. I am reliably informed by Sir Ian Gilmore, who is a guru on the effects on alcohol, that this price measure affects no more than one in 4,000 drinks that are on sale. You have only to go to the supermarket. It is still possible, for example, to get three litres of 7.5 per cent cider—which is the drink of choice of many—for £2.99, and if you are lucky you can get a two-for-one offer, too. Price is critical. It is clear that the Department of Health is not responsible for pricing, duty and so on, but it must put pressure on for a rise in the price. It is not very popular with journalists, and it is even less popular with politicians. Nevertheless, it is an important measure.

I shall talk about treatment. There is no doubt that the best results from treatment come where there is an integrated team approach to patients suffering from the effects of severe alcohol ingestion. That is a team which combines specialist nurses, specialist doctors, primary care doctors and their team in an integrated way. A good example of that service is the one run by Dr Kieran Moriarty in Bolton. It is a very good system. Unfortunately, there are too few of those sorts of arrangements available. We need many more. They work, because you can actually do something with them. You prevent further damage from alcohol by aborting the effects of alcohol very early on. It works.

There is a lot that is needed, and a lot that can be done. We certainly cannot rely on the drinks industry to put up the price. We have to do something nationally. We have to enhance the alcohol services. I hope we can see some action here. I support these amendments as a first step.