Alcohol Strategy (EUC Report)

Baroness Murphy Excerpts

Wednesday 10th February 2016 Grand Committee

[Baroness Murphy (CB)]

My Lords, about a week ago I looked at the list and thought that, well, there are so few of us going to speak in this debate that maybe we should all pack up and go down the pub instead. We have, however, improved our numbers respectably.

As a doctor and a psychiatrist I have, of course, witnessed the ravages of alcohol many times, and I know well its destructive force. Drinking, however, is a pleasure that I greatly enjoy. I can get my endorphins instantly from a glass of wine, which I cannot by going down the pub for at least an hour. Also, I think that most of us in this House, like most of the population of Britain, enjoy a drink; it adds to the conviviality and calm of public gatherings.

I feel that I ought to mention, because it is no longer in the register, that I was for many years a part-owner of a gin distillery, and, in the 1990s, a director of a brewery. I still have some emotional, but not financial, connections with that brewery. I know, therefore, that some members of the alcohol industry realise that it is in its best interest to reduce the associated long-term harm; otherwise they will be subjected, eventually, to what is happening to the tobacco industry, which they are not daft enough not to have seen. The UK has been more effective than any other EU country in reducing tobacco consumption; it has been a great success. If we are to reduce the harm that alcohol does, we need to learn a great deal about that; but we must learn the best of what we know on the evidence, which means having a very diverse strategy. That includes such matters as the noble Lord, Lord Maclennan of Rogart, has mentioned, and the Private Member’s Bill of the noble Lord, Lord Brooke of Alvethorpe, which aims to reduce drivers’ alcohol consumption. A mixed strategy is required to reduce harm overall.

The European Observatory on Health Systems and Policies published a wonderful review in 2013, in which Currie and Gilmore looked at how tobacco reduction strategies were structured in all EU countries. The most effective ones were those with diverse approaches across all elements, as has already been mentioned. It is not only a health strategy. It includes warnings, pricing, taxation and opportunities for treatment and for people across the board to think about what they are consuming.

I congratulate the noble Baroness, Lady Prashar, on her committee’s tackling the way the EU set about its work on an alcohol strategy. It made a mistake that we have often seen made by august bodies such as the WHO and the UN on other matters. They are very good at telling others what to do about strategies, and far less good at thinking about what they themselves can do as a priority. Her committee has issued an excellent report on what the EU should be doing. It is a disgrace that it does not have a strategy to which we can all subscribe, and which makes best sense of what it and individual states can do.

What the EU can do is important and may not be so upsetting to the alcohol industry. Alcohol duty is structured in a barmy way at the moment. As noble Lords know, the problem is that alcohol strength—the quantity of neat alcohol in a drink—which is the driver of harm, is not taxed proportionate to the amount in the drink. Under current EU legislation, you can do it for beer or spirits but not for wine or cider. Have your Lordships ever asked yourselves why supermarket ciders are so darn strong—up to 8% or 9%? It is because they are not taxed in the same way.

The defects in the existing taxation legislation produce these distortions in alcohol pricing. It makes a huge difference. New world wines are now 15%—a slug of Cabernet from New Zealand or South Africa will knock you over. If there was a proportionate alcohol taxation on volume, lighter wines would be encouraged and we would consume far more of the lower-alcohol wines. The same is true of beer. Scandinavian countries, which have taken the point on board, produce many very popular low-alcohol beers. We should press the EU in this area. The industry would be agreeable on this point.

I wholeheartedly agree that rules on food labelling are crucial, particularly for women. I gave up drinking for four months last year because I was on a diet. It was difficult. Two large glasses of white wine, my favourite tipple, are the equivalent of a large plate of French fries. How many women know that? The noble Lord, Lord Patel, is muttering about how many chips I eat. It is crucial that we have proper alcohol labelling. It would help women in particular, but also concentrate the minds of men.

We need to suppress demand in the areas where it is the greatest in order to reduce the culture of drunkenness. We have a culture in this country which is quite different from much of Europe, in that people go out to get smashed. They buy cheap offers at the supermarket and “preload” before they go out—and then get further smashed in the pub. It is encouraging that alcohol consumption is dropping among a proportion of younger people in this country, although that may well be because the population’s structure and demographics are changing. It may be that the attitude to alcohol of native-born, white British, Scots and East Anglians—for example, Norfolk folk—is not changing a great deal. Perhaps we are seeing that in London, with a different sort of population.

We therefore need effective pricing policies for supermarkets, effective taxation and effective warnings. Warning women about consuming large amounts of alcohol during pregnancy is crucial; we should at least get that on the bottles. These are the things that my noble friend Lady Prashar’s committee recommended, and which we should ask of the EU because only the EU can do it. We should say to the EU, “Please, rethink this”, because the industry would, I believe, be agreeable. I am not suggesting for one moment that we do not need to tackle the alcohol industry, but there are ways through the pricing and taxation problem that would be more agreeable to the industry if they were part of an overall strategy. We should press the Government strongly to ask the EU to look again at what could really work. I look forward to hearing what the Minister has to say about what we can do to urge the EU to tackle this problem.

Mesothelioma (Amendment) Bill [HL]

Baroness Murphy Excerpts

Friday 20th November 2015 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I am the last person to speak before the winding-up speeches and the fifth doctor in this debate. Noble Lords will all be highly relieved to know that I will not say anything medical.

Unfortunately, I was unable to participate in the debates on the Mesothelioma Bill last year, so I very much wanted to come along and add my personal support for the initiative of the noble Lord, Lord Alton. Everyone has said that he has been tireless; he is not only tireless but energetic and focused in a way that has brought great rewards for people with mesothelioma. I also wanted to add my personal thanks to the noble Lord, Lord Freud, for the work that he did, and we must not forget the noble Lord, Lord McKenzie of Luton, before him, who also made great strides during his time in office. The noble Lord, Lord Prior, the Minister today, will not be surprised to know that we want to see the same from him.

Why am I here today? Like the noble Lords, Lord McNally and Lord Freyberg, I have a personal story. My father died of mesothelioma. I was a young doctor in the 1970s when I first realised that my father had this appalling constricted breathlessness. He had worked as a powerhouse engineer during the war. He supervised the powerhouses for Boots Pure Drug Company, which was a massive manufacturing plant during the war, making not only the pharmaceuticals needed, from antidotes to chloramine to aspirin, but gasmasks on military contracts. As noble Lords know, military gasmasks had the worst sort of asbestos in them during the war.

There is no doubt that it was the powerhouse lagging and that factory work that produced the illness that killed my father 35 years later. My mother well remembers him coming home with his overalls drenched in white and grey powder, which she washed, of course. She was darned lucky not to get it. As a result of this illness and because of his early death from this terrible disease, she was widowed for 37 years. It is a terrible thing, as a young doctor, to watch somebody dying of this appalling constriction. As the noble Lord, Lord Ribeiro, said, at the time all they could do was keep taking the fluid off. That was the only way to help him through this terrible time.

The mean survival rate has gone up by no more than 2.8 months over the last 30 years. That gives some indication of the desperate need to research. Normally, rather like the noble Lord, Lord Howarth of Newport, I would not have supported the Bill, but we are now at the point where we are seeing a resistance from the insurers. They are not coming to the table. They are not stepping up to the mark and supporting it.

I want to bring home to the Minister what has happened with regard to dementia research because of all the arguments we have heard about why people are not coming forward with good proposals—for example, this is not a fashionable area of research or there are issues about funding. We heard all these arguments in relation to dementia but what made the difference is the point that the noble Lord, Lord Wills, made—namely, there was political focus. Somebody in the Department of Health took an interest in dementia and said that for all kinds of economic and other reasons, and given the seriousness of the disorder, we must focus our efforts on tackling it. Only the Department of Health can get people round a table and ask them, “What are you doing? How can we make this work?”. It does not take a great deal of a Minister’s time to do this. I challenge the Minister to provide a political focus on this issue. He will no doubt tell us how we can tackle the research deficit, but I believe that Ministers need to take an interest in this issue and provide the political focus to make the research happen. Money is important, but providing political support to make the research happen is what is really required.

Atrial Fibrillation

Baroness Murphy Excerpts

Wednesday 4th November 2015 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I am delighted to support the noble Lord, Lord Black of Brentwood, in his campaign to get better recognition for the causes and treatment of atrial fibrillation. I am interested because I have spent a good part of my professional life as a psychiatrist working with elderly people suffering the emotional and neuropsychological aftermath of serious stroke. It makes me hopping mad to come across people who still have atrial fibrillation after they have been treated for their stroke and have then come on for further psychiatric treatment. It is a tragedy to recognise that they still have the atrial fibrillation that could be treated to prevent a further stroke.

I am now retired from clinical practice and I understand that things have improved. It is now much more likely that patients will arrive with appropriate treatment. I congratulate this Government, the previous coalition Government and the Government before that, on supporting the major stroke initiative that has led to much better targeted care of people with stroke, from access and recognition of stroke right through to focused centres and better outcomes in mortality and morbidity. We are making good progress, but there is still much more to be done.

Atrial fibrillation is extremely easy to diagnose, as the noble Lord, Lord Black, said. If you are treating a lot of elderly patients every day, it is very nice to sit down and gently feel their pulse, right at the beginning. This breaks the ice and is a very good way of making contact with an elderly patient you might not know very well. We are now getting to the point when we are joining the elderly generation. Some of us are already well into that period of life. The time has come when we are the patients who need to know about atrial fibrillation and know when we have an irregular pulse. We are the ones who need to understand. The population increasingly understands the causes of stroke and what to look for. We can teach people, with education and public information, how to feel their own pulse. Most people already know; it is so easy, so there is no problem there.

I agree that there is a problem with the drugs. I went to see an elderly friend of mine who was also a doctor in her time and is now 90. She has a touch of atrial fibrillation and she said, “I will take anything except that rat poison”. I told her that she was taking a bit of a risk but she said, “I have discussed it with my doctor, but my next-door neighbour has just died of a cerebral haemorrhage. Are you really going to subject me to that risk as well?”. There are now four new drugs on the market, some of which have been around for about two years, but the problem is that they do not diminish the risk of haemorrhage. We need to discuss the risk with individual patients, but patients are still having to think through whether or not they really want a drug when the side-effect risks are huge.

I have been speaking for four minutes, so I will shut up, but my final point is that we need to take heart from some of the newer treatments. Left atrial appendage ablation, which is available in the States now, and is coming here, is the way forward for the future.

NHS: Clinical Commissioning Groups

Baroness Murphy Excerpts

Wednesday 16th September 2015 Lords Chamber

[Baroness Murphy (CB)]

Does the Minister agree that the inequity of allocations to CCGs is reflected and made worse in allocations on mental health which, for historical reasons, are very skewed to where there are large hospitals? Not only that, but at the moment it seems that CCGs are not even spending the money that is allocated to them for mental health on mental health but are diverting it to other areas. What is going to be done about this in terms of the fairness of the allocations and the insistence that the money should be spent on what it is intended for?

[Lord Prior of Brampton]

My Lords, I am not convinced that the method of allocation is unfair. ACRA will soon be reviewing its method of allocation for 2016-17. I repeat that it is an independent process. How CCGs allocate the money they receive to mental health, physical health, public health or anything else is up to them. With the King’s Fund, we are introducing a range of measures to enable us to see how individual CCGs are performing.