Government Alcohol Strategy 2012

Debate between Dan Carden and Jim Shannon

Wednesday 18th January 2023 Westminster Hall

[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.

Prison-based Addiction Treatment Pathways

Debate between Dan Carden and Jim Shannon

Wednesday 2nd March 2022 Westminster Hall

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

I beg to move,

That this House has considered prison-based addiction treatment pathways.

It is a pleasure to serve under your chairmanship, Dr Huq. Too many people with drug dependency

“are cycling in and out of prison. Rarely are prison sentences a restorative experience. Our prisons are overcrowded, with limited meaningful activity, drugs easily available, and insufficient treatment. Discharge brings little hope of an alternative…life. Diversions from prison, and meaningful aftercare, have both been severely diminished and this trend must be reversed to break the costly cycle of addiction and offending.”

Those are the words of Dame Carol Black in her groundbreaking independent review of drugs—a damning observation.

The treatment system and effective recovery pathways from addiction in prisons are in desperate need of repair, yet the effectiveness of evidence-based, well-delivered treatment for drug and alcohol dependence is well established. When it is properly funded, it works: it cuts the level of drug use, reoffending, overdose risk and the spread of blood-borne viruses.

Analysis of Her Majesty’s inspectorate of prisons data from 2019 reveals that 48% of men surveyed by the inspectorate who reported having a drug problem said that it was easy to get drugs. The proportion of prisoners who said that they developed a drug problem while in custody more than doubled between 2015 and 2020.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. This is not the responsibility of the Minister, but in the papers last week it was reported that the drug uptake in prisons in Northern Ireland has risen to an astronomical height. It is therefore clear that what the hon. Gentleman is saying about the UK mainland also applies to us back home. Does he agree that the premise of prison is to rehabilitate and that addiction pathways are the absolute foundation for the rehabilitation that he and I want to see and that, to be fair, I think the Minister wants to see too? That can work only if funding is sourced and allocated UK-wide to make sure that it happens.

[Dan Carden]

The hon. Gentleman is spot on. I will come on to the function of prisons. Modern, progressive society should aspire to something more than having prisons there for punishment. The function of prison should be to rehabilitate, reduce reoffending and help those in prison to build productive and meaningful lives. I think the Minister will agree that without tackling drug dependence, that function cannot be fulfilled.

Part 2 of Dame Carol’s review calls for improved

“transparency and accountability of the commissioning and delivery of substance misuse services in prisons, including through publishing how much money is spent each year on these services”,

and ensuring that

“everyone leaving prison has identification and a bank account and that those who cannot claim benefits online get the opportunity, from the day of release, to access DWP’s telephony service.”

It calls for ending Friday release dates and for making sure that

“prisoners with drug dependence can access and receive drug treatment in the community as soon as possible after release.”

It also calls for additional prison staff to ensure that prisoners’ experience is improved, and for

“earlier interventions for offenders to divert them away from the criminal justice system, particularly prison.”

I am pleased that the majority of Dame Carol’s observations and recommendations have been embraced by the Government in the form of the 10-year drug strategy, “From harm to hope”, and the prisons strategy White Paper. Diversionary schemes are rightly encouraged by Dame Carol and endorsed by the drug strategy and the White Paper, despite the Government’s heavy “tough on drugs” messaging, because we cannot simply arrest our way out of the country’s addiction crisis, we cannot punish the already marginalised into recovery and we cannot end the pointless cycle of harm without evidence-based policy.

One in four people are placed in prison for committing an offence relating to their drug use. They are often given short custodial sentences of up to six months, most commonly serving as little as six weeks behind bars. Those on short-term sentences are the least likely to have access to drug and alcohol treatment, and prisoners serving seven-day sentences almost always pass through the system without support.

There are many innovative diversionary schemes and community sentences in use in different parts of the country. They reduce prison numbers, focus on treatment, recovery and rehabilitation, and stop small-time offenders losing access to housing, employment and family ties, which too often push them only further down the path of addiction, reoffending and homelessness, and exacerbate that vicious cycle of harm. I hope the Minister will touch on that in her reply.

For those who do reach the threshold of a custodial sentence and enter prison, the only answer to deliver change and break the cycle is to ensure there is access to treatment services within prison and on release. Sadly, the sharp decline in recovery services, particularly in prisons, mirrors the sharp decline in recovery services in the community. That has been further exacerbated by the pandemic, where prison regimes have entered strict lockdowns.

One practical challenge is that efforts to tackle drug use in prison are often undermined by the widespread availability of drugs across prison estates. Time, energy and resources end up being consumed by cracking down on the illicit supply. How can policy deal with that challenge, while also dealing with the demand for these substances and the root cause of that? Security can do only so much without a parallel commitment to reducing demand. The Government should ensure that they are committed to acting on both.

I am yet to meet anyone in addiction and recovery who has not experienced trauma. For those fortunate enough to have no personal experience of addiction, it is difficult to comprehend that the drug of choice is, at first, a solution, before it becomes a problem. Prisoners with drug and alcohol problems tend to have high rates of trauma, and trauma begets trauma.

Trauma has been shown to impact on cognitive functioning and on an individual’s ability to build and maintain social relationships. To be drug or alcohol dependent is a harrowing and hopeless ordeal; it is not a choice. To quote Dame Carol, a

“widespread sense of boredom, hopelessness and lack of purposeful activity in custody”,

coupled with little access to meaningful support in prison, is perhaps the worst possible environment the state could create to deal with this growing problem.

We know that, with access to properly resourced, person-centred, trauma-informed care, people can and do make positive changes to their lives. For prisoners, that care cannot stop when they walk from the prison gates. Many prisoners with drug problems are still being released on Friday afternoons, with nowhere to stay, no access to appointments at probation or drug services, no Naloxone and nothing but £46 in their pocket, with predictable results.

Transition between prison and the community must be prioritised to ensure a significant increase in engagement and community treatment on release. Every person in recovery is proof of the transformational change that is possible. For those who doubt whether someone in prison can address their addiction and make positive changes, I recommend taking the time to look at the fantastic “More Than My Past” campaign by the Forward Trust.

The sad reality is that the UK was once a leader in offering accredited addiction and recovery programmes in prisons. At the beginning of the last decade, there were over 100 programmes in England and Wales in prison settings, with over 10,000 prisoners participating. Today, access to accredited addiction and recovery programmes is a prison postcode lottery. There is no national standard, and the latest figures suggest that the number of people participating in accredited services in prisons is below 200 per year.

In 2012, the Rehabilitation for Addicted Prisoners Trust—now the Forward Trust—managed 14 intensive accredited addiction and recovery programmes in prisons across England, serving around 1,200 people per year. Independent evaluations showed that those programmes helped thousands of people into recovery from addiction, and that prisoners who completed those programmes were 49% less likely to be reconvicted compared with those who completed other programmes. By 2020, most of those programmes had closed due to lack of funding, and only around 300 people were able to access them. As it stands today, after two years of covid restrictions, only four programmes of this kind are still running, with only one currently operational. Despite the evidence, access is sparse, and prisoners have to transfer in order to access such services.

The Health and Social Care Act 2012 transferred responsibility for commissioning health services in custody from Her Majesty’s Prison and Probation Service to NHS England. Funding for prison healthcare and substance misuse services fared well compared with the local authority funded services in the community, but there have been other consequences. Physical healthcare services in prisons have improved, but as Dame Carol pointed out, the arm’s length approach to commissioning substance misuse services in prisons has been widely criticised. Contracts are often placed with general healthcare providers, then further subcontracted out, and the system becomes fragmented and unaccountable.

Since that transfer, there has been an alarming reduction in the range of provision in prisons, particularly in recovery-oriented services. Fewer than 200 prisoners are accessing accredited, structured addiction and recovery programmes, and in its “Alcohol and drug treatment in secure settings” report, the Office for Health Improvement and Disparities showed that there were 43,255 adults in alcohol and drug treatment in prisons and secure settings between April 2020 and March 2021—a drop of around 3,000 from the previous year. However, that figure of 43,255 prisoners accessing the treatment system does not tell us anything about how many were accessing recovery-oriented services. Can the Minister tell me what that treatment consists of, considering that accredited addiction and recovery course attendance has plummeted so drastically? With this new strategy, will the Minister also commit to restoring accredited addiction and recovery programmes to former levels and making them available in every prison?

When discussing addiction treatment pathways in community and secure settings, there is an unproductive and recurring debate: harm reduction versus abstinence. Each has its own set of benefits, yet they represent completely different approaches to recovery. Both approaches to treatment have their perceived pros and cons, but there is no right choice or correct pathway; after all, addiction has many causes, and recovery can be supported in a number of ways. Opiate substitute treatment, needle exchange, and the life-saving naloxone are important interventions—harm reduction saves lives, but so does recovery. It is time to take seriously the challenge of turning people away from drugs and crime.

I understand that the Secretary of State for Justice’s promotion of abstinence-based programmes in the prisons White Paper has caused confusion and some upset. Some believe that his approach goes against evidence-based research and the Government’s own 2017 “Drug misuse and dependence: UK guidelines on clinical management” document. The guidance is clear:

“any plan for reduction and cessation of OST should be based on the clinical judgement of the prescriber in collaboration with the prisoner and the wider team. Reduction and cessation should not be on an arbitrary or mandatory basis but rather requires careful clinical assessment and review…There should not normally be mandatory opioid reduction regimes for dependence…The purpose of healthcare in prison, including care for drug and alcohol problems, is to provide an excellent, safe and effective service to all prisoners, equivalent to that of the community.”

This should not be an either/or. When we think about recovery from any other health condition, that way of thinking would not be accepted. Clinicians would be focused on combinations that give people the best possible chance to make a full recovery. The Government say in their drugs strategy:

“We will treat addiction as a chronic health condition”.

I welcome that. As with many other health conditions, there needs to be a wide range of interventions and services that provide those in need with real choice.

For many people, harm reduction is the start of the recovery journey, but recovery is much more than, “Are you clean or not?” Recovery is not binary, recovery is not linear, but recovery is possible. To support it, there needs to be greater allocation of physical space on the prison estate to carry out therapeutic interventions that all people can access. That must include space for psychosocial, not just clinical, interventions. Well-designed recovery wings create a much less violent and more co-operative population who are focused on rehabilitation. Every prison should have recovery-focused wings. I wonder if the Minister is considering that possibility.

I welcome the commitment from the Ministry of Justice to expanding the use of recovery-focused areas in prison, which pointed to Her Majesty’s Prison Holme House as an example of good practice. The early outcomes from recovery wings have identified a reduction in violence and substance use, and a link to increased employment opportunities on release. Despite the support from addiction treatment charities for recovery wings, and despite their inclusion in the prisons White Paper, I have been made aware of a growing sense of open resistance in the Department of Health and Social Care to the expansion of recovery wings in prisons.

I would be grateful if the Minister could shed some light on those worrying reports. Is that the case, and if so, will she put a stop to it? Will her Department deliver on the reforms set out in the drugs strategy and the prisons White paper to improve addiction treatment in prisons and not stand in their way? Will the Minister tell us how the new spending allocation will reflect the priorities set out in both papers?

To conclude, I will quote Charlie Taylor, Her Majesty’s chief inspector of prisons:

“To lead successful, crime-free lives when leaving custody, prisoners must change the way they feel about themselves and develop a belief that they can take control of their future.”

I hope that officials in the Department of Health and Social Care take heed of the chief inspector’s words as the final decisions are made on what has the potential to be positive progress under this Government’s reforms. Lives depend on it.

Dame Carol Black’s Independent Review of Drugs Report

Debate between Dan Carden and Jim Shannon

Wednesday 27th October 2021 Westminster Hall

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

I beg to move,

That this House has considered Dame Carol Black’s independent review of drugs report.

It is a pleasure to serve under your chairmanship, Ms Fovargue. I refer Members to my entry in the Register of Members’ Financial Interests. The damning conclusion of part two of Dame Carol Black’s review, setting out a way forward on drug treatment and recovery, was that

“the public provision we currently have for prevention, treatment and recovery is not fit for purpose, and urgently needs repair.”

I have called today’s debate because the report’s recommendations are too important to be left gathering dust on ministerial bookshelves. I want Dame Carol’s words ringing in ministerial ears. She says:

“Government faces an unavoidable choice: invest in tackling the problem or keep paying for the consequences. A whole-system approach is needed…This part of my review offers concrete proposals, deliverable within this Parliament, to achieve this.”

Of the review, Dame Carol says:

“It calls for significant investment, but the payoff is handsome: currently each £1 spent on treatment will save £4 from reduced demands on health, prison, law enforcement and emergency services. I am hopeful that the recommendations will be welcomed by this government as they strongly support its crime reduction and ‘levelling up’ agendas.”

The 32 recommendations are a gift to the Government, and should be a moment for change. It is fitting that the debate falls on Budget day. The economic cost of drug misuse is upwards of £20 billion each year; yet the spending on prevention and treatment stands at just £650 million. The recommendations give hope that real change is possible. Addiction is a national crisis. Drug and alcohol-related deaths are the highest on record, at the very moment that treatment services are most ill-equipped to deal with the soaring need.

Forward Trust estimates that more than 2 million people are in need of help with alcohol, drugs or gambling, and its recent YouGov poll showed that 64% of people said that they knew someone personally struggling with addiction. Since I talked openly about my personal experience of addiction and recovery, I have been over- whelmed by the thousands of people who have reached out to tell me their personal stories—of the horror of addiction, and the blessings of recovery. The tragedy is that addiction is everywhere, yet remains so hidden.

In 2019 Dame Carol was commissioned by the then Home Secretary, the right hon. Member for Bromsgrove (Sajid Javid), to independently review illicit drugs in England. I thank her for her commitment and dedication over the last few years, and all those who contributed to this groundbreaking report. Most of all, I hope that my contribution today does justice to the absolute clarity that Dame Carol brings to these incredibly complex matters. Part one of her review was published on 27 February, and made for uncomfortable reading. The unflinching analysis detailed the extent of drug-related harm and the challenges posed by drug supply and demand, including the ways in which drugs fuel serious violence.

The Department of Health and Social Care swiftly commissioned Dame Carol to produce part two of her independent review, which focused on how to improve the funding, commissioning, quality and accountability of drug prevention, treatment and recovery services in England. Part two of her report, published in July, pulls no punches either. It says:

“Funding cuts have left treatment and recovery services on their knees. Commissioning has been fragmented, with little accountability for outcomes. And partnerships between local authorities, health, housing, employment support and criminal justice agencies have deteriorated.”

The report goes on:

“The workforce is depleted, especially of professionally qualified people, and demoralised. Vital services have been cut back, particularly inpatient detoxification, residential rehabilitation, specialist services for young people, and treatment for cannabis and stimulant users.”

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for bringing this issue to Westminster Hall for debate and discussion. Does he agree that more should be done to ensure that alcoholism in particular is treated urgently, along with drugs, and that help needs to be given to families for rehabilitation, which he has referred to, not in a punitive fashion, which is how some would like to do it, but instead to help to draw people away from their addiction? That has to be done in such a way that people wish to get away from their addiction and try to move forward.

[Dan Carden]

Absolutely. That is a valuable intervention, and it is good that we have a Health Minister responding to this debate, because it is a health response, joined up across Government, that this issue calls for.

Part two of the report goes on:

“Areas of the country with the highest rates of drug deaths or the poorest treatment services are the very same areas where the need to level up is greatest. These communities want to see urgent and effective action to tackle the violent drugs market, alongside purposeful efforts to rebuild treatment services and recovery support so that people can get the help they need.”

Alcohol Products: Labelling

Debate between Dan Carden and Jim Shannon

Tuesday 27th April 2021 Commons Chamber

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

I am grateful to Mr Speaker for allowing me this Adjournment debate, and I am grateful to you, Madam Deputy Speaker, and to the Minister, whose reply I look forward to. Earlier this month, the details of the upcoming Government consultation on alcohol labelling—part of the obesity strategy—were leaked to the press. It is a long-overdue consultation and a welcome positive step that should lead to consumers being able to make more informed choices about their own health and wellbeing, but thanks to yet another hostile Government leak, the consultation was roundly attacked and misrepresented by tabloids and industry representatives. It sparked the usual outraged backlash against the nannying state and red tape, when that is simply not the case. I thought I would attempt to put the record straight.

To avoid confusion or misrepresentation, I whole-heartedly support our hospitality industry, and I understand the uphill battle it faces and the devastation that lockdowns and restrictions have caused. There is excitement and anticipation across the country about getting out, socialising, having a drink, seeing live music and enjoying life. We have all missed spending time with family and friends, whether that is relaxing and unwinding or going out and partying.



When we consider the role of alcohol in our society, we see that there is a balance to be struck. As with many things in life, there is the good and there is the bad, because we cannot escape the very real harm alcohol inflicts. The evidence, which I will come to, speaks for itself. Tackling alcohol harm is not about punishing drinkers or landlords, or taking the fun out of socialising. However, we have a responsibility—the Government have a responsibility—to hold the alcohol industry to account, and to ensure its fair and proper regulation.

Alcohol harm is rising, and it has been for many years, however we want to count it. Alcohol is now linked to 80 deaths a day in the UK, many of them of the young, while alcohol-specific deaths are at their highest rates since records began, and the treatment and funding for alcohol addiction are in absolute crisis, yet there appears to be no sense of urgency from Government. Alcohol is responsible for more years of working life lost than the 10 most frequent cancers combined. Before covid, alcohol took up 37% of ambulance time and a quarter of A&E time. For the police, it is even higher, with more than half of police time spent on alcohol-related incidents. All of this comes at a high financial cost, too. Alcohol harm is estimated to cost the UK taxpayer upwards of £27 billion each year.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for bringing this issue to the House. It is a massive issue in his constituency, and very much one in mine as well. Does he not agree that alcohol-specific deaths are at an all-time high owing to a perfect storm? With coronavirus, isolation and lockdown, as well as the fact that very few people use standard pub measures at home, that there are supermarket deals on bottles of alcohol and people do not have to drive to work the next day, it is imperative that we take steps to remind people of the number of units per bottle, make it clear that the glass of wine they are accustomed to at home is not the same as their local pub one, and make people aware of the need to reduce their intake.

[Dan Carden]

I am grateful to the hon. Member, and he is absolutely right.

We know that those in the most deprived communities are disproportionately affected. Despite drinking less on average, they are up to 60% more likely to die from alcohol than more affluent groups. In Liverpool—just one city—there are more than 14,000 alcohol-related hospital admissions every year, and 535 new cases of alcohol-related cancer as well. Alcohol harm and addiction are destroying lives, livelihoods, communities and families.

To return to the matter of today’s debate—alcohol labelling—I would like to ask those listening to remember the last time they looked at a bottle of orange juice. They may remember a number in red detailing the sugar content, a number for how many calories are in the drink, and a whole table with further information on nutritional content. Now picture a bottle of alcohol—wine perhaps. Do they remember seeing any such information about the ingredients, calories or nutritional values? Was there any information about the impact of alcohol on health, or any guidelines for consumption? If I can make a guess, the answer is most likely to be no, or maybe “on some bottles”. That is because none of this information is legally required on alcohol labels. Alcohol products are a conspicuous outlier among consumables. They are exempt from other food and drink labelling requirements, and the only information that is legally required is the volume of the liquid, its strength in ABV—alcohol by volume—and whether any of the 14 most common allergens are present.

In July 2020, the Government unveiled the new obesity strategy. On the subject of labelling, the Health Secretary said

“it’s only fair that you are given the right information about the food you’re eating to help people to make good decisions.”

He is absolutely right, and what he says is as true for alcoholic drinks as it is for anything else. It is surely bizarre that if we buy a bottle of juice, we get a range of calorie, ingredient and nutritional information, yet if we buy a juice and vodka ready-to-drink product, we will usually not get any of the same information. Similarly, alcohol-free beer and wine must display calorie and nutritional information, yet alcoholic beer and wine does not have to.

Covid-19 has reminded us all of the need to take seriously the impact of diet and lifestyle on our physical and mental health. As we know that alcohol damages health and causes harm, it is inexplicable that alcohol products face less regulation than fruit juices and fizzy drinks, so the Government’s consultation is timely and important.

I want to press the Minister to go further with the consultation than calories, nutritional information and ingredients; it must consider health information as well. The majority of the public agree and want to know what is in their drinks. Opinion polling conducted for the Alcohol Health Alliance shows that 74% of people want ingredients on alcohol labels, 62% want nutritional information, including calorie content, and 70% want health warnings.

There is a strong case for displaying calorie information on alcohol labels. For those who drink, alcohol accounts for nearly 10% of their daily calorie intake. Around 3.4 million adults consume an additional day’s worth of calories each week, yet 80% of the public are unaware of the calorie content of the most common alcoholic drinks.

Alcohol harm is also poorly understood by drinkers. Only one in five people know the drinking guidelines, and only one in 10 can identify cancer as a health consequence of alcohol. We have warnings on cigarettes that tobacco can cause cancer, so why is similar information missing from alcohol?

I would like to quote one person with lived experience, who described the lack of health information to me like this:

“I knew little of how many recommended units per week, I knew nothing about the nutritional value, I could tell you how many calories were in a Mars Bar but not the glass of Merlot I was drinking. I knew nothing about the long-term health implications. If I buy a pack of cigarettes I am told they are highly addictive and I am told with every pack what health implication there could be. They are now behind a shutter in the shop – but alcohol? Nothing. I near lost my life to alcohol and the lack of information and regulation makes no sense to me”.

Alcohol labels are an effective tool to change that situation. A study in Canada showed that consumers exposed to health warnings on labels were three times more likely to be aware of the drinking guidelines and were also more likely to know about the link between alcohol and cancer.

A number of alcohol products voluntarily incorporate unit alcohol content per container, a pregnancy logo or message and active signposting to drinkaware.co.uk. I am grateful to the producers who contacted me ahead of this debate to share updated labels that now include calorie and nutritional information. One of the UK’s biggest pub chains has already taken that step and is providing calorie labelling for all alcoholic drinks on their menus. I am grateful to the Minister for confirming, in answer to my written question, that alcohol sold in licensed venues will also be part of the consultation.

If someone pops into their local supermarket and takes a wander round the booze aisle, it is abundantly clear that there are huge inconsistencies in alcohol packaging. That hit-and-miss approach is just not good enough. It is time to put it right and standardise the approach, as we have done with food labelling. Even on the products that did carry chief medical officer guidelines and nutritional information, there are varying degrees of clarity and visibility.

In their report “Drinking in the dark: How alcohol labelling fails consumers”, Alcohol Change UK and the Alcohol Health Alliance recommend that:

“The UK Government and devolved administrations must give a new or existing independent agency appropriate powers to…enforce what appears on alcohol labels, working in the interests of public health and consumer rights and free from influence and interference from corporate interests.”

I support that recommendation and hope that the Minister will consider it in the consultation, when it gets under way.

Sir Ian Gilmore, a leading figure in Liverpool’s fight against alcohol harm and chair of the Alcohol Health Alliance, said:

“Alcohol labelling in this country is…not fit for purpose if we wish to build a healthier society. The public must be granted the power to make informed decisions about their health by having access to prominent health warnings and information on ingredients, nutrition and alcohol content at the point of purchase. The industry’s reluctance to include this information on their products suggests profits are being put ahead of people’s health.”

Ahead of this debate, I received a letter and information from the Portman Group, the alcohol industry-funded social responsibility body and regulator for alcohol labelling, packaging and promotion in the UK, and I am grateful for that. The Portman Group supports the consultation and its intention to provide consumers with more information on calories, the chief medical officer’s lower-risk guidance and drink-driving. It said that

“we believe this can be done most effectively on a voluntary basis”.

It is encouraging to hear some industry support for the consultation and I look forward to further discussions with it, but with alcohol-specific deaths at their highest on record, it is surely time for a proper review of how the industry is regulated and held to account.

The regulation of alcohol marketing in the UK is fragmented and largely self-regulating. Under the current set-up, the Advertising Standards Authority, funded by the advertising industry, Ofcom and the Portman Group, funded by the alcohol industry, all play a role in regulating marketing, from TV advertising to sponsorship deals to packaging. That is surely ripe for review, to consider how a new model and a new alcohol industry regulator could be made more accountable to the public and be fully independent of the alcohol industry.

I hope that the Minister will use her consultation as an opportunity to mandate wider health information on labels, too. This should, as a minimum, include the CMO’s guidelines, pregnancy warnings, drink-drive warnings and cancer warnings, so that we can make informed personal health choices and collectively seek to reduce alcohol harm.

I accept that alcohol labelling is only one small part of seeking to reduce alcohol harm across society. Any progress on improving labelling should be part of a broader strategy: a national, Government alcohol strategy. The last alcohol strategy was formulated in 2012, and, since then, harms have continued to rise. Over the last decade, we have learnt a lot more about the wider health impacts of alcohol, such as the link between alcohol and cancer. The World Health Organisation is clear that policies on the affordability, availability and promotion of alcohol are the most effective—policies that have also proved effective in reducing smoking.

What can really be said of attempts to reduce the increasing and worsening harms caused by alcohol misuse? Why is it that evidence-based research and policies are being ignored in this way? The Government’s addiction strategy is under way—it was promised in 2020, but we are waiting for it—and we also await the second part of the Dame Carol Black review of drugs. These are very welcome, but now is surely the time for a full-scale review of reducing alcohol harm across society. A focused alcohol strategy would allow a much broader and fuller understanding of the extent of alcohol harm and the measures needed to reduce it.

As it stands today, the UK has the highest number of alcohol-specific deaths on record. Drug and alcohol addiction services have been pushed outside the NHS into cash-strapped local authorities, decimated by funding cuts and fragmented. There are fewer addiction psychiatrists in training than ever. Alcohol is now 74% cheaper than it was in 1987, and in England there are over 300,000 children currently living with at least one adult who drinks at a high-risk level.

This current trajectory cannot continue and the urgent need for a national alcohol strategy cannot be overstated. In their approach to obesity, the Government have shown a willingness to take bold action to protect the public’s health. The same boldness is now required to tackle alcohol harm. The consultation on the labelling of alcohol products is the first step towards improving transparency and accountability across the alcohol industry, and ensuring an evidence-based approach to reducing alcohol harms. I implore the Minister to get it under way, and I look forward to her response.

--- Later in debate ---

[Dan Carden]

Will the Minister give way?

[Jim Shannon]

Will the Minister give way?

[Jo Churchill]

My goodness—stereo!