Alcohol Harm

Fiona Bruce Excerpts

Tuesday 17th March 2020 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Paisley.

I thank the Backbench Business Committee for allocating time for this debate. The request for it was made some six months ago, in the hope of it being granted in the run-up to Christmas or when many join in Dry January, but pressure on parliamentary time meant that it has only just been granted. I appreciate that now we are in a very different time as regards health concerns. None the less, alcohol harm is an ongoing and long-term concern not just for those who drink to excess but for their families and wider society, and it will still be with us even after—as we hope—the coronavirus crisis is past.

I thank the Minister for Care for stepping in to respond to the debate at a time of great pressure for her and the Department of Health and Social Care. I pay tribute to the great leadership being provided by the Prime Minister, the Secretary of State for Health and Social Care, the other Health Ministers and all those involved in leading on the exceptional and unprecedented crisis in our nation—thank you.

I appreciate that the current unprecedented situation means that fewer colleagues are present for the debate. Many put down their names and intended to speak. I thank those who are in attendance. One colleague asked me to mention that she regrets being unable to be here: the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is chair of the recently instituted all-party parliamentary group for the excellent 12 steps programme, which has made a difference in so many people’s lives.

There are, and have been for a long time—as long as I have been in Parliament, which is now some 10 years—several all-party groups concerned with alcohol harm: one under that name, one on foetal alcohol spectrum disorder, another on the children of alcoholics, and the drugs, alcohol and justice all-party group, and I am delighted to see its secretariat in attendance today. Alcohol harm, therefore, is not a minority concern here in Parliament, as some may think.

Before I go on to talk about the concerns that many of us have about the impact of alcohol harm, this debate is in no way intended to denigrate the fact that drinking responsibly and enjoying a drink is something that I and many others do. That is not what we are here to do today; we are here about drinking to excess, harming oneself and others.

I will come on to the speech that I had prepared, although that was before we found ourselves in these exceptional circumstances this morning, when the country faces the prospect of many self-isolating for long periods. Even so, while Ministers in the Department of Health focus on the crisis, over the coming weeks when giving health advice, they might still send out a few helpful messages to those stuck at home who may be tempted to drink more than is good for them.

Many tips, many of them straightforward, have been given over the years by organisations such as Drinkaware, whose work I commend, but perhaps not sufficiently widely promoted. This might be an opportunity to do that—for example, taking a non-alcoholic drink before an alcoholic one, having a glass of water by the side of the alcoholic drink, or trying alcohol-free drinks. Last year, here in Parliament, our all-party group hosted an alcohol-free drinks event attended by 60 colleagues. We had an enjoyable time—alcohol-free gin, champagne, lager—[Interruption.] I am very aware that the hon. Member for Strangford (Jim Shannon) attended that event and it was indeed enjoyable. We should try alcohol-free drinks and, as Drinkaware suggests, aim for two or three alcohol-free days a week to rest the liver.

To turn to the substance of the debate, 10 million people are drinking at levels that increase the risk of health harm.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Lady on this timely debate. Does she agree that, in these exceptional circumstances, one of our concerns over the coming weeks and months should be the massive reduction in social interaction? There will inevitably be a spike in the number of people drinking alcohol at home. Both Government and communities have to be aware of that to try and ensure people do so responsibly and not to significant excess, which may well happen in the coming weeks.

[Fiona Bruce]

The hon. Gentleman has expressed far more eloquently than I have exactly the issue that many will face. It is particularly interesting that the 55 to 64 age group is one of the most at risk, with its excess drinking described by charities working in the field as a “national health disaster”. There is an opportunity here to gently—I am aware there is a lot of other stress—help people understand the implications of drinking to those levels.

In the Green Paper published in July 2019, the Government said

“the harm caused by problem drinking is rising.

Over 10 million people are drinking at levels above the official guidelines and putting themselves at extra risk.”

Tragically, exactly the same thing was stated by Public Health England in the third line of its 2016 evidence-based review, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies”:

“there are currently over 10 million people drinking at levels which increase their risk of health harm”.

It goes on to talk about

“1 million hospital admissions relating to alcohol each year”.

Interestingly enough, half of those occur in the lowest three socioeconomic areas.

“More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

Sadly, several years on, we still do not have what is very much needed: a distinct and discrete alcohol strategy—it could be better called an alcohol harm strategy—to address the issue. I recommend the Health Minister to look at the alcohol charter, if she has not seen it, which was produced by some of our all-party parliamentary groups following the 2016 report and makes some suggestions as to what that strategy could contain. They include tackling the increased availability of excessively cheap alcohol, empowering the public to make fully informed decisions about their drinking and providing adequate support for dependent and non-dependent drinkers.

If I had a main call today, it would be to ask that the Government produce an up-to-date alcohol strategy. The last one was produced in 2012 and it is out of date, not only because of statistics—I am afraid I will bore colleagues with some more shortly—but also with reference to our approach to minimum unit pricing, which I will refer to later.

Our relationship with alcohol is complex, and so are its harms. Alcohol is embedded in our culture. Whether we are celebrating, had a tough day or need to reward ourselves, alcohol very often seems to play a role. It has become normalised. It is increasingly difficult to find a birthday card that does not wish an un-beer-lievable or gin-tastic birthday to someone, or makes another reference to alcohol. Although our culture celebrates alcohol—enjoyment in the right proportions is not a bad thing—we are too silent about its harms. All too often, we stigmatise people who are dealing with the consequences of harmful alcohol consumption, or leave them to cope with those consequences alone.

Most of us know a person or family affected by harmful drinking. The statistics are, if I may say, sobering: across the UK, more than 80 people a day die from alcohol-related causes. That figure is far higher in areas of poverty where people struggle to cope. Alcohol is now the leading risk factor for death, ill-health and disability among 15 to 49-year-olds in England, and is associated with around 40% of violent crime. In my local authority of Cheshire East, there were 185 alcohol-related deaths and 8,460 alcohol-related hospital admissions in 2017. The number that sticks out the most, however, is the number of people who do not get help: 88% of dependent drinkers in Cheshire East are not in treatment and do not get the support that they need.

[John Howell (Henley) (Con)]

My hon. Friend said that the effects of drinking alcohol were obvious, but does she accept that for men trying to have a family, for example, the effects can lead to permanent difficulties such as infertility, which is not always obvious?

[Fiona Bruce]

My hon. Friend makes an excellent point. Having engaged on this subject for many years in this place, I thought that there was nothing that I did not know, but I did not know that, so I thank him for drawing people’s attention to it. Similarly, it is of great concern that many people are unaware of the impact of foetal alcohol syndrome, which arises from drinking during pregnancy—we cannot emphasise enough the importance of not doing so.

Public Health England estimates that only one in five dependent drinkers in England gets the right support. That is sad because treatment, when obtained, can be very effective and good value for money. For every £1 spent, there is a societal benefit of £3. It does not stop there, though. Alcohol not only impacts individuals, but wider society and public services, costing NHS England £3.5 billion every year. There is no better time than now to remind ourselves that we should encourage help and the prevention of harm where we can, so that our NHS staff, whom I thank in this time of crisis, can treat those in health difficulties.

Anyone who has been in an A&E on a Friday or Saturday night will not be surprised to hear that alcohol-related incidents account for 25% of A&E work in England. Sir Ian Gilmore, who chairs the Alcohol Health Alliance—I thank them and commend their work informing the public and supporting parliamentarians—said

“While A&E departments used to feel the impact on Saturday nights, it’s now every night of the week”,

and that

“The lack of a strategy is really harming the nation”.

English police spend more than half of their time dealing with alcohol-related casework.

Alcohol’s impact on families is stark: in England, about 200,000 children live with an alcohol-dependent parent. I will speak a little about that, but I will first commend the Government because when my hon. Friend the Member for Winchester (Steve Brine) was Health Minister, he was very conscious of the issue and granted more than £6 million to help the children of alcoholics, following a campaign run by colleagues in the House. He rightly said:

“Alcohol abuse can tear lives apart, not only for the people trapped in the grip of an addiction but for their children, who are often robbed of the support, comfort and structure they need from their parents.

I am committed to finding new ways to help families in the midst of these heart-breaking situations.”

I would be interested to hear from the Minister about progress on the pilot schemes in several local authorities, which I expect are now quite well developed, to help children of alcoholic parents or carers, following his initiative.

I have always found Health Ministers to be very concerned about the issue, but one of the systemic problems appears to be that the Home Office leads on alcohol strategy. That has to change. There is a lot of concern among Health Ministers and the Department of Health and Social Care about the issue, but we need them to lead on it.

Children of alcoholic parents or carers experience real difficulties. They are twice as likely to experience difficulties at school, three times more likely to consider suicide, four times more likely to develop alcohol problems of their own, and five times more likely to develop eating disorders. I am pleased by the progress that I have mentioned, but we still have a long way to go on tackling harms.

The Government are rightly excited about the positive impacts of alcohol care teams in hospitals, and I encourage them to go further and ensure that a team is embedded in every hospital when time can be given to that. However, we know from listening to dependent drinkers that help in hospital needs to be complemented by help in communities, if they are truly to be helped.

The loneliness agenda and social prescribing are important initiatives that need to include suitable provision for dependent drinkers. Having attended an Alcoholics Anonymous meeting as a guest, I was really impressed with the care and support that members of that AA group gave one another. It was clearly proving very effective, but we need to do more.

I thank Adrian Crossley, the head of addiction and crime at the Centre for Social Justice, who is doing a lot of work on alcohol treatment. He basically says that we have to assign funding to each local authority in accordance with locally recognised need. I know that this is an unpopular term, but we must ring-fence it so that it really can make a difference.

We must also develop the Government’s promised addiction strategy to ensure that there are wrap-around services to help to stabilise and then promote lasting recovery—particularly the family support that is needed for the 200,000 children in England who are living with an alcohol dependent parents. Those are important initiatives. There is no wrong door to accessing the most appropriate services, but we need to join them up—whether they are local family services, voluntary groups or mental health support.

If I may, Mr Paisley, I will take a little longer than normal to make my speech, because there are not too many colleagues present. I was disappointed in the Chancellor’s view on alcohol duty in the recent Budget. I thank him for providing £2.5 million towards the development of family hubs in local areas. Such hubs are one-stop-shops where people will be able to go—several are up and running in the country now—for joined-up services from local health providers, local authorities and voluntary groups.

People can go to such hubs with any issue that relates to their family life. One of those issues should, and hopefully will, be addiction. Sadly, many families do not come forward for help. They are ashamed of the stigma, are soaked in a culture that celebrates the products that often blight their lives, and carry a burden that is often unrecognised and unsupported. We need more accessible, practical support for families.

We need to remember, too, that the harms from alcohol do not fall evenly across the UK. The burden falls most heavily on poorer communities. The north of England, for example, has significantly higher rates of alcohol-related deaths than London or the south-east. I am delighted that this one nation Conservative Government are committed to reducing inequalities and levelling up across the country, but, as I have mentioned in this House before, we will not be able to do that simply by repairing physical infrastructure such as roads and bridges. We need to create stronger, healthier communities and families, and one of the ways we can do that is by tackling alcohol harm.

The figures I have mentioned demonstrate that alcohol presents a grave public health challenge. Without question, we need a paradigm shift. Tackling alcohol-related harm needs to become a fundamental policy priority. Regulation certainly plays a part in shifting behaviour on a personal level, as we have seen over the past few years with tobacco; I commend parliamentarians who took a lead on that. As we have seen there, the Government can create an environment that enables us to make informed choices and lead healthier, happier lives.

I will now focus on price. Why? Because the 2016 report from Public Health England concluded:

“Policies that reduce the affordability of alcohol are the most effective”

policies in health treatment. Yet, over the past few years since then, and even before then, quite the opposite has occurred. Alcohol duty rates have been cut or frozen in Budget after Budget and as a result, in real terms, beer duty is some 18% lower than in 2012, duty on spirits and cider is 10% lower and duty on wines 2% lower. We all know that the price of something has an impact on whether we will buy it, and alcohol is no exception; as I say, Public Health England said price was the number one factor in determining how much alcohol is bought.

Alcohol has become dramatically more affordable in the past 30 years. The affordability of beer in the off-trade has more than tripled in real terms since 1987 and off-trade wine and spirits are 163% more affordable. One of the most targeted approaches to addressing the price of the cheapest alcohol is minimum unit pricing. I urge the Minister to look at it again.

Minimum unit pricing, as the name suggests, sets a price below which alcohol cannot be sold. In Scotland, which introduced minimum unit pricing two years ago, it is currently 50p. That means that a pint of beer containing two units of alcohol—for the record, as many here will know, the chief medical officer’s suggestion for sensible and moderate drinking is 14 units a week—cannot be sold for less than a pound.

Minimum unit pricing would have hardly any effect on pubs and restaurants, where the vast majority of alcohol is sold at more than 50p per unit. Instead, it is highly targeted at the cheapest products that cause the most harm, such as white cider and super-strength cheap lager. If the Minister cares to look, I introduced the Alcohol (Minimum Pricing) (England) Bill in 2018, so there is one oven ready if the Government would like to take it up.

One reason the Government did not take it up was that they said they wanted more evidence that MUP would work. I remember the Chancellor saying that we would await the outcome in Scotland. As I say, two years since Scotland implemented MUP, the evidence is very encouraging. Consumption fell by 3.6% in Scotland in the year after MUP was implemented. During the same period, it rose by 3.2% in England and Wales. The important thing is that the fall in consumption appears to have occurred particularly among those consuming the most alcohol, who are most at risk, and it seems to have been in the high-strength, dangerous drinks of the sort that I mentioned that consumption has fallen.

Wales has decided to follow Scotland’s lead and is implementing MUP this month. Following the evidence, these are the statistics. Again, I apologise to colleagues for more statistics. In England, a 50p MUP is predicted to save 525 lives and prevent over 22,000 hospital admissions and 36,000 crimes annually when at full effect. The evidence is clear, we need to act without delay and implement MUP in England. It was interesting that the 2012 alcohol strategy referred to this very positively. I refer the Minister to the foreword by the then Prime Minister:

“We are not rejecting MUP, merely delaying it until we have conclusive evidence it will be effective”.

Will the Ministers look again at MUP and the evidence following Scotland?

The duty escalator which was in place between 2008 and 2012 increased alcohol duty by 2% every year. The result was that alcohol-related deaths fell while it was in place. They have started to rise again since it has been abolished. Last week, the Chancellor announced in this year’s Budget alcohol duty will be frozen across the board. In real terms, this means a cut. It will lower the price of alcohol. All decisions present trade-offs.

While I appreciate the desire to support our local industry of pubs and brewers, I want to reflect on the impact of this decision on health. Research from the University of Sheffield—I am sure the Minister’s staff will look at the report, because it is commendable—has shown that changes in alcohol duty since 2012 have led to nearly 2,000 additional deaths and 61,000 hospital admissions in England. There was an enormous human cost, but also a strain on public services by adding an estimated £317 million to NHS England’s bill. It is estimated the duty changes could have cost England’s businesses as much as £58 million in lost working days since 2012.

Increasing alcohol duty also raises urgently needed revenue. Considering the impact of the current cuts alongside all changes to duty policies since 2012, in this year, 2019-20, the Government are losing out on nearly £1.3 billion in forgone revenue. That is enough money to pay the salaries of more than 40,000 nurses. By 2024-25, the cumulative costs of these cuts will be £13 billion.

While the budget focused on supporting pubs, I do not believe that cutting duty will be that helpful for them. Ending the alcohol duty escalator after 2012 and the subsequent duty cuts and freezes have not made a measurable difference to the rate of pub closures. This reflects the experiences of those working in the pub trade. Nearly 90% of publicans in the north-east said that duty cuts have not had a positive effect on their business. Less than 5% felt that alcohol taxes were the main cause of pub closures, while a majority thought that cheap alcohol from supermarkets and off-licences was to blame.

Before I end, I want to address alcohol labelling. If we want to create an environment in which people are supported to make informed choices to live healthier, happier lives, we need to make sure they have all the information they need. At the moment, people do not get it. We have more information on a pint of milk than when buying alcohol. It is no surprise that only one in five people know that the chief medical officers commend us not to drink more than 14 units a week, but the public wants to know this information. Research from the Alcohol Health Alliance found that more than 70% of people support warnings that exceeding the drinking guidelines can harm one’s health. I put down an EDM on this last June. It is interesting that it garnered support from 20 colleagues. It stated that two and a half years after the chief medical officer’s guidelines of 14 units per week for low-risk drinking were published:

“a survey of 320 products found that two-thirds of alcohol labels still displayed the old guidelines; … that the pregnancy logo and number of units are not legally required to be shown on labels”.

We believe they should be and there is a lack of information generally on alcohol labels compared with other food and drink labels. Will the Government look again at labelling and make the information on alcohol products mandatory? The public want to know more. It is not just that alcohol increases health risks and that therefore information on alcohol content is wanted, but that they are actually interested in the calorific content. I was involved in a joint event with the all-party parliamentary group on obesity some years ago. It was remarkable. Evidence was given that when people drink with a meal and are perhaps not as thoughtful about what they are eating, the overall increase in calorific consumption can be 400 in that meal alone. It is time to look again at alcohol harm. Alcohol containers should, like any other food and drink container, have to display ingredients, nutrients and calories. They should display the CMO’s guidelines and warnings that exceeding this amount could damage one’s health. We can no longer ignore the harm caused to our society, communities, constituents, families and friends by alcohol.

--- Later in debate ---

[Fiona Bruce]

I thank the Minister for giving way and for stepping in to respond to the debate. She said that most people drink responsibly, but Drinkaware’s statistics, which are very worrying, show that 49% of men are classified as increasing or higher risk drinkers compared with 31% of women. That is a very high percentage.

[Helen Whately]

As I said, I fully appreciate and respect my hon. Friend for the huge amount of work that she does to urge us to recognise the harmful effects alcohol can have.

We know that alcohol misuse can have an impact on hospital care and demand. It contributes to a wide range of conditions including cardiovascular disease, cancer and liver disease, as well as accidents, violence and self-harm. Some 12% to 15% of A&E attendances are alcohol-related, and alcohol is a causal factor in the patient’s diagnosis for more than 1.1 million hospital admissions every year. We absolutely take my hon. Friend’s concerns seriously.

As part of our NHS long term plan, alcohol care teams are being introduced in hospitals with the highest number of alcohol-related admissions. It has been shown that those teams significantly reduce avoidable bed days and re-admissions. The seven-days per week service at Royal Bolton Hospital saved 2,000 bed days in its first year, and modelling suggests that alcohol care teams in every non-specialist acute hospital will save 254,000 bed days and 78,000 admissions per year by their third year of operation.

Thanks to the personal testimony and campaigning by hon. Members present and by others who were unable to attend, the Government have invested £6 million to improve outcomes for children with alcohol-dependent parents. That funding includes £4.5 million for nine local areas to test innovative ways of working and to join up systems to support children and families—promising results are emerging in those areas. We have also allocated £1.5 million to voluntary sector organisations to build resources and capacity at national level, including helpline and contact-centre support through the National Association for Children of Alcoholics. We are also investing £6 million through a capital fund to enable local authorities to improve services and facilities for people with alcohol problems.

We continue to educate the public, ensuring that people are aware of the health risks of alcohol through local and national programmes, such as Public Health England’s One You campaign. The alcohol risk assessment in the NHS health check is used to inform a discussion on reducing the individual’s risk. New guidance encourages referral for liver investigation, where risk is identified. In addition, there is a commissioning for quality and innovation—CQUIN—scheme to incentivise increased cirrhosis and fibrosis tests for alcohol-dependent patients.

My hon. Friend also mentioned labelling. We have worked with industry to communicate the UK chief medical officer’s low risk drinking guidelines on the labelling of alcohol products. The Portman Group and others in the industry have made a commitment that labels will reflect the guidelines and we are closely monitoring progress.

We have also made a commitment in the prevention Green Paper to work with industry to deliver a significant increase in the availability of alcohol-free and low-alcohol products by 2025. A roundtable is being organised to take this work forward. Encouragingly, sales of no or low-alcohol beer are up 30% since 2016 and “nolo” alcohol is set to be one of the driving trends of 2020, although I am sure trends are being reviewed in the light of the pandemic.

Public Health England supports local authorities in their work of needs assessment and commissioning alcohol and drug prevention and treatment services by providing advice, guidance and data. PHE is developing UK-wide clinical guidelines for alcohol treatment. That work will promote good practice and improve the quality of service provision, resulting in better outcomes for patients.

We know that alcohol-exposed pregnancies present a significant public health problem across the country. Foetal alcohol spectrum disorder can have a major impact on the early years development of children and their life chances. There is great work under way at local levels to tackle this. For example, the Greater Manchester health and social care partnership recently launched its #DRYMESTER campaign to raise awareness of drinking alcohol when pregnant. NICE are currently consulting on a draft quality standard on FASD. The voluntary sector also plays a vital role here. As part of the children of alcohol-dependent parents funding programme, over £500,000 is being made available to support work on FASD.

Finally, the good news from the budget is that £46 million in funding is being provided to improve support to individuals experiencing multiple complex needs. That includes tackling homelessness, reoffending and substance abuse, including alcohol misuse. In addition, as part of our rough sleepers programme, there is £262 million of new funding for substance misuse treatment services. When fully deployed, that is expected to help more than 11,000 rough sleepers a year. It will enable people to move off the streets and support them to maintain a tenancy for the long term. The funding complements £237 million announced by the Prime Minister for accommodation for rough sleepers, and a further £144 million for associated support services.

Several hon. Members raised minimum unit pricing, particularly the hon. Member for North Ayrshire and Arran (Patricia Gibson), who drew on her experience in Scotland. There are no plans to implement minimum unit pricing in England at present, but the Government continue to monitor the evidence as it emerges from Scotland and Wales.

Several hon. Members talked about the Government’s alcohol addiction strategy. As announced in November, we are undertaking a UK-wide cross-Government addiction strategy. Plans on the contents of the strategy are being developed and we will have more to say on this shortly.

--- Later in debate ---

[Fiona Bruce]

I thank the Minister for Care for stepping in to respond to this debate. I also want to thank my hon. Friend the Member for Henley (John Howell), the hon. Members for East Lothian (Kenny MacAskill), for Strangford (Jim Shannon), for Blaydon (Liz Twist), for North Ayrshire and Arran (Patricia Gibson) and for Ellesmere Port and Neston (Justin Madders) for their contributions.

It is very rare that we hear in this place such a united voice from Members of Parliament from all political parties, but we did so today, because we recognise that alcohol harm is a major threat to our country’s wellbeing. It is a blight, particularly on the lives of the most vulnerable—the youngest and those in many of our most deprived areas. Wider society, too, is paying an incalculable toll. What came across again and again in the debate was that, although all the initiatives that we have heard from the Minister are good and we are grateful for them, much more needs to be done. Alcohol harm must be elevated in the national prevention agenda. A distinct and separate alcohol harm strategy is essential.

Question put and agreed to.

Resolved,

That this House has considered tackling alcohol harm.