Alcohol Harm and Older People

Jane Ellison Excerpts

Thursday 15th October 2015 Commons Chamber

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

It is delightful to be here, a little earlier than expected, for this important debate on alcohol harm and older people, and I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing it. She laid out extremely clearly some of the challenges we face.

Alcohol is one of the four biggest behavioural risk factors for disease and death in the United Kingdom, along with smoking, obesity and lack of physical activity. As my hon. Friend alluded to, it is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, a number of cancers and depression. That evidence base is growing all the time, and it is important that we highlight that. Drinking can lead to a range of conditions and, as she said, it is estimated to have contributed to more than 1 million hospital admissions in 2013-14, costing the NHS a considerable amount of money. Much of that burden of disease and death is preventable. To this day, people continue to be affected by alcohol misuse, so it is right that we give the matter our attention. A lot of that is because of ignorance and misunderstanding, and because we perhaps do not talk about it as much as we should. My hon. Friend is also right to say that getting the tone of the debate and the advice right is sometimes a challenge.

There is a lot of interest in the issue in Parliament, and we have also heard about how alcohol misuse can have a significant and devastating impact on the lives of our constituents. I am sure that all parliamentarians present will have met people who, if they are not themselves personally affected, have seen their family affected by alcohol misuse. It is very sad when we see that.

Many of the concerns were set out in the all-party group on alcohol harm report earlier this year, and I congratulate the group on that work. Obviously, I have met affected individuals and I have read many letters sent to me by colleagues detailing the concerns and frustrations of those who see the cost of alcohol harm and the impact it has on their everyday lives. They want action to be taken right across public life, including from Government, industry and beyond.

The majority of people who drink alcohol do so in an entirely responsible way. Although I welcome recent falls in alcohol consumption, we cannot be complacent, which I certainly am not. There are still many who drink above the lower-risk guidelines. As my hon. Friend has said, Office for National Statistics data suggest that the proportion of over-65s who are drinking above those lower-risk drinking guidelines is increasing. Harms such as liver disease, as well as the social impacts such as crime and domestic violence, remain much too high. This is an important public health issue, to which I continue to give attention. I regularly meet Department of Health officials to ensure that progress is maintained on cutting the number of people of all ages drinking at harmful levels. Before closing, I will touch on occasions in the next few months when we might pay particular attention to that topic.

A number of actions have already been taken. For example, sales of alcohol below the level of duty plus VAT were banned in May last year, to tackle the worst cases of very cheap and harmful alcohol, meaning it is no longer legal to sell a can of ordinary lager for less than about 40p.

In the last Parliament we worked with the industry to take alcohol units out of the market. As my hon. Friend said, more than 1 billion units were taken out of the market. I have challenged industry to build on that: it is a good start, but we can go further and I have had discussions about what that new effort might look like. We can do more to make sure that we have the widest range possible of lower strength drinks available to the public. Some of the simple substitutions my hon. Friend has mentioned can make a considerable difference to help bring people back to lower-risk drinking.

We have also introduced an alcohol risk assessment into the NHS health check. It is aimed at 40 to 74-year-olds. Health checks provide a chance to identify and manage a range of risk factors, such as high blood pressure and cholesterol levels as well as alcohol consumption. They enable identification and brief advice interventions to be provided in primary care and, indeed, non-health care settings. We know that that can work, with one out of every eight people who receive an intervention to help them moderate their behaviour responding to it. Since April 2011, 5.6 million people have taken up the offer of a health check, and I continually challenge the system to build on that, because it can provide a reality check for many people who have not noticed harmful drinking creeping up on them. That is really important.

All health professionals have a public health role and we need to make sure that the system has enough capacity and that our workforce are adequately trained to tackle challenges such as alcohol misuse and, of course, drinking in pregnancy, which we have debated often in this House. There is keen interest in the issue and perhaps we will return to it in more detail when we consult on the revised guidelines, which I will mention in a moment.

Since April, the standard general medical services contract has included delivery of an alcohol risk assessment to all patients registering with a new GP. That is another important moment at which people think about their health and there is a chance to have such a conversation afresh. That assessment has the potential to raise awareness of alcohol as a risk factor with a large percentage of the population. By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. It is important that in future doctors can give better advice on the health impact of the effects of substance use and misuse.

The Government have given local areas more powers and responsibilities to help them tackle harm in their populations. We have backed that with ring-fenced budgets to improve people’s health, and that includes responsibility for tackling problem drinking. We have given local authorities more than £8 billion in funding over three years. As I have seen during my many visits as the Minister with responsibility for public health, local authorities are very well placed to take forward the public health role. They know their communities well, often at a level of detail that the Government could never understand, and they know where to put the right services to help their communities.

The Government have continued to work with Public Health England, which is giving higher priority to alcohol issues. In looking at alcohol during the next 18 months, PHE will examine how a whole-system approach might provide a focus, particularly on return for investment. Local authorities are keen to make sure that they spend money wisely and that their budgets yield good results. That is no less true for public health than for anything else. The work is intended to assist the Government, local authorities and the NHS to invest with confidence in evidence-based policies, prevention and treatment interventions. Public Health England’s support for local authorities’ public health role will continue to be vital. I do not want local authorities to try to replicate the evidence base that national experts obtain. Such experts should provide the evidence base, and local authorities can then be in the position to take it, adapt it to the local needs and build on it.

To help local areas to target and tailor their activities, Public Health England has developed both liver disease and local alcohol profiles. Those are very important tools to put in the hands of commissioners and those who know their communities best. The profiles provide transparent, comparable information to health and wellbeing boards, commissioners, service providers and professionals, letting them look at their own performance and, importantly, at that of others to see how to improve their outcomes.

PHE will also expand the Healthier Lives web tool, which includes indicators on alcohol hospital admissions and figures for waiting times and completions of alcohol treatment. That will allow an area to build up a complete picture of how well it is doing, particularly against national averages and comparable areas. As in all things in the world of public health, there is considerable local variation—the challenges are not all the same in different areas—so we need to give local areas such tools. We have seen good practice in Lancashire, which has used local alcohol profiles to inform its joint strategic needs assessment and to look at the mix and quality of the services it commissions.

[Fiona Bruce]

The Minister is quite right about variation. One of my concerns is about the increase in drinking among older women. Is anything being done specifically to look at how they can be helped to reduce the effect of alcohol harm?

[Jane Ellison]

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

[Jim Shannon]

The Minister knows that Members of this House, myself in particular, have the utmost respect for her and her position, for what she does and for the guidance she gives. However, the very possibility of uncertainty poses an important question for us. The message must go out from the Minister and from us as elected representatives that during pregnancy, there must be no alcohol at all. That has to be evidence-based, as she said, but there should be the same message so that there is no uncertainty.

[Jane Ellison]

The UK chief medical officers are extremely alive to that challenge and it is something to which they have given considerable thought. Perhaps we will return to it when the guidelines are consulted on. I assure the hon. Gentleman that I have had that conversation and that I have been at pains to emphasise how regularly the issue comes up in Parliament. I know that it is being addressed and that it will be talked about when we consult on the new guidelines.

It is clear that there is more that all of us can do. We have to recognise the contribution that not just individuals, but businesses, communities and local government can make to help people better understand the risks associated with alcohol. I agree with my hon. Friend the Member for Congleton that we need to do more. We are working to ensure that there is a better understanding of the risks.

This is an issue to which we will return. The publication of the new alcohol guidelines will provide a moment in the national debate when we can look at it closely with the public, experts, health professionals and industry. That will be a stimulus to fresh thinking, more public education and debate. Those in Parliament who have a particular interest in the issue will want to participate in that important debate. However, change will not happen overnight. I know that the hon. Members who are here will agree that raising awareness of the issue is key. We have an evidence base to show that, in some cases, raising awareness with individuals is the most important thing we can do to help them.

This debate has been an important opportunity to revisit these important issues. We will return to them in more detail in the coming months. That will be a great opportunity to reflect not just on the good progress that we have seen among younger people, but on the work that we are yet to do.

Question put and agreed to.