Alcohol Harm

Liam Byrne Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce]

The hon. Lady is absolutely right. It is tragic that only 6% of dependent drinkers in this country access treatment, despite it being very effective. We need to do much more to make treatment available to them.

A concerning finding of our all-party parliamentary group’s report was that many of those in the emergency services themselves are suffering from depression or are even thinking of leaving the services simply because coping with this kind of pressure day in, day out is proving too much for them. We must tackle that.

After reflecting on the many and varied aspects of alcohol harm in this country, the Public Health England report goes on to say:

“This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.”

What does this Department of Health review recommend? It talks about tackling three things: affordability, availability and acceptability. Affordability means price; availability means the ease of purchase—in other words, the number of outlets and the times at which alcohol can be bought; and acceptability means tackling our drinking culture. I want to give other Members time to speak, so I will not talk in detail about all those things, but I will touch in particular on affordability.

I had the privilege of asking Public Health England’s senior alcohol adviser this week what his top recommendation to Government would be to tackle alcohol harm, in the light of this substantial report. Without hesitation, he replied that it would be tackling affordability and putting in place policies that increase price. The report is absolutely clear:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement. For example, an increase in taxation leads to an increase in government revenue and substantial health and social returns.”

However, since 2012 the Government have done the opposite: they cut the alcohol duty escalator. The report states:

“According to Treasury forecasts, cuts in alcohol duty since 2013 are projected to have reduced income to the Exchequer by £5 billion over five years”.

The very first recommendation in the 2012 strategy was to implement minimum unit pricing. Indeed, the most recent review states that minimum unit pricing is

“a highly targeted measure which ensures tax increases are passed on to the consumer and improves the health of the heaviest drinkers. These people are experiencing the greatest amount of harm.”

In the foreword to the 2012 strategy, the then Prime Minister said:

“We can’t go on like this… So we are going to introduce a new minimum unit price.”

Five years on, that has still not been done, while the alcohol duty escalator has been cut, even though the No. 1 policy recommendation to tackle alcohol harm in the Government’s own review is to address affordability. Will the Minister, who I know is a good woman, now take a lead on this and make it happen?

The Government introduced a ban on the sale of alcohol below the cost of duty plus taxation, but the review states:

“Bans on the sale of alcohol below the cost of taxation do not impact on public health in their current form, and restrictions on price promotions can be easily circumvented.”

Let us consider for a moment white cider products such as Frosty Jacks, which are almost exclusively drunk by the vulnerable, the young, the homeless and dependent drinkers. Just £3.50 buys the equivalent of 22 shots of vodka. The price of a cinema ticket can buy 53 shots of vodka. The availability of cheap alcohol, bought because of its high strength, perpetuates deprivation and health inequalities. Homeless hostels say that time and again the people staying with them drink these products, and many are drinking it to death.

Ciders of 7.5% ABV attract the lowest duty per unit of any product, at 5p, compared with 18p per unit for a beer of equivalent strength. There simply is no reason not to increase the duty on white cider, and 66% of the public support higher taxes on white cider. It is a matter of social justice that the Government should do that, and do it quickly. It need not impact on small, local brewing companies, which could have an exception, and it will not impact on pub sales. Tackling it would benefit the youngest and most vulnerable and save lives.

As I mentioned, the ban on below-cost sales has had no impact on sales of strong white cider. The current floor price of white cider, at 5p to 6p per unit—that is duty plus VAT—is so low that it can be sold for 13p a unit. Will the Minister ask our right hon. Friend the Chancellor of the Exchequer to increase the duty on white cider in the spring Budget on 8 March? This is not the first time that has been asking. Three hon. Members —my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) and I, and no less a person than the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston)—tabled an amendment to the Finance Bill last September, asking for the duty regime for white cider to be reviewed. I urge the Minister to read the excellent speech made by my hon. Friend the Member for Enfield, Southgate on 6 September. Indeed, my hon. Friend the Financial Secretary to the Treasury, who responded, said that the matter needed to be looked into.

Will the Minister press the Chancellor not only to work with her on that, but to introduce the promised minimum unit price and reintroduce the abandoned alcohol duty escalator, so that the tax system not only tackles alcohol harm, but incentivises the development of lower strength products and provides much-needed funding to help with treatment? Looking at all the evidence, we see affordability come out again and again as the most important driver of consumption and harm. Increasing the price of alcohol would save lives without penalising moderate drinkers.

Apart from tackling price, there are of course many other recommendations, both in the Public Health England report and in the APPG report, which came out a week before, that I would be grateful if the Minister would consider. I am grateful that she has already agreed to meet the APPG to discuss our report. Our chief recommendation is that the Government develop a cross-departmental national strategy to tackle excessive drinking and alcohol-related harm. Will the Minister take a lead on that?

Another key recommendation in the APPG report, which again is supported by the PHE report, is the implementation of training and delivery of identification and brief advice programmes and investment in alcohol liaison teams. I remember hearing one suggestion for brief advice to be given whenever anyone is having their blood pressure tested. Just in those few moments, it would be effective for whoever is doing the test just to ask the individual, “How is your alcohol consumption? Do we need to discuss that?” That kind of brief intervention can make people stop and think.

We must pursue earlier diagnosis of those with alcohol problems or potential alcohol problems. There are 1.5 million dependent drinkers, only 6% of whom access treatment. Many people are just drinking in excess of the chief medical officer’s low-risk unit guidelines. In fact, Drinkaware’s research shows that 39% of men and 20% of women are drinking in excess of those guidelines. It says that nearly one in five adults drink at hazardous levels or above. Many people need help through early intervention programmes, as well as more comprehensive treatment and support. Why are we not providing that when we know that it works?

Implementing such interventions is cost-effective for the NHS. I will give a powerful example that was drawn to my attention by Alcohol Concern. St Mary’s hospital in London has trained staff to give brief advice to patients presenting at A&E. It has designed the one-minute Paddington alcohol test to identify and educate patients who might have an alcohol-related problem. That is called the teachable moment and it has resulted in a tenfold increase in referrals to the alcohol health worker, who then carries out further brief interventions, resulting in a reported 43% reduction in alcohol consumption by the people referred. That is a very effective intervention.

It is interesting to note that the Public Health England report confirms that health interventions aimed at drinkers already at risk and specialist treatment for people with harmful drinking patterns are effective approaches to reducing consumption and harm and

“show favourable returns on investment.”

However, it points out that their success depends on large-scale implementation and funding. Will the Minister look at how her Department can give a national lead to share and implement best practice in this field, such as that which I have described?

I would like to say much more on the subject, but I will turn now to the issue of drink-driving. Unpopular as it might be to talk about this in policy terms today, the Public Health England report is clear. It states:

“Enforced legislative measures to prevent drink-driving are effective and cost-effective. Policies which specify lower legal alcohol limits for young drivers are effective at reducing casualties and fatalities in this group and are cost-saving. Reducing drink-driving is an intrinsically desirable societal goal and is a complementary component to a wider strategy that aims to influence drinkers to adopt less risky patterns of alcohol consumption.”

That could not be clearer. The UK is out of line with almost all of the rest of Europe when it comes to drink-driving alcohol limits.

[Liam Byrne (Birmingham, Hodge Hill) (Lab)]

The hon. Lady might have seen the statistical release from the Department for Transport, which I think came out this morning, that says there has been a statistically significant increase in the number of drivers and riders who are killed or injured while driving over the limit in the last year.

[Fiona Bruce]

I have not seen that release, but I am very interested to hear of it. I hope that the Department of Health will look at that and work with the Department for Transport to review the policy. The APPG would like to see a reduction in the drink-drive limit in England and Wales from 80 mg of alcohol per 100 ml of blood to 50 mg. As we have heard, there is a direct link between increased alcohol consumption by drivers and an increased risk of accidents resulting in injuries or fatalities. The Government need to consider lowering the legal limit and possibly a further lower limit for young drivers. They also need to ensure proper enforcement and strong penalties. If we are taking stronger action against the use of mobile phones at the wheel because we know that such action will help to save lives, surely we should do that to reduce the damage from drink-driving. The signal that that would send out to reduce our drinking culture would be major.

I will close with this. During the first world war, the Government introduced controls on alcohol to help the war effort. The crisis of the war offered the opportunity to develop a national alcohol strategy. We have reached our own crisis today, and the Government must take action.

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[Bill Esterson]

Yes. I thank the hon. Lady for being the vice-chair of that group, and for the immense support that she has given to everybody in it. She is right; we took evidence from professionals in the children in care sector that as many as three quarters of children in care could be affected by alcohol damage during pregnancy. It is one of the major factors contributing to them ending up in care in the first place. I am glad that she raised that point. We also heard a suggestion that many children put up for adoption are damaged in that way, and we heard adoption described by one adoptive parent as a family-finding service for children with foetal alcohol spectrum disorders. It is a family-finding service with inadequate support; I will come to that shortly.

In our report, to which the hon. Lady rightly brings me, we identified that increasing prevalence, as well as the impact on children for life—not just while they are children—of irreversible brain damage and the impact on carers, parents, schools, health professionals and society of so many people with brain damage being unable to function fully in society, and all that that brings with it. As The Lancet reported on 12 January, the most extreme end of the spectrum, which is generally referred to as foetal alcohol syndrome, includes

“intellectual disability, birth defects and developmental disorders”.

The article goes on to list

“secondary disabilities including academic failure, substance misuse, mental ill-health and contact with the law due to illegal behaviours, with huge resultant costs to our health, education, and justice sectors.”

In our inquiry, we heard that 40% of people in prison exhibit symptoms of foetal alcohol spectrum disorder. High numbers of care leavers and people with mental illness end up in prison. Given the evidence that I have heard, it would come as no surprise to me, once we start to explore the root cause—I hope that such work can be carried out—to find that alcohol during pregnancy is a primary contributory factor.

Our inquiry took evidence from professionals who made the case that action must be taken. My hon. Friend the Member for Luton North spelled out how those in north America have managed to calculate the economic costs; the same will be true here. The societal costs are fairly obvious, from what I have described, but there is also an impact on families. If they must care for a child with the kind of disability that we are describing—believe me, it can be pretty challenging at times, from my personal experience—it can often have a dramatic financial impact, because people have to give up work to care full time, with little or no support.

[Liam Byrne]

My hon. Friend is making an extraordinary speech. As he will be aware, half of families living in poverty in this country have somebody with a disability in the household. It is not just a family issue or a public health issue; it is an inequality issue too.

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[Liam Byrne (Birmingham, Hodge Hill) (Lab)]

It is a real pleasure to serve under your chairmanship for the first time, Mr Flello. I offer my thanks and congratulations to the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Sefton Central (Bill Esterson) for bringing this debate to the Chamber.

I am here this afternoon to speak on behalf of Britain’s 2.5 million innocent victims of drink. They are the children of hard-drinking parents, and I start my remarks this afternoon with heartfelt thanks to such charities as the National Association for Children of Alcoholics, Childline, Turning Point, Aquarius in my home city of Birmingham and many, many others for all the difference they have made to hundreds of thousands of children. For every child they have helped, for every life they have saved and for every life they have changed, I want to say on behalf of us all, “Thank you.”

I am here because I, too, am the child of an alcoholic. My father, Dermot, was an extraordinary man, and I would not be in politics—I certainly would not be in this place—had it not been for his inspiration. He was the son of Irish immigrants who came to Britain before the second world war. He was one of that generation of radicals in the 1960s. He was the first in his family to go to university. The first speech that really inspired him was Kennedy’s inauguration, with that immortal line,

“ask not what your country can do for you—ask what you can do for your country.”

That inspired him and my mum to go into public service. It was that ethos of public service that he handed down to me.

My father loved new towns. He was a practical idealist, and that is how I ended up growing up in Harlow. The reality was that as he rose up the ranks of Harlow Council to eventually become its general manager, his dependence on alcohol became deeper. When my mum died of cancer of the pancreas when she was just 52, it knocked him over the edge. He moved from being what I guess would be called a functioning alcoholic to becoming a non-functioning alcoholic.

For much of my life, I have grown up with that gnawing insecurity that is all too common for children of alcoholics—that constant feeling of guilt, constantly asking yourself whether you are doing enough. Why can you not do more to stop your mum or dad from drinking? I know what it is like to feel that cold nausea when you find the empty bottles hidden around the house. I know what it is like to feel sick when you hear your parent being sick first thing in the morning because they have drunk too much. I know what those feelings are like, and I know what the psychological reactions are like. I know all about the drive for perfectionism as you try to make the world perfect and impose some kind of order on it. I know what it is like to build up that kind of armour-plating so that nothing can ever hurt you, and I know all about the insecurity and the shame.

I know what it is like to have your parent on the front page of a paper because he has been caught driving four times over the limit. In fact, it was my little brother who was delivering those papers on his paper round. I know what that insecurity and shame feel like, and I know how it lasts a lifetime. I know what it is like to spend lots and lots of time in A&E. I know what it is like to spend lots of time in intensive care units. In my case, I was holding my dad’s hand as he suffered multiple organ failure, only to see him pull through and start drinking again. I know what it is like to spend the final days of your parent’s life in a hospital. It was almost two years ago, just before the last general election, that I was called to my home town of Harlow to be told that my dad only had days to live. I will remember for ever the compassion and care of the staff of the Princess Alexandra hospital in Harlow. I will remember for ever that cold dawn on St Joseph’s day nearly two years ago when the staff of the hospital folded down my dad’s blanket so that we could hold his hand as he breathed his last. I will never forget the compassion of those national health service staff and the way that they cared for us.

I know what those things feel like. I know how deeply they have affected me, and I know how deeply they have affected my brothers, but in a way I count myself as lucky, because since I first took the difficult decision to speak out on this a year and a half ago, I have been inundated with stories from colleagues here, whether they are in the House of Lords, staff or fellow right hon. and hon. Members. I have been inundated with stories from the public. I suppose I learned that like all children of alcoholics, we cannot change things for our parents, but we can change things for our children. What I want to do with others who are here is help use the experiences of the children of alcoholics in this country to change the policy of Her Majesty’s Government. That is why I am glad to see the Minister in her place today.

The stories I have heard are terrible, and I want to bring some of the voices of children of alcoholics to this place this afternoon. One person wrote to me to talk about their experience, saying:

“I felt alone, confused, guilty and second best.”

Another person said:

“Growing up with an alcoholic parent was not great. You feel like a failure, you feel like it’s your fault, you feel second best to the bottle. You never know what state you’re going to find your parent in.”

Another talked about the feelings of helplessness, hate, devastation, frustration and denial. Some felt worthless. Some were carers. Some had behavioural problems. I have teachers write to me about children they look after who are in that position.

Another person wrote and said:

“I am 36 and grew up in an alcoholic home. My mother drank heavily until she died in 2010. She was a lovely person until she drank when she became hateful and emotionally abusive…She was in and out of rehab, detox centres and mental health units for all of her life.”

Another said that they felt awful, that there was little love shown and that they felt alone the majority of the time, although luckily they had grandparents who were supportive until they passed away. Another described their childhood growing up with an alcoholic as

“horrible. I used to come home from school and see my mum drunk/passed out on the floor. I could never concentrate on school work because I’d constantly worry about her. Is she okay? Was she still alive for when I got home? It was a constant worry.”

Another person talked about their feelings of loneliness and how much they hated the signs that their dad had been drinking or in their mother’s speech. Another wrote:

“I wanted to die at 14. I tried but lived sadly.”

One person described their experience as

“losing my childhood, and becoming a parent to my younger sister and trying to shield her as much as possible. I was quiet and withdrawn, not wanting any attention and associating all attention with the embarrassment I felt when my mum was drinking.”

Another wrote about her experience of living in a household where “don’t mention Daddy’s drinking” was the byword. The year that he died, she got sober too. I could go on and on and on. These are not the experiences of a few people; these are the experiences of 2.5 million children in our country—that is one in five children.

From a public policy point of view, should we care? Of course we should, because the evidence is that those children will be twice as likely to develop difficulties at school, three times as likely to consider suicide, five times as likely to develop eating disorders and four times as likely to become alcoholics themselves. This great epidemic of agony is cascading down the generations. The cost of alcohol abuse that the hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about —that £21 billion, although some say it is £50 billion—is cascading down the generations. In this House, we have to stand together and break the silence and the cycle of this terrible disease.

Given the scale of the problem, we would expect that the Government, local authorities and the national health service would be all over it and on top of it, making sure there was action, yet the opposite is true. In a series of freedom of information requests that I conducted at the end of last year, we discovered that none of the 138 local authorities that responded have a specific strategy to help the children of alcoholics. Almost no local authority is increasing its drug and alcohol substance abuse budget, even though many of them are seeing rises in A&E admissions due to alcohol harm. Just 9% of the local authorities where A&E admissions are going up are increasing treatment budgets. A third are cutting the budgets.

In some parts of the country, referrals for alcohol treatment represent 0.4% of dependent drinkers. In other parts of the country, that figure is 11%. That is a wide variation. In some parts of the country, an average of £6.61 is spent per hazardous drinker. In other parts of the country, it is £419—that is in Sefton.

There is no uniformity in the data used to collect statistics across the system. What is clear is that children of alcoholics fall through the cracks because they sit at the junction and on the borders of three different systems: the adult social care system, the children’s social care system and the public health system. Not one of those systems has explicit defined responsibility for helping children of alcoholics. So what happens? Children of alcoholics just slide through the gaps.

That is why charities such as the National Association for Children of Alcoholics are so important. When I was in an agony of public shame after the last election, it was Hilary Henriques, whose son is here this afternoon, who got me back on my feet. I had the prospect of the Prime Minister wandering around the country waving the leaving note that I left back in 2010, and that brought me immense public shame. What I could not describe at the time was the private shame that I felt, having just lost my father to alcohol. I was at my lowest ebb after the last election. It was Hilary who helped me see that there was something constructive and productive that I could do to aid this particular cause.

NACOA has had 1 million contacts in the last 15 years by phone, email or through the website. The demand for its services is going up and up. What I find most troubling is that a third of people who contact NACOA have not told anybody else about their issues. These poor children are suffering in silence. They feel a profound sense of shame and insecurity. They feel that it is their fault. They curse themselves for not being able to do anything about it, and not only do the suffer in silence, but they feel like they are on their own. No wonder so many go on to suffer difficulties in the future.

On 13 February, we will mark international Children of Alcoholics Week, which is when we get the chance, around the globe, to stand up and speak for the children of alcoholics. Thanks to the concerted effort of the all-party parliamentary group on children of alcoholics, we will be able to launch on 15 February, the day after Valentine’s day, the first ever manifesto of children of alcoholics. It has not been written by me, NACOA or by charities, but by children of alcoholics, many of whose stories I read out earlier. I want to give the Minister some highlights.

First, the clear message is that the Government have to take responsibility for children of alcoholics—no one else is going to help these children. Their parents are not going to help. They cannot tell their neighbours. The Government have got to step into the breach.

We need a national strategy for children of alcoholics. We talk about children’s mental health and we talk about alcoholism, but, again, children of alcoholics are in the middle. They need a national strategy of support.

[Ms Karen Buck in the Chair]

We have to properly fund support for children of alcoholics. Helplines such as those from Childline or NACOA are run on a shoestring, yet they make a world of difference. They need a little bit of extra help from the Government.

We need to increase the availability of support for families. There is clear evidence now that family therapy can make an extraordinary difference. We should be boosting education and awareness among children and for those who have responsibility for working with children. I cannot count the number of times that I was involved in talking to the national health service about my dad’s condition. Even when I spent five days sitting on the ward of an intensive care unit, not once did anyone ever say to me or my dad, “Is there a conversation about alcohol that we need to have? And, by the way, are you okay?” We need to transform education and awareness among those who look after our country’s children.

As the hon. Member for Congleton said, we need to develop a plan to change public attitudes, and we need to revise the national strategy to focus on price and availability. The evidence from Canada and Ireland—and I hope soon from Scotland—is very clear that price makes an important difference.

We need to curtail the promotion of alcohol, particularly to students. When kids put up posters of football teams with alcohol brands plastered across their strips, alcohol is being advertised in their bedrooms. We have to think anew and afresh about how alcohol is promoted in this country.

I say in support of the hon. Lady that the Government should take responsibility for reducing the rate of alcoholism. This is a public health question, pure and simple.

[Fiona Bruce]

The right hon. Gentleman gives me the opportunity to point out that the Public Health England report says that the evidence is sufficient to support policies to reduce children’s exposure to marketing. They are needed, and that is what the report says.

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[Liam Byrne]

The hon. Lady is absolutely right. There are a million and one ways in which we can do this. Someone called Gemma contributed to the report and said:

“Going down any street with a pub on it in the UK and there will be a sign outside with a quote such as ‘Drinking at 9 am doesn’t make you an alcoholic’. Well, to be honest, it probably does.”

There are common-sense restrictions that I think we should be debating.

[Kelvin Hopkins]

My right hon. Friend is making a very good point about the opening of pubs at all times of the day. I am one of those who opposed the relaxing of licensing hours. Sadly, it was our party’s Government who did that, and I think that was a mistake. I hope that one day we shall get into power and reverse that, if it is not done before then by the present Government.

[Liam Byrne]

Let us hope it changes even before then.

The Prime Minister has put great store on two things: first, restoring social mobility in this country, and, secondly, children’s mental health. I understand that it will not be too long before the social mobility strategy, or the social justice strategy, is produced. I do not mind or particularly care what it is called, but I look to the Minister for a cast-iron commitment that children of alcoholics will be discussed at the Cabinet Committee next week, and that we will insert into the strategy that is published in the weeks to come a commitment to develop some of the ideas I have talked about this afternoon.

The Government are well aware of our ambitions. We have written to all and sundry about them, including the Prime Minister. If the Prime Minister is in any doubt about the importance and urgency of this debate, I will close with a word from His Grace the Archbishop of Canterbury, who said:

“We all know that having a parent who abuses alcohol is one of the most disruptive experiences for any child and leads frequently to long-term effects in one’s self confidence, one’s capacity to relate, and even for some people in their own relation to alcohol itself. My experience, whether easier or more difficult than that of others, was fairly difficult...One of the things I most missed was the company of others who understood the issue.”

He concluded in the most powerful of ways:

“We are never ourselves when we are solitary, but in all of human history and community it has invariably been the case that it is in relationship that we become most fully what we are called to be, provided that relationship is healthy.”

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[Nicola Blackwood]

I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.

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. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.

That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.

Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.

Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.

The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.

We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.

The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.

Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.

One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.

We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.

Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.

I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.

This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.

[Liam Byrne]

I pay tribute to the Minister and welcome her commitment to working together across the aisle, so to speak, to put a new strategy in place. The troubled families programme is very important, not least because there is a lot of money in it. That money is often focused on families in the most chaotic of circumstances, but our evidence shows that many families with alcoholic parents do not look troubled or chaotic to the outside eye—they are often functioning alcoholics. Our definition of what constitutes a troubled family may therefore need to be stretched a little in order to help those children.

[Nicola Blackwood]

The right hon. Gentleman is obviously an expert on the issue, but understanding how to identify those at risk is not specific to this area of public health; it occurs in other areas and is familiar to me from my mental health brief as well. This will be something that we need to sit down and discuss to understand more accurately.

It may be that we need to look at the troubled families programme to see how that could be addressed in order to work more effectively to target those in need of assistance. The key message today is that children of alcoholics in the United Kingdom should not feel as though they are alone—they should feel as though support is there, and they should know that they will find help when they seek it. I must go on to talk about some of the other issues that were raised; I hope I am not taking too much time.

The NHS remains critical to the prevention of alcohol harms. We must incentivise NHS providers to invest in interventions to reduce risky behaviours and prevent ill health from alcohol consumption. NHS England and Public Health England have worked together to develop a national commissioning for quality and innovation—CQUIN—payments framework, which is an important intervention. For those less familiar with the CQUIN payments framework, it was set up to encourage service providers to continually improve the quality of care provided to patients. CQUIN payments enable commissioners to reward innovation by linking a proportion of service providers’ income to the achievement of national and local quality improvement goals. In this case, it means that every in-patient in community, mental health and acute hospitals will be asked about their alcohol consumption. Where appropriate, they will receive an evidence-based brief intervention or a referral to specialist services, which should improve the treatment of children in the care of alcoholics, as in cases like those raised by the shadow Health Secretary. That is something we should be pleased about.

More than 80% of hospitals offer some form of specialist alcohol service, and investment in similar alcohol care teams in every hospital would potentially provide the NHS with an opportunity to maximise its delivery of identification and brief advice interventions to patients. As I said, that has been identified as one of the most important interventions to change behaviours.

Hon. Members will be aware that the NHS and local authorities have been developing sustainability and transformation plans—STPs. Those are now published on NHS England’s website, and the vast majority include actions to reduce the harms from alcohol, including through investment in brief advice, which was one of the recommendations from my hon. Friend the Member for Congleton, and expanding the approaches for those with more problematic alcohol use. That is an encouraging sign. Underpinning all of our work is the expertise of Public Health England, as we have seen from its report. PHE staff work closely with local authorities and the NHS to try to tackle alcohol harms. Building on its recent review, we must ensure that it gives the right data analysis, so that local authorities know how to effectively target their policies.

One issue raised by a number of colleagues is the call for a review of the licensing legislation to include a health objective, as in Scotland. I have some questions about how effective that would be. Although it is easy to link a criminal justice problem to a specific location, it is much more difficult to link a health challenge to an individual establishment. It is quite hard to prove that buying a drink in an individual establishment has caused someone’s liver disease.

PHE is leading our engagement with the Home Office’s second phase of the local alcohol action areas programme and offering support and advice to participating areas that have identified improving the public health response to alcohol-related harms as a key focus of their approach. Successful applicants were announced by the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), on 27 January, with 18 of the 33 successful areas looking at how they can improve the health of their residents. That is one way in which this is being done.

The House of Lords Select Committee on the Licensing Act 2003 is looking at that Act and is due to publish its report in March. We will, of course, carefully consider its recommendations. I gave evidence to the Committee, which is looking at health as part of that issue.