Alcohol Harm

Lisa Cameron Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce]

I absolutely agree. I am aware of that legal advice. I hope that the Government will do so and that the Minister will take note of that.

In preparing our report, the all-party parliamentary group discovered shocking harm, particularly to people working in our emergency services. I would like to refer to evidence we obtained from an emergency services doctor, Zul Mirza, whom I commend for his work in this area. He talked about how patients coming into his wards inebriated not only can be violent towards staff, but on many occasions damage valuable equipment needed by other patients. Our report also found that over 80% of police officers have been assaulted by people who are drinking. I was deeply concerned to hear one police officer tell us this:

“There is one thing that is specific to female officers and that is sexual assault. I can take my team through a licensed premise, and by the time I take them out the other end, they will have been felt up several times.”

That is shocking.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for bringing this extremely important debate to the Chamber. Given the figures she describes, does she agree that alcohol-related aggression needs to be addressed in terms of treatment? Having worked in the criminal justice system, I agree on the wide-scale aggression that is found in A&E departments at weekends and that the police face mainly at weekends, but also on many days of the week. Given that a low number of Members have turned up to this debate, does the hon. Lady agree that politicians should be taking the issue more seriously? More politicians could probably be found in the bars of Westminster today than here in this debate. We should be addressing this problem.

[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.