Alcohol Abuse

Lord Brooke of Alverthorpe Excerpts

Thursday 30th March 2017 Grand Committee

Asked by

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what is their most recent estimate of the cost of alcohol abuse to the National Health Service; and what steps they are taking to reduce those costs.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Chief Whip for finding a slot for this debate, even though it is the last business. I am grateful that I have so many speakers—I am surprised—and equally surprised by the number of people who have written to me in advance of the debate, which seems to indicate that we should look for a longer debate at some later stage.

After welfare, the cost of health is the biggest charge the Chancellor of the Exchequer has to deal with, yet if one examines Budget speeches one sees that it rarely gets a mention. In fairness to Philip Hammond, it did this year, because of the crisis in care, which is of course directly linked to health. Health costs continue to grow at around 4%, but the economy is down around 2%. With an ageing population, the health service, as one ex-Health Minister in the Lords recently said to me, is a car crash waiting to happen. So every action must be taken or at least explored to avoid further injury to or collapse of the health service.

Like the Queen, the NHS is one of the few remaining pieces of glue that keeps us together as a United Kingdom. People everywhere are increasingly fearful of what the future holds but, happily for the UK, at least for the moment, people do not have the fear that illness brings to many people overseas—the fear of how to pay for their treatment. That burden is lifted by the NHS, and it helps faster recovery, but it is at even greater risk if politicians are reluctant or unprepared to engage in an open and honest debate about the problems we have funding the health service. That is at the heart of my debate today—seeking changes that will reduce the burgeoning public health costs but also changes that lead to healthier, happier and longer lives. As part of that, the Government must confront the stark challenge that alcohol abuse presents for the NHS in terms of the financial costs, resources and the impact on staff time and welfare.

Alcohol is estimated to cost the NHS around £3.5 billion per year, which amounts to £120 for every taxpayer. If I have got the figure wrong, I am sure that the Minister will correct me. Even though drinking has declined marginally in recent years, there is a growing burden of alcohol-related admission problems for the health service. As our NHS tries to deal with these difficulties, there is the difference between costs rising at 4% per annum and growth in the economy at only 2%. The consequences of harmful drinking are a factor that we must address—and that is not surprising, given that Public Health England has recently reported that alcohol is the leading cause of death among 15 to 49 year-olds. There are now more than 1 million alcohol-related hospital admissions a year. Alcohol has caused more years of life lost to the workforce than have the 10 most serious cancers, and in England more than 10 million people are drinking at levels that increase the risk of harming their health. There are 23,000 alcohol-related deaths in England each year, which means that alcohol accounts for 10% of the UK burden of diseases and death, and is one of the three biggest avoidable risk factors.

Evidence indicates that ease of access and persistently cheap alcohol perpetuates these problems, with deprivation and health inequalities particularly prevalent among men from the lower socio-economic groups. Alcohol is 60% more affordable than it was in 1980, and affordability is one of the key drivers of consumption and harm. Cheaper alcohol invariably leads to high rates of death and disease. David Cameron and the coalition Government recognised this back in 2012 when they produced what I would describe as a progressive alcohol strategy. In its foreword, he talked about,

“a real effort to get to grips with the root cause of the problem. And that means coming down hard on cheap alcohol”.

Regrettably, that just has not happened. Other aspects of the strategy have disappeared, too. There seems to be a vacuum with no discernible sense of direction. I hope that today’s debate might start to move us towards a more positive approach than we have had for the past two or three years.

I will not spend much time on minimum unit pricing. I am sure the Minister’s reply will be quite predictable: we are awaiting the outcome of the Supreme Court’s decision on the Scotch Whisky Association appeal. If we did have that, I am sure the Minister would argue that we need to see whether minimum unit pricing is working in Scotland before taking any decision to bring it south of the border. If I am wrong on that, I would be very grateful if he could correct me.

What I would like to hear is whether the Secretary of State is willing to initiate talks with the Chancellor about revamping VAT and excise duties on alcohol so that low-alcohol drinks would not contribute anything, or very little indeed, in the future but we would start to tax at a much higher rate the stronger alcohol, which is particularly damaging to people’s health and which at present does not attract particularly high taxes. I am looking to see whether the Government are prepared to investigate a more differential approach to taxing alcohol.

Wine consumption has increased, particularly in recent years, and, as many people know, wine has got stronger and stronger. At one time it was 11% or 11.5%. Now it is in the order of 13%, 14% or even 14.5%. This is especially true of the red wines from the New World.

Happily, one of the positive sides of Brexit—this freedom we have—is that it will provide greater freedom for adjusting taxation. Such a change could not only raise income for the Exchequer; higher taxes on stronger alcohol could be an inducement for people to drink lower-strength alcohol, which would be better for them.

Is the Minister aware that the Institute for Fiscal Studies has recently done some research on this? Indeed, in February it produced a report which indicates that moving towards the differential taxes I have been describing could meet half the cost of the welfare bill, which of course is a major account the Exchequer has to deal with annually. Whether or not that is a starter remains to be seen, but I would be grateful if the Minister had a look at that report and let the Committee know whether he thinks the idea is worth pursuing, as well as raising the issue with his Secretary of State.

This week I have been to two parliamentary health meetings, one on gout. “Gout is not a laughing matter” was the title of the gathering. It was interesting to learn that one in 40 people in the UK now has gout, and its prevalence is rising. It rocketed between 1997 and 2012 by an astonishing 64%. Again, much of this is linked to the increased consumption of stronger red wines, and to obesity.

Alcohol is a major contributor to obesity, although many people are not aware of this. The drinks industry has managed to evade the usual labelling requirements for calories and sugar content in products. The Government have failed to effect changes here because they have prayed in aid existing EU regulations on labelling, which they say have prevented them moving in this direction. Showing calories and sugar content in alcohol is not required in Europe. There was an attempt to introduce such a requirement in Europe but it was overturned, so we must stick by existing EU regulations. Again, Brexit means we will have a freedom here we did not have previously. I have been campaigning for a long time to have calories shown on alcohol labels. People should know what they are consuming, just as they do with most other products. Why is it not happening?

In fairness, some producers, such as Sainsbury’s, which has its own brands, have shown calories. Sainsbury’s did that because research indicated that drinkers wanted to know about what they were drinking. Why should it not apply elsewhere? I would like to know what the Government are doing on this, given that they now have a strategy on obesity.

Alcohol also contributes to type 2 diabetes, which is reaching epidemic proportions. There is a direct link there. About 10% of alcohol contributes to diabetes and we need to get some movement on that.

This week I also went to a meeting of the All-Party Group on Liver Health—I declare my interest as patron of the British Liver Trust. Liver disease is now costing £2.1 billion a year, up 400% since 1970, and the upward curve continues in the UK while in Europe the cost is declining. There must be a reason for this, and we should be looking at what it is. This is a great problem for A&E departments, as mentioned in previous exchanges with the Minister. Alcohol is a contributory factor in 70% of A&E cases at the weekends, and I would like to know what the Government intend to do about that.

We need to start examining a whole range of other options, particularly given that this week, the Government are taking steps to withdraw certain free prescriptions. We need to look at the 9 million people with hypertension who are getting NHS medication for it. We need to look at the millions of people—and the number is increasing—who are on tablets for depression. Will the Minister say whether people who are on medication for depression should not be drinking alcohol, and whether it is permissible? If in fact, as I know, many people are taking tablets but still drinking, is it not time to look at that in the context of developments this week? People should have a choice: either they take the tablets for depression and stop drinking; or, if they want to continue drinking, they should pay for their tablets over the counter.

I saw the figures in a recent Written Answer from the Minister on how much is being spent on medication—it has rocketed since 2010. We have to start looking for a different approach. We need the Government to accept responsibility for the policy areas they can control. We need the industry to accept greater responsibility—I will not go on about the industry in great detail today; I will leave that for a separate debate—and we need people to take more individual responsibility, given this new world in which the NHS is under great financial pressure. I hope I will get a positive response on many of these points from the Minister, and maybe we can look forward to a wider debate on drawing up a real strategy in the future.