Alcohol Harm

– in the House of Commons at 4:00 pm on 25th November 2021.

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Photo of Derek Thomas Derek Thomas Conservative, St Ives 4:00 pm, 25th November 2021

I beg to move,

That this House
notes the grave harm to society caused by excessive alcohol consumption and alcohol addiction;
further notes that alcohol-specific deaths in 2020 were the highest ever recorded by the Office for National Statistics across many parts of the UK;
and calls on the Government to commission an independent review of alcohol harm.

I thank the Speaker and the Backbench Business Committee for allowing this debate to go ahead. I am grateful to have secured this debate because the issue of harm caused by alcohol misuse has concerned me for many years—since long before I got into this place. I have seen far too many examples of when alcohol misuse has wrecked lives, trashed families, caused great disruption to communities, exhausted police and NHS staff and led to a miserable, hopeless lived experience for those who find they have an alcohol addiction.

I was due to co-sponsor this debate with Dan Carden, who is unable to be here for family reasons. Colleagues will be aware of what he has had to say on this subject in respect of his own lived experience and through his sterling work as vice-chair of the all-party parliamentary group on alcohol harm.

I declare an interest as a commissioner on the commission on alcohol harm, which is ably led by Baroness Finlay. She said:

“Alcohol harm impacts us all—in families, our communities, and throughout society. For too long, the onus has been on individuals, with drinkers urged to ‘drink responsibly’…We need to finally acknowledge the true scale of the harm caused by alcohol, which goes far beyond individuals who drink, and put the responsibility squarely with the harmful product itself. By doing so we will help to do away with the stigma and shame that surrounds those who are harmed by alcohol and often stops them from accessing the help that they need.”

Those words were in the introduction to the commission’s “It’s everywhere” report.

The alcohol harm commission was set up to examine the full extent of harm across the UK—the physical, mental and social harm caused to people around the drinker, to wider society and to the drinker themselves. We considered the effectiveness of current alcohol policy and made recommendations for the reduction of harm.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I commend the hon. Gentleman for bringing this debate forward. Is he aware that in Northern Ireland there were 336 alcohol deaths in 2019—the highest number of alcohol deaths on record, and up 18% on 2018—and similarly record-high figures in England and Wales for 2020? Does he agree that the Government’s current strategy is not working and that something has to change?

Photo of Derek Thomas Derek Thomas Conservative, St Ives

I absolutely agree. The figures are similarly worrying for Cornwall and across the Isles of Scilly, which I represent. The point of this debate is to try to start a new conversation about how we can support those who are caught up in such a difficult and tragic situation.

Those whose lives are affected by alcohol every day best understand its impact, yet their voices are often missing from policy discussions. We set out, as a commission, to give these individuals a platform. In addition to experts by experience, we heard from hospitals; local councils; UK and devolved Governments; academics and universities; alcohol treatment providers; the alcohol industry; medical royal colleges; children’s charities; homelessness organisations; public health experts; and older people’s representatives.

The commission received evidence on the wide-ranging impact of alcohol on wider society through the burden it places on public services and the economy. In England, hospital admissions related to alcohol reached a record level of 1.26 million in 2018-19, and the total cost of alcohol to the NHS is estimated to be £3.5 billion. The costs of alcohol are not limited to health: my right hon. Friend the Minister for Crime and Policing has noted that

“alcohol-related crime in England and Wales is estimated to cost society around £11.4 billion per year.”

The body of evidence received by the commission indicates that alcohol is a harmful and addictive substance that must be carefully regulated—as is done with tobacco. Far from being an issue for individual responsibility, as it is often framed by the industry, there is a compelling case for Government intervention to end the cultural celebration and normalisation of alcohol in public, while vulnerable individuals suffer harm and stigma behind closed doors.

The long list of vulnerable people in need of protection from alcohol harm includes alcohol-dependent people, children, drink-drive collision victims, domestic abuse survivors and those who experience crime and antisocial behaviour, including emergency service personnel. Another such example is an unborn baby at risk of foetal alcohol syndrome disorder, a condition caused by prenatal exposure to alcohol in the womb and which is around three to five times more common than autism, but much less widely acknowledged and discussed. FASD is a lifelong neuro-developmental mental disability that affects the brain and body. Maternal alcohol misuse is one common factor in children being taken into care, increasing the likelihood that those children have been exposed to alcohol before birth. The prevalence of FASD is therefore much higher in those who are care experienced, with one study suggesting that two thirds of adopted children are potentially at risk of FASD. It is unacceptable to leave their fate up to individual responsibility. Instead, we need systematic change to protect vulnerable individuals and communities.

For starters, I call on the Government to ensure that those with FASD, or at risk of FASD, are given proper support. One possible route to provide that support would be as part of the excellent work of my right hon. Friend Dame Andrea Leadsom. Her vision for the 1,001 critical days now being brought into reality as part of a newly funded Best Start in Life initiative would be the obvious approach. The family hubs, which I know my hon. Friend Fiona Bruce has been a great advocate for, is a key part of this initiative and may well be the place where support for children with FASD and their families can be delivered.

The covid-19 pandemic has accelerated alcohol harm in the UK. Deaths from alcohol increased by 20% in England and Wales and by 17% in Scotland in 2020. They are now at the highest level since records began. In England, the number of adults drinking at high-risk nearly doubled between February and June of last year. The data also show a rapid acceleration in deaths from alcoholic liver disease since the start of the pandemic, beyond that of the pre-existing upward trend. Those numbers are alarming. We know that drinking harms more than just our liver, with alcohol being a causal factor in more than 200 diseases and injuries. In my own constituency, between 2016 and 2018, 760 people received an alcohol-related cancer diagnosis. Alcohol is of course also linked to mental health issues: in many countries, including the UK, those with depressive or anxiety symptoms were among the groups with the largest increase in consumption during the pandemic.

Latest data provided to me by the Alcohol Health Alliance showed that, in my constituency, 73% of dependent drinkers in 2019-20 were not in treatment. Shockingly, that is better than the national average. The Royal College of Psychiatrists warned last year that addiction services in the UK are not equipped to treat the soaring numbers of high-risk drinkers.

Even if I had not taken a serious interest in alcohol harm previously, having seen further statistics that relate to my constituents, I have no excuse but to draw attention to this terrible situation. For example, those drinking above the chief medical officer's recommended levels—at-risk drinking—account for 24% of my constituents. There were 220 alcohol-related deaths recorded in 2019, 11,422 alcohol-related hospital admissions in 2019-20, and 192 road traffic accidents attributed to alcohol between 2014 and 2016.

Never before has action on alcohol been so urgently needed as it is now. We must do more; we must do better. The Government must commit to increasing treatment funding and maintaining that funding so that everyone who seeks support is able to receive it. The Dame Carol Black independent review of drugs called for additional funding of £1.78 billion for drug and alcohol treatment services over the next five years. The Government must act on this now. Additionally, there must also be a commitment to increasing the numbers of the addiction treatment workforce.

Outside of treatment service provision, significant work is needed to tackle the stigma surrounding alcohol. While serving on the commission on alcohol harm, I had the privilege of reading and hearing deeply personal and moving testimonials, with experts of experience commonly agreeing that the focus on individual responsibility for drinking leads to a culture of secrecy, shame, and stigma. Tim Norval, an expert by experience, told the commission that the stigma people carry tells them,

“I’m worthless. I’m not worthy of the treatment. I’m not worthy of the support”.

But the blood that runs through their veins is just the same red as mine. There is absolutely no reason whatever that they deserve any less treatment than I would if I had any sort of health condition. We all have a part to play in changing the narrative around alcohol addiction: please, encourage and participate in conversations about drinking and its effects, and challenge the stigmas around alcohol use.

Beyond health consequences for the drinkers themselves, there is of course a significant impact on those around them. A national survey found that approximately one in three victims of domestic violence in England and Wales reported that the perpetrator was under the influence of alcohol. Alcohol or drugs was thought to be a factor in 61% of care applications in England.

Across the UK, the people from the most deprived areas are more likely to die or be admitted to hospital than those in the least deprived areas. The Institute of Alcohol Studies found that lower socioeconomic groups experience up to 14 times the incidence of alcohol-related violence than higher socioeconomic groups. Researchers have linked alcohol consumption with inequalities in life expectancy, social and emotional wellbeing, and child development. Public Health England has also stated that tackling alcohol-related harm is an important route to reducing health inequalities. In the light of this and the announced levelling-up White Paper, it is important to reiterate that for any levelling-up agenda to be truly successful, it must address alcohol harm as a top priority. Beyond that, there are several additional steps that could move the UK in the right direction.

I have long pressed for minimum unit pricing to be introduced in England to bring us in line with other UK nations. The evidence from Scotland has been highly encouraging. I especially highlight the fact that the impact on prices has almost exclusively been in the off-trade sector, while on-trades prices have largely been unaffected. This is important because colleagues have told me that a reason for not supporting MUP is the perception that it will harm our village pubs. This debate is not related to the “Saving Your Local Pub” campaign, but it is important to note that introducing MUP would have little, if any, impact on pubs and off-licences. What MUP can do is address the “in your face”, cheap alcohol promotion that faces us all when we venture into a supermarket—something that appeared to be more apparent during the lockdowns.

To conclude—I am sure that you will be glad to hear me say that, Madam Deputy Speaker—there are some clear recommendations that I would like the Government to consider and act on, with no unnecessary delay. First, we need to deliver a new comprehensive strategy. The UK Government must introduce a new alcohol strategy as part of the covid-19 national recovery plans. The strategy must take into account the best available evidence and include population-level measures to reduce harm from alcohol. Its development must be free from the influence of the alcohol industry. Although the Government must support economic recovery and our hospitality industry, this must be balanced with minimising harm from alcohol. A new strategy should include the interventions recommended by the World Health Organisation.

The last alcohol strategy will be celebrating its 10th anniversary next year. The Government have so far failed to fulfil their promises for an update, and have now caused fears that alcohol will fall by the wayside while they focus on drugs and gambling. Developing such a strategy, specifically on alcohol, would allow the Government to understand all the influences and drivers of alcohol harm—including its availability, price and marketing—and to identify the most effective ways to tackle this in the UK. The final report of the commission on alcohol harm concluded that we need a new alcohol strategy that is evidence-based, comprehensive, and focused on population-level measures. Organisations such as Alcohol Health Alliance UK, Alcohol Change UK, the OECD and the World Health Organisation have echoed those calls. I support the recommendation wholeheartedly and call on the Government to launch such a strategy urgently.

The second of three recommendations is for the Government to introduce MUP without delay to reduce the consumption of cheap, high-strength products. The Chancellor’s move in this direction in the Budget was welcome. However, alcohol duty collects between £10 billion and £12 billion each year, but is estimated to cost £27 billion in social costs, including the cost to the NHS that I have mentioned.

Finally, I call on the Government to introduce alcohol advertising restrictions to reduce alcohol harm, and protect children and vulnerable people, including those in recovery.

If we have any hope of turning the tide on alcohol harm, there is no more time to wait. We must do more, do it better and do it now.

Photo of Liam Byrne Liam Byrne Labour, Birmingham, Hodge Hill 4:14 pm, 25th November 2021

I am grateful for the chance to contribute to this debate, and I thank the Backbench Business Committee. It is a real privilege to follow Derek Thomas. In my remarks I will speak for myself, but I will also try to say a few words for my hon. Friend Dan Carden, who, as was mentioned, is with his family and his father Mike, who is receiving palliative care after treatment for lung cancer. I know I speak for all of us when I say that all our love, prayers and best wishes go to my hon. Friend and his family.

This debate is profoundly important. It is important for many people, such as the hon. Member for St Ives. It is important for many of those who are hon. Members and, like me, children of alcoholics. I am the son and the grandson of alcoholics. I watched those people die from alcohol and I watched how this terrible disease cascades down the generations, causing chaos, pain and distress in its wake. In the all-party children of alcoholics group, which I co-chair, we have come together because we know that we have to try to break the silence in order to break the cycle of the disease cascading down any more generations to come. We know too that we have to normalise the conversation, and that means that we have to help organise the conversation. That is why, for us, this debate is so important.

There are so many people, and so many Members of this House, who are still bound in fear with stigma and shame that stops them speaking out. I have now lost count of the number of our colleagues here who have approached me in the Lobbies and corridors to say, “I too am the child of an alcoholic”, but, for whatever reason, they are not able to speak out. I almost did not speak myself. I did so only through the spiritual guidance of Father Gerry, God rest his soul, at St Chad’s Cathedral in Birmingham, who helped show me that if, by speaking out, I could effect change, then I was doing the right thing: that in fact what I would be doing is honouring the boy that became the man that became my dad. My father was the child of an alcoholic and he had no help available to him. So I hope that this debate encourages more of us in this place to speak out and talk publicly about the things that people have said to me in the Lobbies and the corridors, because we have a wrong to right, and that wrong is that we have no strategy for tackling alcohol harm.

My work on this issue goes back to 2015 and the election of that year. David Cameron, the Prime Minister at the time, was busy waving my famous leaving note at the Treasury. It was something that caused me immense public shame. But what I could not talk about at the time was the intense private shame that I was going through nursing my father in the final days of his life at Princess Alexandra Hospital in Harlow. He died on the morning of St Joseph’s Day. After his death, and after that election, I fell to pieces. It was only through getting in touch with the National Association for Children of Alcoholics that I discovered that I was not alone.

I grew up knowing all the feelings that every child of an alcoholic becomes all too familiar with: trying to make yourself invisible to disappear from the shame of some terrible public incident; the chronic insecurity; the co-dependency of supporting others, in my case, my mother, from the age of eight; the bouts of violence, luckily, in my case, occasional; the hospital visits; and the trouble with ambulances. There is the pervasive sense of guilt. Am I doing enough? Is my father okay? Is he eating? Is he starving? Or is he on a floor somewhere?

There is the drive for perfection: the striving to please someone who does not really seem to care. Not long after I got into the Cabinet—it was a moment of immense pride for me and I wanted to show my dad how proud he should have been of the work that I put in—he came to our office at the Cabinet Office; it is a grand place. He was too drunk to stand. It was utterly humiliating and we had to bundle him out as fast as possible. I came to see that nothing I could do would ever be good enough, and nothing I could do would stop him drinking. Every child of an alcoholic can tell scores of stories just like mine.

Those who helped me process trauma taught me that you have to build an integrated picture of the past with the good and the bad, the light and the dark. For children of alcoholics, the pieces of the puzzle that you try to put together are so sharp that they cut you, and you bleed. That is why support from organisations such as the National Association for Children of Alcoholics is life-changing. It is not just a helpline; it is literally a lifeline. That is why we must do better in putting a strategy in place to combat the harm of alcohol.

I am not sure that I would be here without NACOA’s help, and that is why I say a profound thank you to Hilary Henriques and her team—Piers, and Josh Connolly. I also thank the amazing patrons Calum Best, Tony Adams, Camilla Tominey, David Coldwell, Sophie K, and so many others. I speak for all involved in our movement when I say a profound thanks to Her Royal Highness Princess Catherine for her leadership in supporting Forward Trust and the Action on Addiction alliance of which NACOA is so proud to be a part.

My father was an inspiration to me. He was brilliant, charismatic, a fighter for love and a fighter for decency. But he was in the grips of an addiction for which there was no help. What was true for him is now true of thousands of children. What is so appalling is that one in five children in this country are in that predicament—they are children of parents who drink too much. More than 60% of care applications involve the misuse of alcohol or drugs. Parental alcohol misuse accounts for nearly 40% of cases where a child is killed or seriously injured. Children of alcoholics are more likely to become addicted to alcohol, to develop eating disorders and to take their own lives. That is why we need a strategy to combat the harm of alcohol.

When we started our work in 2016, we discovered that not one local authority had a strategy for children of alcoholics. In our last survey, that had gone up to half—but that means that half do not have strategies in place—and more than 90% of local authorities were cutting budgets for drug and alcohol treatment despite some having rising admissions for alcohol accident and emergency cases. Half of councils saw referrals for alcohol treatment going down, not up, yet we still do not have a strategy for alcohol harm.

My hon. Friend the Member for Liverpool, Walton wanted to make the point that almost three people an hour die of alcohol-related causes. Alcohol-related harms now cost us £27 billion a year. People from the most deprived communities are 60% more likely to die than those in richer communities. Alcohol-specific deaths have soared by more than 20% over the course of lockdown, and 40% of crime is linked to alcohol, yet we still do not have a strategy to combat alcohol-related harm.

To help Ministers, children of alcoholics across the country united to draw up our first manifesto for change, with a simple set of 10 messages therein. It has a beautiful instruction from his grace the Archbishop of Canterbury, himself the child of an alcoholic. We want: to ensure that there is a strategy for children of alcoholics; properly funded local support; better support for families; better education and awareness for children; a plea for the Government to help lead a change of public attitudes; better education and training for those who work with children; minimum alcohol unit pricing; to curtail the promotion of advertising on alcohol; and the Government to take responsibility for reducing rates of alcoholism. We want a strategy for reducing the harm of alcohol.

My hon. Friend the Member for Liverpool, Walton wanted to highlight the points made about minimum alcohol pricing. If he were here, he would have highlighted that in some ciders a unit of alcohol costs just 19p. That means a person can buy the recommended weekly maximum of 14 units for £2.68—less than the price of a cup of coffee. In Scotland and Wales there is minimum unit pricing, which is working—it is driving down addiction rates—and the Government should learn from it. Equally, alcohol advertising needs to be curtailed.

Finally, we thought that under Jeremy Hunt we were making progress. Funding for the NACOA helpline was put in place, as was funding for pilots. Inexplicably, at a time of surging alcohol misuse, the funding for those programmes has stopped. We assume that that is an error and we look forward to meeting the Secretary of State to talk about reinstating that funding.

We know that we cannot change things for our parents, but we are damn well going to change things for our children. That means campaigning until we get a strategy in place to tackle the harm from alcohol.

Photo of Duncan Baker Duncan Baker Conservative, North Norfolk 4:25 pm, 25th November 2021

I am honoured to make a contribution to the debate. In particular, I thank Dan Carden, who cannot be here and of whom we will be thinking, and my hon. Friend Derek Thomas for helping to bring the debate to the House.

Before I go any further, let me say that the previous speech was probably one of the most moving contributions I have heard in the House. I say to Liam Byrne that his father would be immensely proud of what he has said this afternoon. I commend the bravery with which he stood up and spoke movingly about his personal experiences. Even though I do not know him, I am incredibly moved to have heard what he said, and I thank him.

The World Health Organisation estimates that, every year, some 3 million people around the world die due to the harmful use of alcohol. That accounts for a staggering 5.3% of all deaths. In England and Wales alone, there were 7,423 alcohol-related deaths in 2020, which, shockingly, was a rise of 19.6% from 2019. Based on those statistics, it is absolutely the case that alcohol remains an alarming and clear problem, not just around the world but in this country.

As we have heard, alcohol misuse can have many effects, from causing death and disability to fostering and exacerbating mental health and behavioural disorders. Health consequences aside, its harmful use can bring with it many socioeconomic losses to individuals and wider society. It is therefore paramount that we address alcohol misuse and work collaboratively to mitigate that sad and perennial problem in our society.

Tackling alcohol misuse will require a multi-pronged approach and an essential part of that is investing in programmes that address alcohol harm. I know that the Government continue to work on that and I am sure that we will hear more about that from the Minister. We must invest in bodies such as NHS England and Improvement, whose programmes have a long history and a deep understanding of how to help with the issue.

In my research for the debate, I was pleased to learn that £27 million has been invested to establish alcohol harm teams in hospitals that will provide specialist support where needed; that £80 million has been allocated for substance-misuse treatment in 2021-22; and that there is a further £90 million for medically managed in-patient detoxification units. That spending will come in, in addition to local authorities’ funding for substance misuse treatment, through the public health grant. From what we have heard, that is welcome. More must be done, but things are being done.

I am a firm believer that through investing in such programmes, alongside strengthening the capacity for local authorities to help to co-ordinate community action and bring knowledge and expertise to the table, we can begin to make a difference. I do not think there is a quick fix or single solution to something that is very damaging for society, but we want the Government to take more approaches to deal seriously with the issue. They are taking action, engaging with campaign groups, and investing in services and communities, which is the only way really to begin to target the harmful effects of alcohol misuse.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Public Health and Primary Care) 4:29 pm, 25th November 2021

I am grateful to the hon. Members for Liverpool, Walton (Dan Carden) and for St Ives (Derek Thomas) for securing this debate through the Backbench Business Committee. I would like to take this opportunity to praise the opening speech by the hon. Member for St Ives, who I think covered the points very well and summed up the position. I find myself in agreement with many of the points that have been made, and I am grateful to hon. Members for their personal testimonies, which have added very strongly to what we are considering today.

In Scotland, on average, alcohol causes about 688 hospital admissions and 23 deaths per week. That is a lot of misery for a lot of families, and it comes at a vast cost and disruption to the health service—a similar problem to what has been seen in England. Fighting alcohol abuse must therefore be a priority for us all, because all our families and communities must get the support they need. Alcohol is everywhere in our society, and in many ways it is hardwired into our cultural DNA. It features in countless songs, poems, stories and humour—from the works of our national bards, Burns and MacDiarmid, through to popular culture.

I remember hearing the late Hamish Imlach in concert, and he had quite a few songs about booze and drink in his repertoire, but he also used to crack jokes. He said that he had an allergy to leather because he realised that every time he fell asleep with his shoes on, he woke up with a blinding headache. I tell that anecdote not to be flippant, but in an attempt to illustrate how ingrained the problem with our culture actually is.

It will therefore come as no surprise to anyone that Scotland has a long-standing and problematic relationship with alcohol. The damage that misuse causes is indeed stark. It causes harm to individuals’ health, employment and relationships, as well as to the wider community and public safety. Hearing figures that suggest one in five people have been harmed by other people’s drinking in the last year alone is frightening. Then we have the financial burden on the economy through costs to the NHS, police and emergency services, and in lost productivity to businesses.

In 2020, adults in Scotland drank an average of 9.4 litres of alcohol per head, which is 18 units per adult per week, or almost 30% more than the low risk guidelines. That is an improvement from 2015, when the average was 10.8 litres. It is moving in the right direction, but not fast enough, and of course an average hides a wide variation in consumption rates between different individuals. Notwithstanding this trend of reduced consumption, the sad reality is that the pandemic has driven up alcohol-related deaths. Evidence from various surveys shows that those who were drinking heavily before the pandemic were more likely to increase their drinking during lockdown, thereby increasing their risk of harm.

Reducing harm from alcohol is an issue devolved to the Scottish Parliament. As we have heard, Scotland is leading the world on alcohol pricing, being the first country to implement a minimum price of 50p per unit, which aims to reduce the harms, save lives, reduce hospital admissions and, ultimately, have positive impacts across the whole health system and for our wider society. The early indications are very encouraging. Before minimum unit pricing was introduced in May 2018, the weekly lower-risk drinking guideline amount of 14 units could be bought for £2.52, which is as little as 18p per unit.

The ability of the Scottish Government to tackle health issues such as alcohol harm is now, I fear, at risk from the UK Government’s plan to grab devolved powers back under the new internal market legislation. I hope that the Minister can give us a guarantee that under no circumstances will they use the United Kingdom Internal Market Act 2020 to undermine the Scottish Government’s ability to set minimum unit pricing, because it really is making a difference.

We must recognise that tackling alcohol harms does not simply mean addressing alcohol use. Mental health, trauma, isolation, housing and employment are just a few of the issues that can either lead to or contribute to problematic substance abuse. The Scottish Government’s alcohol framework sets out our priorities for preventing alcohol-related harm, and includes consulting on potential restrictions on alcohol advertising and improving health information on product labels, although some aspects, such as TV advertising, are currently reserved to the UK Government.

The framework contains some 20 actions building on existing measures to change Scotland’s relationship with alcohol, and there is a strong focus on reducing health inequalities and doing more to protect children and young people from alcohol-related harm, including through education. Key actions include consulting on options for mandatory restrictions on alcohol marketing in Scotland, and pressing the UK Government for a 9 pm watershed on alcohol TV adverts—as they have consulted on for high fat, sugar and salt in foods—and under-18 films at cinemas, or else they could perhaps devolve the broadcast advertising powers and we can do that ourselves. They also include giving consumers useful health information on product labels and continuing our “Count 14” campaign work to raise awareness of the UK chief medical officer’s lower-risk drinking guideline of 14 units per week; I expect many people still remember the previous higher limits. I could say much more about the work done in Scotland but it is important to recognise that, whatever we are doing in any part of the UK, more can still be done to make sure people get into appropriate treatment quicker in order to reduce harms and help with treatment and recovery.

As I said earlier, while alcohol harm is a devolved matter, several of the levers that can influence the issue remain here at Westminster, and I therefore wholeheartedly support the call in the motion for the Government to commission an independent review of alcohol harm.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 4:35 pm, 25th November 2021

It is a pleasure to speak in this important debate and to follow such powerful contributions by colleagues. I commend in particular Derek Thomas on securing the debate and on the way in which he led it. He said he wanted to start a new conversation. That was an elegant way to put it and is a good challenge to us all; we should all work in that spirit, and his efforts in the commission and in Parliament more generally reflect that.

I was particularly grateful to hear the hon. Gentleman mention foetal alcohol spectrum disorder. That is a hidden harm in society; we are scratching the surface of our understanding of the profound challenges it poses for individuals and society at large. I hope the Minister will give a commitment in her speech to a national prevalence study on it, as the sector is calling for; that would be an incredible thing for a public health Minister to pick up. That fits in neatly with what Duncan Baker said about investing in services that are proven to work. That is important, particularly in relation to work with our local authorities, which I will refer to shortly. Gathering evidence on conditions such as FASD would help us build services that could be very impactful.

The contribution from my right hon. Friend Liam Byrne was exceptionally moving, and his candour and the vulnerability with which he spoke will have touched those watching the debate and given people permission to speak out themselves. I congratulate him on the work he has done, and the work my right hon. Friend Jonathan Ashworth, the shadow Secretary of State, has done in this area is also genuinely transformative, changing societal perceptions and giving people permission to speak. I felt very lucky to have been sat here to hear the contribution of my right hon. Friend the Member for Birmingham, Hodge Hill.

My right hon. Friend spoke movingly as well for my hon. Friend Dan Carden. We have missed him today, for entirely understandable reasons today. He and I have been friends for a very long time—from long before we were elected here a few years ago—and he and his family are in the thoughts and prayers of me and my family, and I am sure they are also in the hearts of all hon. and right hon. Members. His courage, too, in speaking out as he has done has given others permission to do the same.

Every day in our country 70 people die from alcohol-related causes. Alcohol is a powerful drug that has a wide range of effects on the human body, and the impact goes far beyond just individual health: it meaningful both for the health and wellbeing of the person concerned and for their family and the community they live in. Alcohol is linked to 200 different diseases and injuries, including heart disease, liver disease and stroke, and costs the NHS £3.5 billion every year. Alcohol is now the leading risk factor for ill health, early mortality and disability for those in my age bracket of 15 to 49. There are over 1 million hospital admissions related to alcohol each year and, as with many public health issues, they are disproportionately reflected in the poorest communities; a third of all alcohol-specific deaths are in the most deprived 20% of communities.

In my city of Nottingham our hospital admissions entering the pandemic in 2017-18 were 25,000, an all-time high, and the pandemic will only have turbocharged that. We know that in 2020 a record high of nearly 7,000 people died from diseases that are a direct consequence of alcohol, up 20% on the year before. That is a staggering change. In 2020-21, 126 million extra litres of alcohol were sold, and the heaviest drinkers increased their buying by 14%. That is a really significant change in behaviour from what was already a very challenging baseline.

As I say, alcohol harm does not just affect the individual; it harms families, too. Alcohol harm is associated with violence and domestic abuse. While alcohol use is never the sole reason for domestic abuse, the World Health Organisation estimates that roughly 55% of perpetrators were drinking alcohol prior to an assault. As we have heard today, alcohol is also a major factor in child maltreatment, with Department for Education statistics showing that parental alcohol use was a factor in 16% of child-in-need cases.

We feel the harm more widely, too, with crime and antisocial behaviour, traffic collisions and unemployment. As colleagues will know, I have been campaigning for a number of years on violence and abuse against retail workers; again, alcohol is an anchor factor in that type of abuse. Drink-driving causes almost 9,000 casualties and 260 deaths a year. That is an awful lot of empty places at the table this Christmas, and a lot of hearts broken.

Good treatment services are our way, as a society and as a Parliament, to respond to the harm in our society, but even prior to the pandemic, only one in five dependent drinkers were believed to be in treatment. We must do much better than that. I think we can be much more ambitious. The hon. Member for St Ives mentioned the significant proportion of dependent drinkers in his constituency who are not in treatment—and, as he said, his constituency actually outperforms the national average.

That takes us, as we are often taken in Thursday debates about public health, back to the public health grant and our cuts to it over the last decade, which have been a cost efficiency but, as a value proposition, poor public policy. Between 2016 and 2018, more than two thirds of local authorities in England cut their alcohol treatment budgets, with 17 imposing cuts of more than half. Those cuts are part of the reason why dependent drinkers are often unable to get support. St Mungo’s estimates that funding cuts meant that 12,000 fewer rough sleepers accessed support in 2018-19 than if funding had remained at 2010 levels. Of course, as I say, covid will have exaggerated that even further.

Due to these resource cuts, alcohol treatment providers have reduced their offer to try to make sure that they can see as many people as possible. Currently, there are just six NHS in-patient detox units operating in the entirety of the UK, with fewer than 100 beds in total. A lack of outreach services means that those with complex needs are missing out, and a reduction in capacity means that those at lower levels of drinking, where treatment could be really impactful as an early intervention, are missing out too. We are not investing properly in those services, but we need to.

I look forward to hearing what the Minister has to say. I hope that she will address the point about the public health grant and what more can be done to restore what we have lost. As I say, there may have been a short-term cost saving on a financial line in the Budget, but in reality the cost—in human terms, of course, but also in cash terms to the rest of the health service—far dwarfs whatever has been saved. I hope that we can look at that and restore it as a matter of urgency.

Before closing, I want to revisit the point about labelling on alcohol products that I and my right hon. and hon. Friends pressed during proceedings on the Health and Care Bill. I will not reiterate the arguments, which I had the chance to make at length, but it is safe to say that we on the Opposition Benches are impatient for consistent, high-quality information to be available. It is about informed choice; we know that that is what consumers want, too. The settled will of the House, as established during proceedings on the Bill, is to let industry continue its efforts through self-organisation, and it is doubtless true that significant progress has been made in this area in recent years, so we will watch that with great interest. I hope that those in industry who are least willing to make this important change do not see Monday’s vote as a defeat of the concept of labelling itself but, rather, see that they are being given time and space to sort it themselves. If they do not, we will return to the issue.

In conclusion—I want to give the Minister plenty of time to address the comments that colleagues have made—the point about a strategy is well made. Now is the time to pull the efforts together under one roof so that they can be measured, understood and action-planned together—I think that is a good call. The funding that sits beneath them must be restored to its 2010 level. This is a significant harm for the individual and for our communities. I have no doubt that there is a cross-party commitment to attack this issue, and those are ways to do that.

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care 4:44 pm, 25th November 2021

I thank my hon. Friend Derek Thomas for leading on this important debate. There may not have been too many contributions, but those we have had have been really, really valuable. I am very sorry to hear that Dan Carden cannot be here for this important debate. I send my best wishes to him and his family at this very difficult time.

The majority of people drink alcohol responsibly, but we know that there are people who drink at levels which lead to significant harms. Alcohol misuse can have devastating impacts on individuals, families, communities and society. Over the course of the pandemic, we have seen an increase in those drinking at higher risk levels, and, sadly, an increase in alcohol-specific deaths. I would like to take this moment to commend our frontline workers. They have been tirelessly working and supporting people in need in the most difficult circumstances.

Throughout the pandemic, drug and alcohol treatment providers have continued to support and treat people. To ensure treatment services continue supporting people to the highest standards, we have made the largest increase to treatment funding for substance misuse in 15 years. We have provided £80 million of new investment in 2021-22. Some £9.8 million of that uplift has been allocated specifically to increase the availability of in-patient places for medically assisted withdrawal. That is of critical importance for people heavily dependent on alcohol, where rapid withdrawal can be extremely dangerous. The funding is in addition to the money that local authorities already spend on substance misuse from the public health grant.

The Government have agreed to carry forward the recommendations of part two of Dame Carol Black’s independent review of drugs—my hon. Friend the Member for St Ives talked about Dame Carol Black’s report in his speech—and to publish a new drugs strategy later this year. Although the subject of the review was drugs, the implementation of many of its recommendations will also benefit people seeking treatment for alcohol dependency, for example through the introduction of mechanisms such as an improved commissioning standard and a strong focus on building back the workforce. To further improve alcohol treatment, the Office for Health Improvement and Disparities is developing comprehensive UK guidelines for the clinical management of harmful drinking and alcohol dependence. The guidelines should develop a clear consensus on good practice and improve the quality of service provision.

There is clear evidence that growing up in a family affected by parental alcohol dependency can cause significant harm to a child’s wellbeing and damage their long-term outcomes. Thanks to the personal testimony and campaigning from Members here today—I will respond further to Liam Byrne later in my speech—we have invested £7.2 million on a package of measures, over four years, to improve outcomes and support for children whose parents are alcohol dependent. Some £5.7 million of that has funded nine local areas to implement innovative and evidence-informed interventions, and will make system-wide improvements to working holistically with these families. Early findings of the programme indicate positive results, for example in the local areas receiving programme funding, and we have seen improved identification of children in need, and more parents starting alcohol treatment. We are actively considering how we share lessons from the programme nationally, and the implications for future policy and practice. To aid that, we have commissioned an independent national evaluation of the programme, expected to be published in spring 2022.

Alcohol harms are not experienced equally across groups. Despite reporting lower or similar levels of drinking, those of lower socioeconomic status experience disproportionate alcohol-related harm. There are also significant geographical disparities, with the highest rates of mortality from alcohol-specific causes seen in the northern regions.

As part of the long-term plan, we have provided national funding to support the implementation of specialist alcohol care teams in the 25% of hospitals with the highest rates of alcohol dependence-related admissions. It is estimated that the programme will prevent 50,000 admissions over five years.

We are also committed to supporting the most vulnerable in our society. This year, we are delivering up to £52 million for substance misuse treatment services for people sleeping rough, building on the £23 million in 2020-21. That will fund evidence-based drug and alcohol treatment and wraparound support to improve access, including for those with co-occurring mental health needs.

The Government believe that people have a right to accurate information and clear advice about alcohol and its health risks, enabling people to make informed choices about their drinking. As a result, we continue to educate the public, ensuring that people are aware of the health risks of alcohol through local and national programmes, such as the Better Health campaign and the Drink Free Days app.

An alcohol risk assessment is a mandatory component in the NHS health check so that people are given advice on cutting down if their drinking is putting their health at risk. To ensure that people have all the information they need at the point of purchase, we will shortly consult on whether mandatory calorie labelling should be introduced on pre-packed alcohol and alcohol sold in the out-of-home sector. The consultation will also seek views on mandatory provision of the UK chief medical officer’s low-risk drinking guidelines and a drink-drive warning. Alex Norris talked about the impact that drink-driving can have on families. Respondents to that consultation will have the opportunity to provide suggestions for further labelling requirements that they would like the Government to consider.

I will take the opportunity now to address the issues raised during the debate. My hon. Friend the Member for St Ives talked about foetal alcohol spectrum disorder, and I reassure him that we take that very seriously. We have asked NICE to produce a quality standard in England for FASD to help the health and care system to improve the diagnosis and care of those affected, based around the Scottish intercollegiate guidelines network—SIGN 156—standard. To help improve support for those living with its consequences, we have funded five voluntary organisations in 2020-21, and we are analysing the evaluations to be taken into account for further policies on FASD.

The right hon. Member for Birmingham, Hodge Hill shared his moving and personal experiences of being a child and a grandchild of an alcoholic. I thank him for his openness. He talked about stigma and the importance of sharing experiences. I am sure that, by sharing his experience today, he will have made a difference to so many people, and I thank him for that.

The right hon. Gentleman asked about a number of other issues, including the strategy, as the hon. Member for Nottingham North and Martyn Day did. The Government have committed to publishing a new UK-wide cross-Government addiction strategy, which will focus on creating further opportunities to tackle and address addictions, such as alcohol and drugs as well as gambling-related harms, in a comprehensive and joined-up way. As I said, alcohol and drug addiction are far too often intrinsically linked, and we are committed to tackling that.

Photo of Liam Byrne Liam Byrne Labour, Birmingham, Hodge Hill

I wonder whether the Minister could share with the House her forecast timeframe for that addiction strategy and, in so doing, perhaps recognise that there are significant differences between addiction to drugs and alcohol, not least because one is legal and the other is illegal.

Photo of Maggie Throup Maggie Throup The Parliamentary Under-Secretary for Health and Social Care

I thank the right hon. Gentleman for that intervention. I am sure he will appreciate that Dame Carol Black’s report acknowledged that there are differences, but they are intrinsically linked as well. I fully take his point that one is illegal and the other is illegal, and that will be taken into consideration.

My hon. Friend the Member for St Ives, the right hon. Member for Birmingham, Hodge Hill and the Scottish National party spokesman, the hon. Member for Linlithgow and East Falkirk, talked about the minimum unit price. The Government continue to monitor the impact of the minimum unit price as evidence emerges from Scotland and Wales. Although some evidence has been published by Public Health Scotland relating to the impact of MUP, further important components of the evaluation are not scheduled for release until 2023, including the impact on alcohol-related admissions and deaths.

Another important issue raised in the debate was the relationship between domestic abuse and alcohol addiction. The Domestic Abuse Act 2021 will mean better protections for victims and more effective measures for going after perpetrators. We are reflecting the importance of joined-up domestic abuse, mental health and substance misuse services in supporting statutory guidelines.

Let me briefly address the issue that the hon. Members for Linlithgow and East Falkirk and for Nottingham North raised about amendments that were not made to the Health and Care Bill. Alcohol has not been included in the advertising restrictions in the Bill, mainly because the Government have existing measures in place to protect children and young people from alcohol advertisements. The 2019 and 2020 consultations on advertising restrictions on less healthy food and drink did not consult on including alcohol in the restrictions, either online or on TV. Finally, alcohol products are not available for children to purchase, so they do not have the same level of exposure to them.

In closing, I reiterate the Government’s commitment to supporting those who are most vulnerable to and at risk of alcohol misuse. I am confident that our strong programme of work under way to address alcohol-related harms, the increased funding for treatment providers and the recommendations in Dame Carol Black’s review that we are taking forward will all further support people who are experiencing alcohol dependency and alcohol-related harms, as well as those on whom they have an impact.

Photo of Derek Thomas Derek Thomas Conservative, St Ives 4:55 pm, 25th November 2021

I appreciate all that has been said, including the Minister’s response. In my speech, I talked about

“miserable, hopeless lived experience for those who find they have an alcohol addiction.”

We have heard clearly how that experience extends to families and particularly to children. I do not believe that it has to be hopeless, but we need a nationwide strategy with population-level measures.

I thank all hon. Members who have contributed to the debate, which has helped to address the stigma and put the subject back on the agenda, and which may start a new conversation. I appreciate all that the Minister said and all the measures that are being introduced. I would love the conversation to continue, to really help the families who are being severely harmed by alcohol misuse.

Question put and agreed to.

Resolved,

That this House
notes the grave harm to society caused by excessive alcohol consumption and alcohol addiction;
further notes that alcohol-specific deaths in 2020 were the highest ever recorded by the Office for National Statistics across many parts of the UK;
and calls on the Government to commission an independent review of alcohol harm.