Alcohol Harm Reduction Strategy

– in the House of Lords at 12:09 pm on 18 October 2007.

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Photo of Lord Avebury Lord Avebury Spokesperson in the Lords (Civil Liberties), Home Affairs, Spokesperson in the Lords (Africa), Foreign & Commonwealth Affairs 12:09, 18 October 2007

asked Her Majesty's Government what consultations they are holding in connection with the revision of their alcohol harm reduction strategy.

My Lords, when we debated the first Government alcohol harm reduction strategy in May 2004, I said that it had little hope of making a real impact on England's most dangerous habit, and I am sorry to say that that forecast has been disastrously confirmed. Alcohol harm has steadily increased over the years and is continuing to increase. It is no wonder that Ministers refuse to update the estimate of September 2003, which put the amount of the damage at £20 billion a year. From the figures that I have studied, I believe that £22 billion would be a more accurate figure now—an increase of 10 per cent since the Government published their preliminary strategy in 2003.

The number of deaths per head of the population from causes linked to alcohol consumption has increased every year since 2001 by 4 per cent for men and 3 per cent for women. Every man dying from an alcohol-related cause loses 20 years of his life and every woman 15. Hospital admissions for adults where there is either a primary or secondary diagnosis of selected alcohol-related diseases increased by 61.3 per cent between 2001-02 and 2005-06. These figures may be an underestimate; the North West Public Health Observatory is about to publish a wider picture of hospital admissions to include, for instance, accidents, fall injuries and certain types of cancer which may be related to alcohol consumption. Reported alcohol consumption by children aged 11 to 13 almost doubled between 2001 and 2006, so there is far worse to come.

The evidence on alcohol-related attendances at A&E departments is inconclusive, but anyone who has had a serious accident on a Saturday night will know that it is mayhem there over the weekend. A survey of 191 A&E departments found recently that only 2 per cent of them used a formal screening tool to identify hazardous drinkers, and none routinely measured blood alcohol levels. That study, done by St. Thomas's Hospital, showed that any statistics on the number of alcohol-related attendances at A&E departments must be treated with caution, including the Home Office's evaluation of data from five A&E departments, which is due by the end of the year. The objective of that survey is to assess the effects of the Licensing Act, but as well as variations in identification and recording methodologies, major police operations were aimed at ensuring that the Act was effective, which would distort the figures immediately after it came into force. It will be necessary to take a much longer term view, based on common procedures, which I hope will be adopted for classifying attendances as alcohol-related.

I am not dealing with the Licensing Act today; there will be an opportunity to do so when the evaluation is published, looking also at ambulance call-outs and crimes of violence in the five selected areas. But for what it is worth, the Metropolitan Police collect regular statistics on crimes of violence. These show that between 1 o'clock and 4 o'clock in the morning in selected areas of Greater London, there was an increase of 53 per cent in the 12 months following the Act coming into force. However, that must be seen in the context of an equally staggering increase of 53 per cent in the previous 12 months.

As before, the main problem is that the Government discarded the possibility of using price and availability to reduce consumption in both the original strategy and the revised document, Safe. Sensible. Social. It ought to have been entitled "Dangerous. Foolish. Anti-social", because those are the main characteristics of English drinking.

There is to be a review of the evidence on the relationship between price, promotion and harm, on which there are abundant data already. The end product to be considered, if necessary, is regulatory change, directed, presumably, at special offers and promotions rather than pricing in general. The Chief Medical Officer, Sir Liam Donaldson, has called for the tax on alcohol to be increased as a deterrent to excessive drinking. I understand that the Conservatives want a "treatment tax" on alcohol. However, with no direct attack on consumption by adults, the Government rely on people knowing the "sensible drinking" guidelines and the personal risks associated with drinking above those levels. People have very little idea of what the units mean or what is meant by hazardous or harmful drinking, and still less of the possible long-term consequences for their life expectancy and health. Reduction of consumption by under-age drinkers is listed as an objective, but the Government apparently believe that this can be done by providing young people and their parents with,

"authoritative, accessible guidance about what is and what is not safe and sensible".—[Hansard, Commons, 5/6/07; col. 10WS.]

It is dangerous and naive nonsense to think that that will be effective. Some 5.9 million people exceed the recommended guidelines, so merely giving adults the information does not work and there is even less chance that it will have any effect on children's behaviour. But much more could be done to get at people suffering from alcohol harm at what Professor Robin Touquet calls the "teachable moment".

I welcome, as far as it goes, the decision to pilot studies in nine A&E departments, 24 GP practices and 24 criminal justice sites to identify those who drink harmful quantities and refer them to a nurse or social worker for advice. But the pilots will not be reported until May 2009, and then there will no doubt be further delays before deciding on the preferred model. We know already that brief interventions could result in 250,000 men and 67,500 women reducing their consumption from hazardous and harmful to low risk and that, for an investment of £24 million, the NHS could save £40 million over five years. The Department of Health has provided PCTs with a mere £15 million to spend on their local arrangements for commissioning and delivering alcohol interventions, but the money is not ring-fenced and there is nothing to stop them using it to reduce their deficits, as many have already done. Resources should be provided now to enable PCTs and police authorities to launch brief interventions on a much wider scale, with the option of making the continuation of the funding after 2009 conditional on adjusting the local programmes to conform to whatever models are found to be most effective.

However, there must also be a national programme for training the workers who will deliver the brief interventions, and there must be a budget for residential places for those who need longer-term treatment. The London Borough of Lambeth, where I live, for example, says that residential places for young people cost £4,000 a week, for which it has a nil budget.

I hope that, in all the advice models tested, those who drink harmful quantities will be invited to consider an alcohol-free lifestyle. The Government say that 10 per cent of the English population do not drink at all and, instead of insisting that so-called "sensible drinking" is the model for everyone, they should recognise that for some people it is an addiction as dangerous as heroin and that many others could be healthier and happier if they stopped drinking altogether. Alcoholics Anonymous welcomes referrals from professionals in the health and criminal justice systems, and the service that it provides should be recognised and encouraged.

There is to be a new programme to help local partnerships and communities to tackle alcohol-related crime and disorder, yet the Home Office's young people's substance misuse partnership grant is 10 per cent less in the current year than it was in 2006-07, and the cuts, euphemistically described as,

"changes in levels of funding", in the Home Office letter to drug and alcohol action teams, are excused on the grounds that they follow several years of increased funding. The £15 million for PCTs, mentioned earlier, is meant to cover services to prisons, for which responsibility was transferred to them in April this year. I gather that none of the extra money has gone to Brixton, in the London Borough of Lambeth, and I wonder whether any other prisons have got any of it.

On drink-driving, RoSPA's recommendations for a reduction in the blood-alcohol limit and random testing have been ignored, although 20 people are killed and 220 seriously injured in alcohol-related road accidents every week—well over a third of the total, which remains stubbornly above 30,000 a year. RoSPA also advises staff who drive in the course of their work not to drink at lunchtime. I suggested to the Prime Minister when he took office that alcohol should not be served at lunchtime events hosted by public authorities, and particularly by government departments, which would set an example that other employers could then be advised to follow. I am sorry to say that he did not reply.

Those examples show that we have a very long way to go before there is an effective strategy for combating alcohol harm, and I hope that this debate will prod the Government towards a set of policies that will eradicate a drinking culture that is poisoning this generation and leading to a catastrophe in the future as appalling in its effects as climate change or terrorism. We need national leadership, not more cross-ministerial and departmental groups.


Your Lordship. Would it be possible for Insurance companies to make some adjustment for none-drinkers?I am aware that this will depend upon the honesty of the person applying for insurance, but no doubt someone with more active brain than myself may come up with a solution.

Submitted by Alix Cull

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Crossbench 12:21, 18 October 2007

My Lords, I am grateful to the noble Lord, Lord Avebury, for tabling the Question. It is a very important topic facing our society, and causes more and more distress, not less and less.

I hope that the Government will consult the professionals who deal day in day out with the outcome of problem drinking as well as consulting those who are looking into the underlying causes of the binge and dangerous-drinking epidemics that we are now in.

Our city centres are given over to alcohol fuelled revelry on Friday and Saturday nights—many cities have closed their centres to traffic because the police can control the crowds more easily and try to minimise the accident risk. What do we know is happening? At peak times, as has been said, up to 70 per cent of admissions to accident and emergency units are related to alcohol consumption. It is true that Professor Touquet's Paddington alcohol test is incredibly useful because it builds on that teachable moment, but it is also a sad fact that there are not adequate numbers of alcohol counsellors to then deal with the problems identified.

Many of those who attend are not there with trivial injuries, such as falling off the pavement and twisting an ankle. Every year young people fall under Tube trains and die. Many are bright students on a night out. I expect that the Minister will tell us that road deaths are down—they are—but they are still too high. Why do we tolerate 80mg/100ml blood levels when 50 mg/100ml would be safer and easier to understand? We could even have a simple rule: that "Don't drink and drive" means do not drink—no drink. It would be easier to understand and clearer for all. As a social drinker myself it would be easier to have a clear rule of having soft drinks if I have the car keys.

The catalogue of deaths is huge. Every day 23 people die from alcohol-related causes in England and Wales, which is more that the total number of people dying from MRSA, cancer of the breast and cancer of the cervix put together. Yesterday I was in York and heard of two students who died recently in alcohol-fuelled accidents. One drowned because he fell into the river and the other died from a head injury caused by falling over when drunk. They were young students having just gone up to university with their lives ahead of them. Make no mistake, this is a story repeated time and again across the nation in our cities and universities.

Every weekend young people are beaten up in city centres around the country and left maimed for life. Some do not survive their injuries. The total cost of alcohol misuse to the health service has been estimated at at least £1.7 billion a year. In 2004 in England, 38 per cent of men and 16 per cent of women in the age group 16 to 64 had an alcohol use disorder. That is over a quarter of that population, equivalent to about 8.2 million people.

What has this done to the nation's economy? The Government's own data reveal that an annual cost through lost productivity as a result of alcohol misuse is at least £6.4 billion per annum, with up to 17 million working days lost through alcohol-related absence. The research evidence shows that mental functioning in those who have drunk heavily in the preceding 24 hours is seriously impaired, so even those who make it into work are not functioning properly.

It has often been said that 0drinking alcohol is a matter of personal choice—indeed, it is. The trouble is that the third-party damage caused by alcohol is not a matter of choice. Around half of all violent crimes—1.2 million violent incidents—are linked to alcohol misuse annually. Around a third—360,000—of domestic violence incidents are linked to alcohol misuse. If you are the child who has been hit, or the battered partner, that was not your choice. The cost of crime and anti-social behaviour linked to alcohol misuse is £7.3 billion annually and no one chooses to be the victim of a crime.

One could say that if you are informed and still drink, then you have brought the cirrhosis and other diseases on yourself. But alcohol is an addictive drug, and relatively cheap to buy. We know that the amount of alcohol consumed by girls aged between 11 and 13 has increased by 83 per cent in the six years 2000-06 while, for boys, consumption has gone up by 43 per cent during the same period. One million children have alcohol-addicted parents.

Ask youngsters why they binge drink, as I have been doing in preparation for this debate, and they tell you "Peer pressure": the pressure to be seen to have a good time. Many admit they feel awful, sick and unwell but they feel more miserable if they feel they have no friends. So they go with the crowd, fall to the peer pressure and play those drinking games with the drink on the table. The one who is not functioning well, of course, ends up losing and therefore downing the drink. They get plastered and then, soon, hooked.

It is then a way of life to prove that they are cool and having a good time. They run into debt, they function less well, many get injured or harm others and a few die. Among those who get arrested for criminal damage, 35 per cent of prisoners think they have an alcohol problem and 46 per cent believe that alcohol was a factor driving their offending behaviour.

Advertisers go right up to the line. Look at advertisements for alcohol: they make it look as if it is going to be really fun to down that vodka, those spirits, as if you will somehow feel good. They do not tell you that you are going to feel awful and might harm the people nearest to you.

What are we doing about it? The Government announced a planned £3.2 million on alcohol management initiatives. That figure is not to be sniffed at, but welcomed. We have Professor Drummond's study on alcohol screening and brief intervention pilots, known as SIPS. However, I hope that the Government are not going to put everything on hold waiting for the results of some of these studies to come through and that they are not going to be used as stalling tactics. The evidence is already there. We know things need to be done, and we know what works. The Paddington alcohol test is a clear example.

The key determinants of alcohol consumption have been identified as price, prevailing social culture and accessibility. The price is too low relative to other costs in our society. The prevailing social culture is that binge drinking is "cool", that you are somehow a better, more fun person if you go out and get smashed out of your mind on a Friday and Saturday night as a young adult.

Lastly, on accessibility, can we really afford not to consider putting the genie of unrestricted licensing hours back in the bottle? I hope that the Government will consult on this piece of their own legislation, among all the other things to be consulted on.

Photo of Viscount Falkland Viscount Falkland Liberal Democrat 12:29, 18 October 2007

My Lords, I thank my noble friend Lord Avebury for giving me the opportunity to debate with other noble Lords this problem of alcohol in our society. I pay tribute to his work—of which noble Lords may not be aware—having worked with him on the recent, dismaying alcohol Bill and seen the amount of badgering he did of Ministers, officials and police officers, and the amount of information he got. He is probably one of the major figures in the fight to reduce alcohol harm in our society, and a difficult job that is too.

Any of us who have had any sort of military training, however slight—in my case, being in the cadet force and in the Army for a short period— learnt very early on that a strategy has to have clear fundamentals and aims. Any Government face great difficulty in trying to produce a strategy to reduce the overall harm in our society. I do not blame them for trying to do it, but each of the many components of the problem—the constraints of time do not allow me to go through as many of them as I would like—requires a different strategy and different tactics to enable the strategy to be carried out.

I always think of myself as a young man, but I realise that I have been speaking in this House on alcohol since I joined the All-Party Group on Alcohol Abuse—now the All-Party Group on Alcohol Misuse—22 years ago. During that time, we have had some excellent chairmen and I have learnt a lot, but what has been achieved in dealing with the harm alcohol causes in our society has, for all kinds of reasons, been very slight.

One area where there has been a cultural change is drink-driving, but to my dismay I find that that is faltering a little. Whether it is because of a new generation coming along, new patterns of policing or whatever, the reduction of harm from drinking and driving has evened out. That is very worrying. The noble Baroness, Lady Finlay of Llandaff, made an excellent speech which referred to that, but she did not recommend what I would recommend: that the Government think again about coming into line with other countries and reducing the amount of alcohol that drivers are allowed to drink. I do not know why we stand out and stand firm on allowing what is nowadays a comparatively high level. It is much higher than that in France, which, through a combination of that lower level and the quite draconian policing introduced by the new President, Mr Sárközy, when he was at the Ministry of the Interior, has seen considerable reductions in accidents on the roads as a result of drinking.

It would be invidious to select an individual chairman of the All-Party Group, but Alan Milburn, when he was chairman, set up an inquiry into the institutions—police, prisons and so on—to see what the problem was. We took considerable evidence and produced a very good report which was greeted politely but is now gathering dust somewhere in the Home Office. Of course, these matters are now not necessarily dealt with in the same way by the same departments of state. If that report were dug out and taken seriously, it would give a great deal of information about what happens in prisons, referred to by the noble Baroness, in the Probation Service and in hospitals.

One of the most memorable events during those 22 years was taking evidence in a hospital in Liverpool. A nurse in the accident and emergency department told us about the extraordinary change in juvenile drinking resulting in children being brought in by their friends when found in a coma after taking enormous amounts of alcohol in the course of an evening's revels. That alarms their friends to the extent that they take children to accident and emergency wards, where they must be attended to very quickly to deal with the alcohol poisoning and to prevent permanent brain damage and possible death. That struck me very forcefully. That is an ongoing problem: juveniles drink more than they used to and young women drink to an extent that they did not use to.

On that subject, I think—and have done so for the past 20 years—that a number of measures have been quite pointless. One is illustrated by my 15 year-old son, my youngest son. One afternoon, I was sitting exactly where I am standing now quietly listening to a debate. I got a vibration on my mobile and there was a message from his housemaster at school which said, "Sad news, I am afraid. Charlie has been found in possession of a forged proof-of-age card". I got very concerned about that; I knew that his mother would be very concerned about that. On further inquiry, I found that every child who has the nous to do it as a forged proof-of-age card. They get them off the internet. His fault was not the fact that he had a proof-of-age card, it was the fact that he was caught. The message further said to me, "We decided to go to look at his locker, where we found that he had a store of Strongbow cider". He was not drinking the cider, he was trading it, which I think was a good point; he is obviously a budding entrepreneur, so his rather patchy academic life may not be so important as he is showing some skills not only in drawing and painting, which is his main forte, but in dealings. So I have great hopes for him, but not much hope for the proof-of-age card.

Photo of Lord Graham of Edmonton Lord Graham of Edmonton Labour

My Lords, does the noble Viscount agree that an element in our society that can be enormously influential in this is the retailers, the supermarkets, and those who work in them? Will he commend the action of the British Retail Consortium, for instance, which is strenuously trying to police this matter, and USDAW, which represents the shop workers, who, at the end of the day, carry a great deal of responsibility?

Photo of Viscount Falkland Viscount Falkland Liberal Democrat

Absolutely, my Lords, I agree with the noble Lord. He and I share a position as patrons of a treatment centre that is probably one of the most successful in the country and he knows as well as I do the importance of the business of clamping down on retailers who sell illegally. I absolutely agree with him.

The other issue is the use of units in health. I do not think that units in health are very helpful, because they give an overall picture that does not deal with variations in physiques, size, age and so on, except that women have different problems from men. Generally speaking, the use of units as an educational tool is not very effective.

I see that I am running out of time. I shall just list some areas that I have jotted down where a strategy is needed. Apart from the nation's health, juvenile drinking and drunk driving, which I talked about, there is domestic violence and child abuse, where drinking is often a cause of sad cases that are well publicised. There is pub and club violence, which we dealt with when discussing the Bill that I referred to which changed the drinking hours and gave longer hours for pubs and clubs. There is women's drinking, absenteeism and its economic cost. All those aspects need a strategy and tactics to achieve that strategy. That makes it extremely complicated. It is a question of time, but Governments do not have time. The short termism of Governments is not helpful in addressing what is still a very grave problem in our society.

Photo of Lord Roberts of Llandudno Lord Roberts of Llandudno Spokesperson in the Lords, International Development, Spokesperson in the Lords, Welsh Affairs, Whip 12:39, 18 October 2007

My Lords, I am delighted to join the noble Lord, Lord Avebury, the noble Viscount, Lord Falkland, and the noble Baroness, Lady Finlay, in sharing the concern that we all have about this particular problem. In 1910, there was a great battle for power in the House of Lords. One Liberal poster at the time attacked the "Peerage and the Beerage" and said how closely associated they were. Perhaps it was not referring to the Liberal Benches, but the other Benches at that time.

I speak for a minority, although there are probably 10 million of us teetotallers. That means that the opinions I express are probably not those that everybody would agree with. But we all agree that, however committed drinking habits are, this problem merits the most urgent serious consideration.

The debate is about alcohol harm reduction in England. As a Welshman, I venture over the border, because the problem is just as acute in Wales. But this very morning, Scottish Health Action on Alcohol Problems expressed alarm at the heavy drinking in Scotland, saying that 1 million people are at risk in Scotland alone.

In Wales, I was surprised to read figures telling me that sales of alcohol have doubled in 10 years. That is directly related, as the noble Baroness, Lady Finlay, mentioned, to hospital admissions for alcohol-related problems. In 1999, 252 hospital admissions out of 100,000 were alcohol-related. By 2005, six years later, that was up to 309 per 100,000, and BMA Wales says that there is a "growing alcohol problem".

The report of the Directors of Public Protection Wales claims, as other noble Lords have mentioned already, that alcohol consumption in Wales alone costs £1 billion a year—£320 million on working hours lost, £365 million on drink-related crime and disorder, £85 million on healthcare costs and £230 million on tackling family break-ups. I am not quite sure how accurate this is, but it is thought that 1,000 premature deaths a year in Wales are alcohol related. One cannot assess the degree of trauma among families and children resulting from excessive drinking—the child brought up in a home where there is domestic violence and needless poverty because of the money spent on alcohol. That child has not been given the proper backing and opportunity because money was spent in other ways. The Welsh Assembly funded the Wales Domestic Abuse Helpline. It is said that one in four women in Wales will be a victim of domestic abuse at some time in their lives. I am ashamed of that figure, but I submit that much of it is alcohol-related.

One figure that I am sure is utterly reliable and alarms me tremendously relates to drinking by 11 to 15 year-olds in Wales. Wales has the highest level of underage drinking of any European country. A report last year, Alcohol and Health in Wales: a Major Public Health Issue, stated a different figure from the BMA—that 70 men and 90 women in Wales were likely to die of alcohol-related conditions in this particular year. A report in the Observer for the United Kingdom as a whole showed an astounding rise of 27.3 per cent in male drinking admissions to hospitals in England between 2001 and 2005. If that figure is correct, it must cause us the utmost concern.

It has been agreed—the noble Viscount, Lord Falkland, and others mentioned this—that tackling this growing problem does not lie in 24-hour pub opening hours and round-the-clock availability of alcohol, which perhaps has changed the pattern of drinking. The Minister might correct me, but I would suggest that it has not led to a reduction in alcohol consumption or related disorders. Is the Minister able to say whether it is time to outlaw drinking on the streets? Following the smoking ban in buildings and pubs, there is more such drinking with tables outside public houses and hotels. We must look at that problem. Because people cannot smoke inside a public place, they now do so on the streets.

We should also look at the deep discounting of alcohol sold in off-licences and supermarkets, and at banning special promotions. I have heard of many promotions which will lead only to an increase in the alcohol problem. We should look at the pricing mechanisms which can be used to discourage heavy consumption of high alcohol products, compulsory alcohol labelling and, as has already been mentioned, reducing the drink-drive limit. In Wales, Scotland, England and Northern Ireland, there should be a far more concentrated educational approach to this problem in schools. That is what a Government might do, but every individual can, by his or her own example, contribute to tackling this problem.

I am old enough to remember the early years of "Coronation Street". The Rovers Return was there then and it is still there. Ena Sharples' chapel mission went many years ago. The balance has gone out of society. On some television programmes, including soaps, people shout, are aggressive and are abusive, which is considered by many people to be the norm and how one is supposed to behave. It reflects the role model which society tries to emulate. Without restricting the soaps, is it not time that we asked the programme makers, "Can you not sometimes just lower the decibels a little bit and change the approach"?

This House is very civilised. We rarely raise our voices.

Photo of Lord Roberts of Llandudno Lord Roberts of Llandudno Spokesperson in the Lords, International Development, Spokesperson in the Lords, Welsh Affairs, Whip

My Lords, I was at Prime Minister's Questions yesterday. It was like a bear garden. Young people look at that and say, "That is the role, the example". I do not know how we could speak to the other House because in no way could we try to influence it, but is that not something which we in public life should consider? Government and individuals are able to influence this problem, perhaps not 100 per cent, but at least in some measure.

Photo of Baroness Coussins Baroness Coussins Crossbench 12:48, 18 October 2007

My Lords, I declare an interest as a former chief executive of the Portman Group, whose work is cited in the alcohol harm reduction strategy. I was a member of the Prime Minister's strategy unit group which advised on the first edition of the strategy in 2004, and am a former trustee of the Alcohol Education and Research Council. I am currently a paid non-executive adviser to Brown-Forman, a global wines and spirits company.

The revised strategy published earlier this year is by necessity a wide-ranging document, covering health, education, law enforcement and industry issues. In it, the Government acknowledge that some progress has been made; for example, it reports a drop in under-age sales and fewer alcohol-related violent crimes. I believe that the Government are to be congratulated on their belated but nevertheless welcome commitment to spend £10 million next year on a sustained responsible drinking advertising campaign. I agree with the noble Lord, Lord Avebury, that the police need to be adequately resourced to carry out certain aspects of law enforcement which are central to the strategy. Drink driving is an obvious example, while another is the criminal offence known as proxy purchase, which is when adults buy alcohol to pass on to under-age drinkers, yet this is seldom targeted or enforced.

I should like to focus the rest of my contribution on just two aspects of this broad debate, which I hope will help to put it into a proper perspective. The first is to do with evidence, and the second concerns the role of the drinks industry. On the first, it has become a government mantra to say that policies must be evidence-based. This is important not only for the integrity of policy, but also in order to secure and retain the confidence of the public and others with whom the Government wish to work in partnership to tackle alcohol misuse, such as NGOs, practitioners and those who produce, advertise and sell alcohol. When the requirement to be evidence-based is disregarded, sometimes blatantly, the Government's authority is weakened and consumers are confused.

The recent fiasco over advice on drinking in pregnancy is a case in point. The Government announced that although there was no new scientific evidence to justify a departure from existing guidance that pregnant women who choose to drink should consume no more than one to two units once or twice a week, they were nevertheless changing the advice towards a zero-consumption approach on the dubious grounds that women would find it easier to understand a simpler message. This volte-face was widely criticised by media commentators, and only last week was further challenged by a draft recommendation from the National Institute for Health and Clinical Excellence that pregnant women might safely drink up to 10.5 units a week after the first trimester. This degree of discrepancy on such an important and high-profile aspect of potential alcohol harm is intolerable. Credible, authoritative advice must be agreed and communicated urgently.

The industry is being asked by the Government to agree to a voluntary labelling scheme which includes information in line with government advice on drinking in pregnancy. But why should the industry put its reputation on the line and even risk legal action by carrying misleading or inaccurate information? One of the reasons the industry has been so committed to working with the Government since 1995—when all the current sensible drinking guidelines were first introduced, not just those on pregnancy—is that the guidelines were determined for the first time as a result of detailed scrutiny of extensive scientific research. The guidelines are balanced and evidence-based. The industry accepts that some people most certainly need to drink less, and the Government accept that moderate drinking generally causes no harm and may even bring some health benefits. We need to have the same degree of clarity on drinking—or not—in pregnancy.

The other point I should like to make about evidence is that the selective or distorted reporting of statistics and research findings can often create a groundswell of calls for this or that measure which then obscures the debate and risks diverting the Government from properly targeted policies. For example, who would have thought from reading the media coverage over the past year that current licensing statistics from the DCMS indicate that only 2 per cent of the UK's licensed premises have 24-hour licences, or that out of the 3,000 premises that make up that 2 per cent, only 120 are pubs—and I am told that 70 per cent of those are in Dorset. The other 2,880 premises are mainly hotels, supermarkets and convenience stores, yet the impression given is that so-called "24-hour drinking" is the rampant scourge of every town and city centre, and that irresponsible pubs are at the heart of the problem. I am not suggesting for a moment that there is no problem with drunken public behaviour, but only that it needs a proportionate response and that pubs in general should not be the scapegoats.

Who would have thought that, according to robust data from Her Majesty's Customs and Excise, overall consumption has actually been falling in the UK since 2004 or, as the General Household Survey shows, that there are more teenage abstainers now than ever before, and that even the number of young people aged 16 to 24 who drink at harmful levels has dropped since 2003. Admittedly, nearly a third of this age group still drink too much—so it is not a problem to be dismissed, by any means—but the movement is in the right direction at last, although you would not believe it judging by the media or the calls for ever-increasing restrictive policies from various groups and practitioners.

Respect for the evidence cuts both ways, of course. As the noble Lord, Lord Avebury, mentioned, the Government are currently commissioning research into whether there is a link between alcohol harm and the pricing, discounting and promotion of drinks. If any credible detrimental connection is established, the industry will have a duty to respond constructively and swiftly; and if competition law restricts the industry's room for manoeuvre, the Government must assist and jointly find a way through the apparent impasse. By the same token, those who are already champing at the bit and calling for all manner of further restrictions on price, promotion and availability of alcohol, should wait for the evidence and not pre-judge the results.

I also want to mention the broader role of the drinks producers in helping the Government to implement the harm reduction strategy. The World Health Organisation called on Governments to consult industry as part of its global resolution on the harmful use of alcohol. The Government deserve credit for their dialogue with the industry over the initial strategy, acknowledging it as a stakeholder and not only a consultee. It is very important that this dialogue be maintained and strengthened if the industry is to deliver what the Government hope it will in the second wave of action on the strategy.

The industry often gets it in the neck as an easy target to blame, but until now it has provided the resources for more sustained national campaigning and information to promote the Government's own sensible drinking message than any other source. In particular, the drinkaware consumer website address now appears on more than £150 million-worth of TV, cinema and print advertising every year; on the labels of 3 billion cans and bottles; and in thousands of supermarkets, shops and pubs. Lest anyone should think this a small or futile gesture, the drinkaware website gets more than 2.5 million hits every month. So the industry is clearly succeeding in driving consumer traffic to this excellent source of user-friendly information and advice.

The aims of the strategy will be achieved all the more quickly and efficiently if the Government and the industry continue to work together on common ground. Alcohol-related harm is in the interests of neither.

Photo of Baroness Falkner of Margravine Baroness Falkner of Margravine Spokesperson in the Lords, Children, Schools and Families 12:58, 18 October 2007

My Lords, I, too, thank my noble friend Lord Avebury for initiating this debate. He is an undisputed expert in this area, as the Minister will be aware, being familiar with his Questions and interest over many years. He is an indefatigable campaigner on the issue and a source of enormous expertise to the whole House. This debate is close to his heart and has been a long time coming.

In particular, I hope the Government will look more closely at my noble friend's reference to research on teachable moments and brief interventions. There are clearly examples which need to be looked into of moments when people are at a certain point of vulnerability and it is possible to achieve a great deal more than it would be at other times. However, as the noble Baroness, Lady Finlay of Llandaff, said, one of the problems with teachable moments is that you very often do not have enough alcohol counsellors to deal with the problems that arise. When the time is ripe, you need to have that ability.

My noble friend Lord Falkland spoke about his years of looking at the problem, not least through the work of the All-Party Alcohol Misuse Group. In preparing for this debate I have looked at a little of that group's excellent report. I was particularly touched by my noble friend's anecdote of his son Charlie's experience. As the parent of a child who is reaching that risk-category age, I empathise hugely with the problems that today's parents face with the issue.

The noble Lord, Lord Roberts, told us some shocking figures from Wales and drew our attention to the importance of availability, as did almost all other noble Lords. The noble Baroness, Lady Coussins, warned us of the irresponsible use of statistics; hence I will use them here with trepidation. In fact, now that she has spoken, I will cut out most of them from my speech. But while she has been upbeat about movement being in the right direction compared with statistics from some years ago, I hope she will agree that, for persistent drinkers among children, the figures are not promising. We need to do a huge amount of work there. That is the angle on which I will concentrate my own few remarks in this debate.

The Government's own research acknowledges how intractable the problem is. While there has been a drop in the overall number of children drinking—and the Government are to be congratulated on that—we know that the problem is getting worse with a persistent hard core. According to the latest NHS report, from early September, looking at secondary school pupils in 2006, almost 21 per cent of 11 to 15 year-olds are drinking more than 10 units a week. Of the children who drank in the last week, boys drank 12.3 units and girls drank 10.4.

We know that changing habits and lifestyles is an uphill task in public policy, but we also know that we have good experience in that area. If we take smoking as an analogy, as the noble Lord, Lord Roberts, briefly referred to, it has taken several decades to arrive at the situation where almost everyone, including smokers, is aware of the damage caused to their health and the health of others. We have engaged in public health information campaigns, the science has been definitive and its message has been clearly understood. It is no longer acceptable to expect to smoke in social situations in other people's houses.

We may need to undertake a similar effort with regard to alcohol. I suspect, though, that this will be rather harder because of the prevalence of drinking that is embedded in our culture. Gone are the days when people had a drink on high days and celebrations. Woolworths, for example, has recently been able to market champagne at £5 a bottle along with a range of mix-and-match sweets. It is sending out a clear message that champagne is not for high days but for every day. When that message comes from a national retailer that admits that its customers are mainly among young people under 18, it is doubly worrying.

Leaving aside drink retailers, though, the point I am making is that Britain and some other Anglo-Saxon societies seem to see alcohol as an essential component of leisure and pleasure. Whether it is a quick drink in the pub or wine bar on the way home from work or being curled up on the sofa watching a football game, the indispensable element appears now to be beer or wine. That is clear from the Government's own research, which shows that the problem of alcohol abuse in Britain is deeply rooted and has manifold repercussions in its social costs.

Culture can change over time, however. I will focus on three areas we need to address. First, it is clear that children and young people have easiest access to alcohol in the home. Better parenting is the remedy proposed for a range of social issues, but would it not be better for the alcohol awareness campaign vis-à-vis children also to be directed to parents? My suggestion here is that many parents may not be aware of the extent to which alcohol harms vital organs and children's development and growth in these crucial years. Have the Government commissioned any research into the level of knowledge adults have about the physiological impact on children's health of alcohol consumption?

I know, anecdotally, as the parent of a child in that group, that the social acceptability of children's drinking is an issue on which parents need much greater clarity. The middle classes in Britain have long harboured the view that Continentals are much more liberal about children drinking, and that if only we emulated the so-called Continental lifestyles and allowed our children to drink, they would grow up to be responsible drinkers.

The reality, of course, is that levels of drinking, in adults as well as children, in many countries on the Continent are significantly lower than in Britain. We nevertheless have examples—I am sure that other parents can testify to this—where one goes to lunch or a family party at a weekend and an 11 year-old is allowed a bottle of beer or glass of wine. I have seen it on many occasions. While there are many social problems where the Government are not best placed to bring about social change, this is perhaps an area where there is a role for them to make certain kinds of behaviour unacceptable. Just as smacking children is now socially unacceptable, so, likewise, should we make it socially unacceptable for children to drink with our approval and in our presence.

We know that self-declaration is deceptive as a measure of consumption of alcohol; it is about as deceptive as it was with smoking. The Government's strategy paper states that that is because people may not be aware of the amount they consume, as information about units consumed is not easy to translate into real amounts consumed. Perhaps we need to acknowledge that a parallel labelling system might bring clarity to the debate. An example could be to label bottles of wine and beer more clearly to state the health implications of drinking two, three or six glasses of a given drink. In other words, we need a harder-hitting, clearer message.

One cannot avoid, as many noble Lords have mentioned, the relationship between price, availability and consumption. We know from a recent campaign to stamp down on sales of alcohol to under-age drinkers that 22 pubs and off-licences face fines of up to £10,000 and three-month bans after being caught repeatedly serving under-age teenagers. A further 224 licensed premises were caught twice during the sting operation. That enforcement campaign ran 10 weeks and found, according to the accompanying press release, that "only" 15 percent of pubs and shops were prepared to sell alcohol to teenagers. I would argue that 15 per cent is way too high. If a short campaign resulted in those figures, the problem may be more severe during seasons when drink consumption rises across the board.

We therefore welcome the Government's commitment to a review. As the noble Baroness, Lady Finlay of Llandaff, reminded us, the evidence exists in spades; now we need to act on it. There may also be a case for greater consultation with parents and communities on their preferences for availability of alcohol. Last year, Massachusetts held a referendum at the time of local elections on whether to extend the availability of alcohol in retail outlets on Sundays. After vibrant campaigning on both sides of the debate, the public were much better informed and voted a resounding "no". Perhaps the lesson here is that simply supplying information is not enough and that we need to engage people in decisions about the kind of society that they want. I suspect that that engagement will show, as polls have done, that people are concerned but perhaps impotent in terms of voice. We need to take this campaign forward in many different ways.

Photo of Earl Howe Earl Howe Shadow Minister, Health 1:09, 18 October 2007

My Lords, the noble Lord, Lord Avebury, has brought us to a subject that is not only of critical importance for public health but also, in view of this week's press coverage, extremely topical. For that, the House will be grateful, and I congratulate him on a cogent and powerful speech.

As with so many public health issues, including obesity, drug-use and teenage pregnancy, we are dealing here with a societal problem which any government acting alone cannot hope to cure. However, government can do a lot. My worry during the past few years is that the growing problem of alcohol abuse has not sufficiently occupied Ministers' in-trays or red boxes. Of course, the Minister will point to various worthy-sounding initiatives, but as with obesity, we will fight a losing battle unless focused and concerted efforts are made to change public attitudes and patterns of behaviour. As it is, the odds are stacked decidedly against any quick fix. In the past 15 years, children's alcohol consumption has doubled. In the past five years alone, consumption across the board has gone up by 15 per cent, which is a continuation of an upward curve that started 50 years ago, only much steeper. People are starting to drink at a much younger age, with nearly one-quarter of young people aged between 11 and 15 regularly drinking up to 10 units a week. Perhaps the most shocking statistic of the lot is that one in 10 primary school children regularly drinks alcohol.

The cost of all this—to the health service, the criminal justice system and to people's lives—is enormous. The noble Baroness, Lady Finlay, and the noble Lord, Lord Roberts, brought that home very graphically. My personal view is that we have reached a point where, without very major initiatives at national level, these trends are only going to get worse. What might those initiatives look like? The Government's alcohol harm reduction strategy, which was published three and a half years ago, contained some good ideas, such as providing better information to consumers about the dangers of alcohol abuse and clamping down on irresponsible sales promotions. However, if you talk to doctors who practise in this field, they will say that the strategy was not nearly ambitious enough. The principal target of the harm minimisation strategy was binge drinking, which although of course it was worthy of being a target was by no means the only important one. There was no explicit ambition in the strategy actually to bring down the overall level of alcohol-related harm, let alone any timescale for trying to do so. When it was published, Professor Drummond of the National Treatment Agency for Substance Misuse rather brutally remarked that,

"no effective strategies have been used in the making of this document".

Perhaps that was a little harsh but certainly it reflected his frustration that the strategy failed to get to grips with alcohol misuse as well as the underlying causes of it.

Unfortunately, as with the Government's policy on cannabis, the message on alcohol has sometimes been mixed. The alcohol harm reduction strategy of 2004 followed hard on the heels of the relaxation of the licensing laws. The Government strongly defended that relaxation at the time, saying in effect that it was unfair to criticise Ministers for giving the man in the street what he wanted. But if ever there was a case for piloting something, that was surely it. In fact, my own party said exactly that at the time. As it was, we were plunged straight into a giant national experiment, the results of which are still being evaluated. Whatever the findings are—and no doubt the Minister will be able to tell us how the Department of Health views them so far—the messages sent out by the growth of superpubs and longer drinking hours are surely the wrong ones. You have only to read history, not least the history of the l8th century and the arrival of cheap gin, to realise that the introduction of the licensing laws was no accident. It is a good thing that the Government are now looking again at the 2003 Act and, if they decide, on the evidence, to reverse it, we on these Benches will support them.

However, the elephant in the room here is not the licensing laws but, as a number of noble Lords have said, something rather more far-reaching: the price of alcohol. Alcohol is more than 50 per cent cheaper than it was in 1980—and this at a time when people's disposable incomes have increased very considerably. I appreciate the arguments against imposing large tax hikes on alcohol. One of them is that we cannot find ourselves severely out of step with other EU member states; another is the adverse effect on our drinks industry. But it would be helpful to hear from the Minister exactly why the Government resist the notion, if indeed they do, that significant price rises on alcoholic drinks, perhaps introduced over a period, would not be beneficial to the nation. The Government's review of their alcohol strategy was published in June and in it there is a pledge to look at the extent to which low prices and advertisements increase the amount that we drink. Perhaps the Minister could tell us the timescale for doing this.

A lot of people believe that more can usefully be done to reduce children's exposure to alcohol advertising. We already have restrictions on television during the hours when young people are most likely to be watching, but I wonder whether the Minister is aware of the finding by Alcohol Concern that TV advertisements for alcohol increase dramatically between 3 pm and 5 pm, which is the precise time when children return from school. Are the Government looking at that finding?

The other main prongs of the Safe, Sensible, Social action plan are tougher enforcement of the existing law on sales and drunken behaviour and campaigns to promote sensible drinking. It is not particularly profitable in a health debate to spend time on law and order policy, although I wonder whether the policy will be matched by the necessary resources. I should be interested to hear from the Minister a little more about the public information campaigns that are planned.

The report focuses a lot of its attention on,

"the minority of drinkers who cause or experience most harm to themselves".

In view of the findings published this week by the North West Public Health Observatory, I take it that the spotlight is now not only on teenage binge drinkers but on middle class social drinkers. The two are linked, because the evidence is that peer pressure and parental example are the most significant drivers of drinking among young people. Among adults especially, one issue has to be looked at; the level of general public awareness of government health warnings. While a majority of people have heard of the guidelines, a significant proportion of those people say that they do not know what the guidelines are. There is ignorance on another level as well. If you ask people what a unit of alcohol looks like, the chances are that they will give you the wrong answer. A 125 ml glass of wine contains approximately one and a half units. However, a glass of wine that you pour at home is probably going to be larger and may be much more than one and a half units, particularly if it has a stronger alcohol content. If the messages to the public continue to be expressed in terms of units, at the very least those messages have to become more sophisticated.

The Safe, Sensible, Social document is, I fear, an admission on the part of Ministers that their previous initiatives on alcohol abuse have failed. I do not think that any of us can stress enough how important it is for this one to succeed. People point to illicit drugs as the cause of much crime; which is absolutely true. But the evidence is that alcohol abuse underlies much drug-taking, teenage pregnancy, school truancy, crime and the growth in sexually-transmitted diseases. Alcohol abuse is truly at the heart of many of our society's ills. Only a serious and concerted public health campaign, sustained over a long period, can hope to reverse the very worrying trends of recent years. That campaign is now well overdue.

Photo of Baroness Royall of Blaisdon Baroness Royall of Blaisdon Government Whip 1:18, 18 October 2007

My Lords, I, too, congratulate the noble Lord, Lord Avebury, on securing this important and timely debate. I am grateful for his expertise and for the close interest that he takes in the Government's efforts to tackle the harms that are associated with alcohol misuse. I also thank him for his clear exposition of the challenges that we face; the demands on all of our services and the blight on so many people's lives, which are unnecessary. He is right that alcohol can be an addiction. I very much like his suggestion that lunches hosted by public bodies should be alcohol-free and that that should be an example for the rest of society. I will take that back.

I also warm to the suggestion made by the noble Baroness, Lady Finlay, that if you have the car keys you have a soft drink, but I am told by my colleagues at the Department for Transport that the department will keep the blood alcohol consumption limit under review, and there are no plans to change that at present. But it does not harm us or stop us from saying, "If you have the keys, please take a soft drink".

Too many people are drinking above sensible levels and are unaware of the harm that they may be causing to themselves. This week's publication of the local alcohol profiles for England provides clear evidence of the problems we face. The hazardous drinking of the middle classes hit the headlines, but the problems are much deeper. The important work undertaken by the North West Public Health Observatory was commissioned by the Government to enable public health directors to identify action that needs to be taken in their areas to tackle the impact of harmful drinking. The figures are disturbing, but the fact that we commissioned this study shows that we do not seek to hide the data and statistics.

Alcohol-related illness or injury accounts for 180,000 hospital admissions per year and, in 2005, more than 4,000 people in England and Wales died from alcoholic liver disease. These are matters of deep concern. Since 1979, alcohol-related deaths have more than doubled for men over 35, with more people dying at a younger age. Then there is the third-party damage, graphically illustrated by the noble Baroness, Lady Finlay. Against this backdrop, the Government launched in June their renewed alcohol strategy, Safe. Sensible. Social.The Next Steps in the National Alcohol Strategy. In the main, the strategy reflects that of the Government's first ever national strategy to tackle alcohol misuse in England, published in 2004. In the run-up to its publication, it was the subject of an extensive consultation exercise eliciting more than 300 responses.

Safe. Sensible. Social. builds on and refines the 2004 strategy, rather than heading off in a new direction. It does not mean that the previous strategy was not successful; we are building on its success. Although we did not feel it necessary to repeat the earlier consultation, we worked closely with around 80 stakeholders and representatives of key stakeholders from the medical profession, the alcohol industry and NGOs in developing our proposals.

Noble Lords, including the noble Viscount, Lord Falkland, mentioned specific problems related to young people and alcohol—the peer pressure and the dreadful consequences of alcohol abuse. That is why the strategy will focus largely on young people, and stakeholders broadly share our analysis of progress since 2004. They support our proposals to focus activity on three groups most at risk—binge drinkers aged 18 to 24, young people under 18 who drink alcohol, and harmful drinkers, including middle-class drinkers whose drinking is damaging their health, often without their realising it—while challenging the social acceptability of drunkenness and driving which causes harm.

To help young people and their parents make informed decisions about drinking, the Government will provide authoritative, accessible guidance about what is and is not safe to drink. We have announced that we will convene a panel of experts, including paediatricians and psychologists to examine the effects of alcohol on the developing child.

When there are new proposals, the Government have published a commitment to consult in more detail with a wide range of organisations on how best to implement them. These consultations will take place in 2008, when a number of reviews that we have commissioned will have reported their findings. In the mean time, the Government are keen to ensure the continued engagement and support of both industry and non-industry stakeholders. Therefore, the Department of Health and the Home Office are convening an alcohol corporate social responsibility group, comprising departmental representatives, the Office of Fair Trading and the Advertising Standards Authority, as well as representatives from the on-trade and off-trade and public health bodies. The group will provide the key mechanism for securing stakeholder support to ensure that we make progress on strategy actions.

The noble Lord, Lord Avebury, and many other noble Lords raised the issue of price and availability. The Government recognise that many people are concerned that the practice of "deep discounting" could encourage customers to purchase more alcohol than they would otherwise do, which could lead to harmful drinking.

The noble Earl, Lord Howe, asked why the Government resist a stepped increase in tax on alcohol. Tax is a matter for the Chancellor, with decisions taken every year at the time of the Budget. The Government have announced that they are commissioning an independent review of the relationship between alcohol policy and harm. This crucial review will seek to establish, through a systematic review of the evidence, how and in what circumstances price—including discounting, advertising and other forms of promotion—drives consumption of alcohol and all forms of alcohol-related harm. The Government will use the review's findings, which they intend to publish in July 2008, to assess whether particular types of discounting, linked to purchasing of bigger quantities, and promotional activities contribute to alcohol-related harm. They will, if necessary, consider the need for regulatory change in the future, following public consultation.

In November 2005, the alcohol industry launched its Social Responsibility Standards document, a landmark set of principles and standards that are intended to underpin responsible production and sale of alcohol. There are now many examples of industry good practice. What is less clear, though, is how widely these standards have been implemented across industry, how visible they are to the public and whether they go far enough in protecting those at most risk, such as young people. Safe. Sensible. Social. therefore includes a commitment by the Home Office to review the effectiveness of the alcoholic drinks industry's Social Responsibility Standards in contributing to a reduction in alcohol harm in England and, following public consultation, to consider the need for regulatory change in the future, if necessary.

Noble Lords are correct to point out that current advertising in our cinemas portrays alcohol as being cool and attractive, whereas we know that it is not. The Advertising Standards Authority is assessing the extent to which implementation of the code has reduced the appeal of alcohol advertising to under-18s. We look forward to seeing the results of the review later this year.

The noble Lord, Lord Roberts, mentioned the role of schools. In England, education about alcohol is part of the national curriculum. Perhaps either the contents or the way in which they are taught need to be improved, but parents also have a responsibility, as many noble Lords have pointed out. As the mother of three young people, I know just how difficult it is, even as a responsible parent, to inculcate these values into young people. I certainly note the points made about catching people at certain points of their vulnerability and the need for counsellors to deal with them at this stage. I will take those points back to the department.

Nearly two-thirds of male prisoners and over one-third of female prisoners have an established alcohol problem. All prisoners are assessed, including for alcohol problems. As we know, primary care trusts are responsible for commissioning advice, support and treatment for those in prison with alcohol-related problems. There is much to be done and I well understand the concern that has been expressed.

The Government announced in May a groundbreaking agreement with the drinks industry to include alcohol unit and health information on drinks labels. We are looking to the alcohol industry to ensure that most bottles and cans carry this information by the end of 2008. In addition, the Government are seeking to ensure that there is on labels information for pregnant women about alcohol. In response to the noble Baroness, Lady Coussins, I am pleased to clarify the Government's position on alcohol and pregnancy. There is no change in government policy. The advice is that, as a general rule, pregnant women or women trying to conceive should avoid drinking alcohol. If they choose to drink, to protect the baby they should not drink more than one to two units of alcohol once or twice a week and they should not get drunk.

Most people are aware of units as a measure of alcohol consumption. However, as noble Lords have pointed out, consumers find it hard to relate them to what they drink, with only 13 per cent of people keeping a check on the number of units that they drink. Including alcohol unit content consistently and visibly on containers should help to fill this gap. Like many people, I am not really aware of what a unit constitutes, and it is getting more and more difficult to buy small wine glasses for consumption at home.

The Comprehensive Spending Review, published by the Government on 9 October, announced a Home Office PSA target to reduce drug and alcohol harm. This includes a new national indicator to measure change in the rate of hospital admissions for alcohol-attributable conditions. It is the first ever national commitment to monitor how the NHS is tackling alcohol harms through both intervention and treatment. This will operate from April 2008. Jointly with the Home Office, we shall be embarking on a sustained national £10 million communications campaign to challenge public tolerance of drunkenness and drinking that causes harm to health and to raise the public's knowledge of units of alcohol so that everyone has the information they need to estimate how much they really drink.

The Government will support the development of a range of new kinds of information and advice aimed at people who drink at harmful levels—about twice our guidelines for regular drinking. For example, the Department of Health has invested £3.2 million to facilitate the development of the most effective and appropriate screening tools and brief intervention techniques. These will help to identify people who are drinking at harmful or hazardous levels and offer them help and advice to reduce their alcohol consumption.

A consortium headed by St George's Medical School and Newcastle University is establishing a series of intervention and brief advice "trailblazer" projects in primary care and other healthcare settings, including A&E, as well as criminal justice settings. We expect that the final report will be issued in 2009, although I realise that the timescale is disappointing.

The Government are determined that the steps that are set out in Safe, Sensible, Social will shape an environment which will minimise the health harms, violence and anti-social behaviour associated with alcohol, while ensuring that people are able to enjoy alcohol safely and responsibly. The noble Baroness, Lady Falkner, is absolutely right about the need for a change in culture, and that takes time.

This has been an excellent, well-informed and deeply disturbing debate, and I shall ensure that the Secretary of State and the Minister responsible are aware of all the comments made.