Alcohol Harm Reduction Strategy

Part of the debate – 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.


Alix Cull
Posted on 19 Oct 2007 12:08 pm (Report this annotation)

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.