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Alcohol Misuse

1.29 pm

Mrs. Marion Roe (Broxbourne): I am pleased to have the chance to raise important issues in relation to alcohol misuse. As both vice-chairman of the all-party parliamentary group on alcohol misuse and vice-president of the specialist alcohol service covering my constituency, the Hertfordshire Alcohol Problems Advisory Service, I am all too aware of the health and social impact that alcohol has on communities. I am also acutely aware of the lack of measures to address alcohol misuse, particularly the absence of a strategic Government response to the issue, despite the large amount of evidence demonstrating the cost to society of alcohol misuse in its many forms.

Only a few months ago, the Royal College of Physicians put a figure on the burden of alcohol problems on the NHS, stating that they cost between 2 and 12 per cent. of NHS spend. Even at the lowest figure of 2 per cent., that amounts to about £500 million a year. Many of us would agree that there is much room for improvement in the waiting times experienced by patients requiring treatment for a range of conditions.

If the Government really want to address waiting times, the impact of alcohol problems cannot be ignored. At a recent meeting of the all-party parliamentary group on alcohol misuse, the reality of the impact of alcohol problems on the whole hospital system was brought to life by Dr. John Kemm, a consultant in public health who was a member of the Royal College of Physicians working party that produced the report "Alcohol—can the NHS afford it?"

In a graphic representation of a ward round in a busy city hospital, Dr. Kemm described patients in beds on the male medical and surgical wards. I have time to give only a flavour of that ward round. First, we had Mr. Smith, who drinks 40 units a week and has acute pancreatitis, more common in heavy drinkers and difficult to treat. Then we had Mr. Taylor, who had had a dense, right-sided stroke, which is unusual in someone so young—but the night before Mr. Taylor had had a binge on alcohol, which is recognised as increasing the risk of stroke. On the surgical ward, Mr. Carr had had a gall bladder operation; while the original problem was not due to his drinking, his slow and difficult recovery is due to the fact that he is a heavy drinker. His wound had become infected and he had to stay in hospital for an extra five days. Next we had Mr. Ponsonby who had fallen from his roof while doing DIY and broken his femur. Forty-eight hours after his operation he suddenly became agitated and disturbed with a case of delirium tremens, which meant that the hospital had to get in a specialist nurse for 24 hours to look after him. The role of alcohol in his fall should have been spotted and his alcohol dependence managed better. And so the ward round went on.

Dr. Kemm also described a Friday night in the casualty department, the type of cases seen—the majority alcohol-related—and the stresses that staff are put under. I was struck by one relating to a patient who had cut his head open. His X-ray showed no obvious problems but unfortunately he was extremely drunk. As the symptoms of being extremely drunk are very like those of a head injury, none of the doctors dared

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discharge him. Instead, he was kept in all night and had his blood pressure checked and his pupils tested every 15 minutes, taking up a bed and valuable staff time.

The position outlined by Dr. Kemm reflects what is happening in Hertfordshire. While the local primary care trust has recognised the need to address alcohol misuse within the hospital setting, the lack of specific funding and national targets, as well as of robust ways of measuring the role of alcohol, means that alcohol is not dealt with—for example, by screening all patients and having a specialist alcohol worker to take referrals from across the hospital, as recommended by the Royal College of Physicians.

Many of the alcohol-related problems seen in hospitals are preventable—accident and emergency staff see many injuries caused by alcohol-related accidents and alcohol-related violence. Research by the former Health Education Authority showed that one in six people who attended A and E departments for treatment had alcohol-related injuries or problems. That rose to eight in 10 people at peak times on Friday and Saturday evenings—a staggering number, which, not surprisingly, has a significant impact on hospital resources.

Has the Secretary of State for Health considered alcohol misuse within the context of the good practice guidance for A and E departments, which he announced only last week and which is aimed at reducing waiting times for patients? Waiting times for A and E departments and the whole hospital system could be significantly reduced in the long term if the Government made the investment required to implement a comprehensive strategy on alcohol misuse. The Government have been promising such a strategy for a long time—indeed, since the public health Green Paper was published in early 1998. So far, however, there is no sign of a strategy, despite the latest promise in the NHS plan that one would be implemented in 2004. The Government are missing an enormous opportunity to reduce the cost to not only the NHS, but society as a whole.

I stress that the examples that I have given of hospital patients blocking beds are not out of the ordinary. Much of the population has problems with alcohol, ranging from dependency to alcoholism. That impacts on not only people's health, but their relationships, families, finances and ability to hold down a job.

The new figures for alcohol dependence show that 7.4 per cent. of people aged 16 and over are alcohol dependent to varying degrees—mild, moderate and severe. That amounts to about 3 million people. The latest figures on hazardous drinking, which is defined as patterns of drinking with a high risk of damage to future health, show that almost one third of women aged 16 to 24 and more than half of young men drink at hazardous levels.

Deaths directly from alcohol-related causes remained steady in the early 1990s, but have increased by 43 per cent. since 1994. Significantly, the rate of liver sclerosis has shown as huge increase, mostly among men in their thirties. That could be a warning to us all not to ignore the growing problems and, in particular, the effects of starting to drink at an early age and of regular binge drinking.

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I am not overstating the facts when I say that the problems that I have outlined lead to family break-up, divorce, unemployment and, in some cases, even homelessness. They also increase the burden on the NHS and social services. I am concerned, in particular, for the children of problem drinkers. Almost 1 million children live in homes where the drinking of one or both parents has reached risky levels. That impacts on children's lives, often in distressing ways. Some live in fear of what they will find each day when they return from school or are forgotten at the school gates. Many grow up quickly and must care for their brothers and sisters in the face of parental neglect due to drinking. They must do all that while trying to maintain a veneer of normality for the outside world.

Much good work is being undertaken in Hertfordshire with young carers of alcoholic parents, but it is rare and is not undertaken across the country. A national alcohol strategy could include such work as a target and ensure that good practice is shared.

Like many of my colleagues, I am concerned about the increased drinking that is evident among young people. I mentioned the high levels of hazardous drinking among 16 to 24-year-olds, but there has also been an increase in the frequency of drinking among schoolchildren and in the amount that they drink. The average weekly consumption by pupils who drink has risen from 5.3 units in 1990 to 10.4 units in 2000, which is equivalent to more than five pints of beer a week.

The United Kingdom also seems to hold the dubious honour of having one of the highest rates in Europe of binge drinking by 15 and 16-year-olds, as well as the highest number of members of that age group who have ever been drunk, according to a survey launched earlier this year under the sponsorship of the World Health Organisation. That is an inevitable part of the overall trend in this country, which, unless properly tackled by a Government strategy, will go unchecked.

Alcohol is at last being dealt with as a distinct and important issue in drug education, and I welcome the establishment of a specialist team in the national charity Alcohol Concern, supported by Government funding, to provide schools with guidance on alcohol. That has not yet, however, been translated into resources locally for specialist staff to work with young people.

The established role of drinking in society means that a more holistic approach is needed to change attitudes to drinking generally, rather than simply improving alcohol education for young people, although, of course, that is important. Alcohol is part of our culture, so it is important that adults and children should learn to drink without risk. To achieve that aim a strategy is required that would combine a raft of measures into one linked action plan, including community safety, safe drinking messages, education and support, and treatment for problem drinkers. I am aware that alcohol misuse is not an issue for just one Department, although one would expect the Department of Health to take the lead role.

The Home Office has highlighted the role of alcohol in violence, such as the 13,000 violent incidents reported to the police that take place in and around pubs and clubs every week. The Department of Trade and

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Industry should be concerned about the impact that employees' alcohol problems have on productivity, and about absenteeism. It should encourage employers to implement alcohol policies. That approach is low in bureaucracy and has a low cost; it is aimed at preventing acute problems from developing and at avoiding the cost of losing valuable staff.

The latest figures on drink driving from the Department for Transport, Local Government and the Regions show an increase in the number of drink-drive deaths and injuries, despite the successes of the drink-drive publicity campaigns in past years. Why is there such an increase?

The Department for Culture, Media and Sport has now taken responsibility for licensing and, worryingly, may end up taking decisions about more flexible licensing hours in isolation from Home Office concerns about alcohol-related violence. Any increase in licensing hours must be accompanied by an assessment of the additional measures that will be needed to prevent disorder and to ensure that people with an alcohol problem will be referred for help if they are arrested. I am informed by Hertfordshire Alcohol Problems Advisory Service that the local arrest referral scheme is for drugs only, yet more than half of those referred for help have serious alcohol problems. However, without a Government decision to make alcohol a priority, no funding is available to set up an equivalent alcohol scheme or to deal with those with alcohol problems who are inevitably identified by the drugs scheme.

Those examples highlight the need for a national strategy on alcohol misuse. None of the issues can be considered in isolation from the larger policy picture. The complexity of alcohol misuse and the fact that it occurs in so many different settings demonstrate the need for a rounded strategy with the input and support of all key Departments that have a role in relation to alcohol policies. Despite powerful evidence of the human and financial cost of alcohol problems, I am surprised and concerned that the Treasury has not yet been persuaded of the potential to reduce alcohol-related harm and its related costs through proper funding of a national alcohol strategy made up of preventive and remedial measures.

Lack of a national strategy means that, more often than not, alcohol misuse is not dealt with locally, as other issues are identified as national set priorities, with funding, and those issues are dealt with first. Without a national framework for action, no one has the task of taking the lead. Where localities take the initiative on alcohol issues, the quality of action varies. Experience and good practice is not shared. In addition, there is an unwelcome impact on specialist alcohol services across the country.

The promise of a Government strategy has led to a limbo period. Local commissioners for health and local authorities are waiting for national priorities to be set before deciding which services to fund, and to what level. That inevitably leads to the loss of skilled staff from alcohol services, exacerbating an already worrying situation in which insufficient funding is available to provide an adequate service to meet local needs. Although HAPAS provides a high-quality service, it struggles to meet the demand for counselling and treatment. Because funders are uncertain about what

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they ought to be funding, I ask the Minister to give me an assurance that alcohol counselling services, including early intervention, will be at the heart of the strategy.

I urge the Government to ensure that a properly funded alcohol strategy is produced as soon as possible. It must not merely focus on a limited number of non-contentious areas, but must seize the opportunity to bring about real change in our drinking culture by taking a fully rounded approach that tackles all aspects of alcohol misuse in one comprehensive strategy. Substantial action is required to make a real difference, which in the longer term will result in a healthier country and less strain on publicly funded services. It will also make our towns and communities more pleasant places to be.

1.46 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : I congratulate the hon. Member for Broxbourne (Mrs. Roe) on securing this debate. It gives us an excellent opportunity to bring the issues up to date. I would like to acknowledge her extensive personal experience on the all-party parliamentary group, which is underpinned by a great deal of local action in her constituency and area. It is particularly valuable for Members to bring to these debates not just a sense of overarching strategy but personal experience of services on the ground. We are all informed as a result.

We must acknowledge that alcohol is an enjoyable part of life for many people in this country. Some 92 per cent. of men and 86 per cent. of women in Great Britain drink alcohol, and the vast majority do so moderately and sensibly without harming themselves or others. However, some misuse alcohol, with potentially devastating consequences for them, their families and communities. The hon. Lady illustrated, in her wide-ranging speech, the breadth of the problems. They are not confined to matters of health, education, crime and disorder or employment. Once a situation of alcohol misuse has arisen in a society, all of those areas give cause for concern. We must bear that in mind when we develop ideas and strategies for tackling the problems.

There are a number of specific health risks in the misuse of alcohol. For example, roughly 30 per cent. of accidents are alcohol-related. I am told that between 25 and 50 per cent. of drownings are connected with alcohol. In 1999, there were 420 deaths from drink-driving and alcohol is a factor in about half of pedestrian deaths on the roads. The number of short-term health risks is huge, and there are long-term health risks as well. Some 3 per cent. of cancers can be attributed to alcohol. Alcohol misuse is the most common cause of liver disease. In 1999, there were 4,700 deaths from liver disease, and 39 per cent. of men and 8 per cent. of women who attempt suicide are chronic problem drinkers. A huge amount of despair is caused not just to the people involved but to their families.

As the hon. Lady outlined, all those problems place immense pressure on the national health service in terms of both hospital treatment and primary care. The hon. Lady also highlighted the pressure that alcohol misuse places on accident and emergency departments. I am conscious of those pressures. I have visited casualty departments on a Saturday evening, when I was

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involved in "casualty watch" in a previous incarnation, and I have seen for myself, at first hand, the terrible problems that staff face from people who have misused alcohol become violent and, been injured, and who are not susceptible to the most caring and compassionate treatment that is available.

I assure the hon. Lady that, as happens for people with mental health problems, there is no bar to putting workers in accident and emergency departments to try to ensure that people are treated appropriately and directed to other services, especially if the immediate presentation of alcohol may wear off but there is an underlying problem. Many A and E departments are putting such measures in place because they recognise that that reduces stress on staff and, in the long term, helps to stop the recurrence of problems, because the same people with the same problems present almost every weekend. Diverting such people into other services is part of reforming emergency care. That was mentioned in the strategy that we issued last week about streaming patients in A and E departments to give them the right care at the right time and in the right place. Extra funding is attached to that strategy: £118 million is being invested now to ensure that we relieve the pressure on A and E departments. Clearly, that is not all related to alcohol misuse, but a portion addresses the tremendous problems faced by staff in A and E departments, especially at weekends.

The hon. Lady rightly highlighted the Government's commitment to formulate and produce a national alcohol strategy. The original timescale was ambitious, and I acknowledge that the strategy has been slow to emerge. However, we must examine that in the context of the Government's specific clinical priorities for early action relating to coronary heart disease, mental health and cancer. Obviously, those matters compete for Government time and development by the Department of Health, and resources must be available in order to make a real impact. I reassure the hon. Lady that we said in the NHS plan that the alcohol strategy would be implemented by 2004. We are on track to meet that target and we shall develop a national strategy.

The hon. Lady highlighted the key issue of how we can draw in not only the Department of Health, but the Department for Education and Skills, the Home Office and the Department for Work and Pensions to ensure that we have a joined-up strategy. It should be focused on health without ignoring the other crucial ways in which we can address the problems. It is all very well to have an excellent treatment centre, but if a person does not receive adequate housing, education or access to employment after being released from the centre, the problems that caused the person to misuse alcohol, because of a lack of social support, could kick back in and we could find ourselves in a similar position in subsequent months. Therefore, there must be a genuinely joined-up strategy—I do not say that in the manner in which those words are currently abused.

I reassure the hon. Lady that the absence of a strategy does not mean that nothing happens. The strategy will focus, target and prioritise, and help to draw together ideas. However, many developments have taken place concerning alcohol and crime. The Government recently produced an action plan to tackle alcohol-related crime. The police have new powers to close

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premises that are the focus of disorderly behaviour. Hotspots are targeted and we have more "pubwatch" schemes. In my area of Greater Manchester, the practical step of persuading public houses to use plastic glasses has dramatically reduced the number of horrific and savage facial injuries caused by people misusing alcohol. We have simplified and strengthened local authorities' powers to control drinking in public places. All hon. Members, as constituency Members of Parliament, know the problems of inappropriate drinking in public places and the intimidation that that causes for ordinary people going about their business. Giving local authorities the powers of arrest and to confiscate alcohol addresses the problem.

Over the past three years, the Department for Education and Skills made £21 million available to support the training of teachers to deliver effective drug, alcohol and tobacco education policies. It is key for us to join up those issues. That funding is set to rise to £47.5 million over the next three years, which shows how seriously the Government take public education on the matter.

We have also issued new guidance and assistance to target young men and women in our action to reduce teenage pregnancy. There is clearly a connection between the misuse of alcohol and teenage pregnancy, and trying to ensure that we provide information and education to support young people in making informed choices about not only alcohol but the rest of their lives is important to us.

We have closed a loophole, through the Licensing (Young Persons) Act 2000, which created a new offence of proxy purchasing alcohol—buying alcohol on behalf of others aged under 18. That is a real step forward.

We have also taken action on housing. Rough sleeping has been reduced by about 62 per cent. over the past three years. Many people with alcohol problems fall into housing difficulties, perhaps not paying their rent, being evicted and finding themselves out on the streets. The rough sleepers programme to try to put people in hostels—off the streets and into supportive, caring environments—has been key to tackling some of the problems involved.

The hon. Lady is right to keep up the pressure on the Government to ensure that we produce a strategy and that, in doing so, we take into account the views of voluntary sector groups, user groups and people with hands-on experience of such services. We already have about 600 treatment services throughout the country. About 180 relate purely to alcohol, but many are

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combined drug and alcohol services, as the same issues apply in terms of detoxification, support and counselling, which, as she said, should be at the heart of the strategy.

We want to reduce the problems of alcohol misuse rather than simply treating them. We are talking as much about putting money into prevention and ensuring that people do not go down that road in the first place, as about providing high-quality treatment services for people already in difficulty. We need to be creative in examining prevention work and finding out what works. I have found that in health promotion we lack an evidence base on campaigns, whether for safe drinking, drugs education or sexual health education. No robust evidence exists to show us how a campaign affects people's behaviour and whether they stop drinking, drink less or stop taking drugs. We have a long way to go before we get to the heart of the matter, and we are doing an awful lot of work in all those services to ensure that when we spend money, we get value from it. We want to ensure that we do not embark on campaigns that are not robust and effective.

Funding is available in the health service for alcohol services. At the moment it is mainstream funding, and it is for local commissioners to decide what their local communities need in terms of alcohol support services.

The hon. Lady is right: developing a strategy will help give focus and priority to this important field. Ensuring that we in the Department of Health join it up with our work on drugs is important. Perhaps even more important are the issues that the hon. Lady highlighted. We must have a strategy that draws in all our partners in Government Departments, education, housing and employment, and involves local government, which delivers many of the services, the voluntary sector, which has been extremely active in devising innovative and imaginative schemes that work, and users of services, because that is how we shall achieve sustainable change and help reduce alcohol misuse.

As I said earlier, the vast majority of people enjoy alcohol in a safe and moderate way, but ensuring that people who are in difficulty, unable to cope and need support, help, treatment and counselling in order to ensure that they and their families can live with dignity and support is a top priority for us. I thank the hon. Lady for bringing the matter to the attention of the Chambers. It is important to continue to progress as quickly as possible and to ensure that we deliver a strategy that lives up to her expectations and the expectations of those involved in the field.

Question put and agreed to.

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