Alcohol Harm

Kelvin Hopkins Excerpts

Thursday 2nd February 2017 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Flello, and to speak on the importance of tackling alcohol harm. It is a measure of the concern across the House that there are not one but three all-party parliamentary groups concerned with alcohol harm. It was the three chairs of those APPGs who applied for the debate: myself, as chair of the APPG on alcohol harm; the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), who chairs the APPG on children of alcoholics; and the hon. Member for Sefton Central (Bill Esterson), who chairs the APPG on foetal alcohol spectrum disorder. I will leave it to those Members to speak of the harm caused to children and unborn children through alcohol consumption, but as vice-chair of those two APPGs, may I commend and say how much I fully support their work?

We are all here to express, with one voice, our gravest concerns about the harm caused by alcohol consumption to individuals, their families and wider society. As we will hear, one thing is clear: the Government’s alcohol strategy, which is now five years old, must be reviewed. Urgent and much more robust Government action is needed to address the devastating damage caused by alcohol harm. It all too often harms innocent bystanders, whether those injured in road traffic accidents, children and partners caught up in domestic violence, patients needing treatments for serious illnesses—they have to wait because precious NHS resources are being used to tackle the issue—and taxpayers, through the tax bill we all pay.

This is not about saying that people should not drink—like many other hon. Members here, I enjoy alcohol—but about promoting responsible drinking and the need to change our country’s drinking culture and our relationship with alcohol. It is also very much about social justice, because the poorest and most vulnerable disproportionately suffer the most amount of alcohol harm. The Government need to wake up to the urgency of their need to take a lead on this. Urgent words were expressed in the 2012 alcohol strategy, but appropriately urgent action has sadly not followed.

The Minister will doubtless point to a few improvements in recent years, and they are welcome, although with major reservations. For example, although the number of adolescents who drink has gone down, the volume of alcohol that they are drinking has not. That sadly indicates that although fewer adolescents might be drinking, those who do are drinking to excess. A 2012 YouGov report revealed that 41% of 18 to 24-year-olds are drinking at harmful levels. We also hear reports of women of a certain age—around my age—drinking too much, and even of much older people struggling with alcoholism as they try to cope with loneliness and isolation.

The fact is that there is a massive problem in this country resulting from alcohol consumption, both excessive and just above Government guidelines. To evidence that, I refer to the Public Health England report, published in December 2016 at the specific request of the former Prime Minister, David Cameron, entitled, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An evidence review”. It cannot be dismissed as just a thought piece; it has more than 200 pages of evidence-based information and conclusions, has been robustly peer reviewed no less than three times and was produced by Public Health England—an executive agency of the Department of Health that

“exists to protect and improve the nation’s health and wellbeing”.

The report paints a bleak picture. Paragraph 1 states that

“there are currently over 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.”

It continues:

“In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years… More working years of life are lost in England as a result of alcohol-related deaths than from cancer of”—

there are many of these—

“the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

I deliberately read that out as I wanted it recorded in Hansard.

The Institute of Alcohol Studies quotes Public Health England, stating that

“167,000 years of working life were lost to alcohol in 2015”.

That is because alcohol is more likely to kill people during their working lives than many other causes of death—that is, it causes premature deaths. In fact, there were 23,000 alcohol-related deaths in England each year. Alcohol accounts for 10% of the UK’s burden of disease and death, and in the past three decades there has been a threefold rise in alcohol-related deaths.

[Kelvin Hopkins (Luton North) (Lab)]

I congratulate the hon. Lady on everything that she has said. In the mid-1970s, a Home Office report showed that Britain had the second lowest level of alcohol consumption in the whole of Europe; we have risen rapidly while the rest of Europe has been coming down. They have learned from their previous mistakes, and we ought to as well.

[Fiona Bruce]

I thank the hon. Gentleman for his intervention, which reflects his long commitment to tackling the issue. I also thank him for his involvement with our all-party parliamentary group.

The NHS incurs an estimated £3.5 billion a year in alcohol harm costs. Treating liver disease alone now costs £2.1bn a year, for example. However, that is just the financial cost, which I rather suspect is an underestimate. Many other costs are incurred as a result. The all-party parliamentary group on alcohol harm recently produced a report called “The Frontline Battle”, which described the impact on the emergency services—the police, fire services, A&E departments, doctors and so on—of treating or helping people who are inebriated or suffering as a result of excessive alcohol consumption. It found that, on a Saturday night, 70% to 80% of all A&E attendances are alcohol-related.

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[Kelvin Hopkins (Luton North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Flello, and it is an extreme pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made a superb speech. She takes a very strong lead on all the serious matters relating to alcohol, and we are grateful to her. She has also taken the lead by securing this debate, together with my hon. Friend the Member for Sefton Central (Bill Esterson) and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne). I have supported as best I can of all their efforts, and I am pleased to take part in this important debate. I admired the eloquence of the hon. Lady’s speech. Some of what I say may overlap with what she said, but I hope that that will just reinforce what she said rather than causing difficulty.

Many serious problems arise from inappropriate alcohol consumption. Alcohol is a subject about which I have been concerned since I first entered the House in 1997, shortly after which I was elected chair of the all-party parliamentary group on alcohol misuse, now the APPG on alcohol harm. Over many years I have spoken and asked questions in on the subject in the House, and I have tabled a number of early-day motions during the past 17 years, expressing concern and asking for action on the damage to people’s lives and to society as a whole that is caused by alcohol. Several of my early-day motions have referred to foetal alcohol spectrum disorders —the lifetime damage to babies caused by alcohol consumption in pregnancy. I shall speak more about that later.

Just two weeks ago, I raised concerns about alcohol in my oral question to the Prime Minister, and a little earlier I put another oral question to Ministers about Britain’s high drink-drive alcohol limits. It was disappointing that I received a most unsatisfactory, perfunctory answer to the latter question, which was little more than a brush-off. The Institute of Alcohol Studies had briefed me before that question and has again provided compelling statistics about the costs, in lives, injuries and money, of drink-driving. Indeed, it has provided today the statistics that my right hon. Friend the Member for Birmingham, Hodge Hill referred to. The total number of drink-drive accidents rose by 2% to 5,740 in 2015, there was a 3% rise in overall drink-drive casualties to 8,480 in 2014, and about 220 people are killed in drink-drive accidents each year. Going back, there were 240 deaths and 8,000 casualties just in 2013.

Our drink-driving limit is sadly higher than that in every other country in Europe except Malta. A lower limit would prevent a minimum of 25 deaths and 95 serious casualties a year—I suspect it would actually prevent a lot more. When the lower limit is imposed, as I am sure it will be at some point, rather than people perhaps having a couple of pints and thinking they are probably under the limit, the limit will be low enough to deter people from drinking at all before they drive in case they get too close to the limit. Reducing the limit to European levels would have a disproportionately beneficial effect. There is also wide popular support for a lower limit: 77% of the population, rising to 79% in towns. The limit must be reduced. In 2013, the death toll from drink-drive accidents rose by 25% in just one year.

Another serious component of Britain’s alcohol problem—especially England’s alcohol problem—is the burden on the health service, as the hon. Member for Congleton mentioned. That is another matter I have raised with the Prime Minister. According to statistics provided by the Alcohol Health Alliance UK, the NHS’s costs related to alcohol are £3.5 billion a year—the hon. Lady was absolutely right in suggesting that is probably a significant underestimate—and one in five hospital admissions are alcohol-related. In the nine years to 2013, hospital admissions related to alcohol rose by a staggering 51%.

To bring us up to date, 70% to 80% of all A&E attendances on Friday and Saturday nights are alcohol-related, resulting in a massive burden on hospital staff and resources as well as assaults on staff. I also understand from the report the hon. Lady mentioned that other patients, particularly children and elderly people, are often frightened by violent drunks on Friday and Saturday nights in A&E. Some 80% of police officers have been assaulted by people who have been drinking. As I said in my question to the Prime Minister, alcohol is heavily implicated in domestic violence and attacks on women. After that question, I was contacted by people concerned about child abuse, who again said that many cases of such abuse involved alcohol.

By far the most tragic of all the problems caused by alcohol, in my view—this view is probably shared more widely—are foetal alcohol spectrum disorders. Estimates suggest that each year some 6,000 babies are born damaged for life by alcohol consumed in pregnancy. It causes misery for those children and their families and costs the state vast sums of public money every year. In Canada, the lifetime cost to the state has been calculated as up to $3 million dollars for every child suffering from FASD. The children concerned are referred to, somewhat unkindly, as “$1 million-dollar babies”. I have a good friend who lives in Canada—a former school friend—and he tells me about the situation there.

FASD also causes learning difficulties and behavioural problems. A high proportion of people convicted of crimes and in our prisons are victims of FASD. Research by the Medical Research Council has concluded that even moderate drinking in pregnancy has an impact on IQ and learning abilities. There is no safe level, and that must be communicated to all women planning and experiencing pregnancy and, above all, to all professional medical staff. The recent report by the all-party parliamentary group on foetal alcohol spectrum disorder, which I was happy to contribute to, made strong recommendations on such information; I was pleased to emphasise the information that is required. FASD is the leading known cause of learning disabilities, and much of what is thought to be autism is actually the effects of alcohol consumed in pregnancy. The Government must wake up to the tragedy of FASD and take urgent action to ensure that all women know about it.

Again, in Canada the Government take the matter so seriously that girls are made aware of the problem in primary school. They are asked in class what they must not drink when they have a baby in their tummy, and they all say, “Alcohol.” They know about the problem. In the US and elsewhere, alcoholic drinks containers are required to have warning labels—not just a small symbol of a pregnant woman, and not on a voluntary basis. The Government warning in the US states:

“According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”

If every woman was aware of that, I am sure that the levels of drinking in pregnancy would drop like a stone. However, women are not aware of that—even women I know have not been aware of it. I should say that my daughter-in-law did not drink at all during her pregnancies, and we have two delightful and very healthy granddaughters as a result.

Such a warning should be compulsory on all UK alcoholic drinks containers and should also be displayed in all NHS medical facilities—GP surgeries, clinics and hospitals—as well as all establishments selling alcohol. Women cannot be blamed for not knowing about the dangers, but the Government must be responsible for ensuring that in the future all women are alcohol-aware and know the dangers of drinking during pregnancy. Tackling FASD must be the priority for the Government’s alcohol policy.

Finally, we must do something to help prevent the consumption by young people in particular of strong, cheap alcohol, which the hon. Member for Congleton mentioned. It can, and does, quickly lead to addiction. In recent decades we have seen people as young as 30 dying of cirrhosis of the liver, which is quite appalling. That used to be a disease of older people, but now it is a disease of young people who are drinking vast quantities of cheap, strong alcohol.

As the hon. Lady said, minimum pricing is absolutely essential for reducing alcohol abuse and addiction. I emphasise addiction again because so many people talk about this as though it were a matter of choice. If any of us drank to excess over a prolonged period, we could become addicted. It is a serious danger. A 50p unit price would have no effect on pub prices—I am a lover of the great institution of the British pub and drink wine—but would stop the selling of vast quantities of cheap alcohol by supermarkets. In some cases, as has been reported many times, alcohol is actually cheaper than bottled water.

In recent decades Britain has had a dangerous love affair with excessive and damaging alcohol consumption. That must be stopped. Moderate and sensible consumption —as I have said, I drink myself—would not be affected. What I am suggesting would actually put a brake on the booze bandwagon, which has been out of control for some years now and has to be stopped.

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[Bill Esterson]

Yes, that is right. My right hon. Friend has described his experience before, and I am sure that he will say more later. Many people are affected by being children of alcoholics; I think that the issue is directly related and a similar concern and challenge. Poverty and inequality are clearly linked to the damage done by misuse of alcohol, and I am afraid that the group on which I am concentrating is one of the most affected in our society.

We heard in our inquiry about the lack of support. There is only one specialist clinic in this country to diagnose FASD—it is in Surrey, and is led brilliantly by Dr Raja Mukherjee, who gave evidence to our inquiry—but that simply is not good enough. If 35,000 children are affected every year, we need a lot more than one clinic to help diagnose them, because diagnosis is needed in order to ensure that support is available.

[Kelvin Hopkins]

I applaud everything that my hon. Friend is saying in his speech. It was reported at one stage during our deliberations on the report that some medical staff literally do not know about FASD, even now. That is appalling.

[Bill Esterson]

That is right. The symptoms are misunderstood and significantly misdiagnosed, and too many professionals dismiss them. I have seen entirely contradictory diagnoses—doctors have described FASD symptoms perfectly well and then said that the child does not have it, due to the kind of misunderstanding that my hon. Friend just mentioned. We must improve understanding among health professionals. We must improve awareness, information and education among professionals, not just in health but in education.

In our inquiry, we also heard that children often cope at nursery, reception and key stage 1, and well into key stage 2, and it is only much later—from about year 6 onwards, as the expectation of independence grows in the school system—that the real problems start to emerge. Children who are damaged in this way find it difficult to cope in the school system, but because they have not been diagnosed early—because there has been no awareness or understanding, and they have got that far in the school system—it is assumed that FASD is not the problem, and that it might be due to what is going on at home or other external reasons, when the true cause is a disability. Again, we need greater support, awareness, understanding and training for education professionals as well as those in health and elsewhere.

What is needed? The Government should consider the following objectives. One objective should be to reduce the number of children exposed to alcohol during pregnancy. The Lancet’s report goes into great depth: international research suggests that just under 10% of the world’s population of women drink during pregnancy, but in this country, the figure is 41%, more than four times the international average. A similar figure was presented last year in the evidence of the FASD Trust, which serves as the secretariat for the all-party group and for which I am very grateful. That level of drinking during pregnancy suggests that the incidence of FASD may be four times higher in the UK than in the rest of the world. If we follow that logic, the World Health Organisation’s international figure is 1%, so in this country it may be 4% or 5%—that is where the figure of 35,000 babies comes from.

As well as an objective to reduce exposure to alcohol during pregnancy, the Government should introduce an objective to increase support and understanding in schools, in the health and care sector, in criminal justice and in wider society. How should they go about that? During our inquiry, we heard that the phrase should be used is

“no alcohol in pregnancy is best for baby and you”.

That fits the description of the strategy that we should adopt in this country. I welcome the fact that the chief medical officer revised the guidelines after we published our report—perhaps not entirely because of it, but I am sure we contributed. That was a big step forward. The guidelines now say that women who are pregnant or are trying to conceive should not drink alcohol at all. That is right, but by no means does it go far enough, because people do not know the guidelines—I am afraid that the increase in alcohol consumption suggests that, sadly, that is all too true.

As part of our strategy, we have to increase awareness, not only among professionals but among the wider population, of the support needed for women before pregnancy. In north America, which my hon. Friend the Member for Luton North mentioned, information is displayed in all the health facilities, education facilities and even airports—I have seen big signs in Canadian airports that say “Don’t drink if you’re pregnant or trying to conceive”.

[Kelvin Hopkins]

Another factor in America that I did not mention, because people draw back from it, is that people who are under the age of 21 cannot drink alcohol, and anyone who supplies alcohol to somebody under 21 can be sent to prison. That actually happened to a young Englishwoman who was on holiday in Florida: she provided alcohol to her younger sister and was sent to prison for corrupting a minor. It is taken very seriously indeed.

[Bill Esterson]

I am sure that the Minister has heard my hon. Friend’s comments. I agree that we must raise awareness among girls—and among boys too, because it is really important that boys and men play their part in influencing their partners in abstaining from drinking.

Awareness among professionals of how to prevent drinking during pregnancy has to be part of our strategy, but so does the support that is needed afterwards. Drinking during pregnancy will still happen, however much we are able to reduce it. Very sadly, some of the worst damage happens straight after conception; if someone has a drink before they know they are pregnant, it is too late to do anything about that drink. Support is essential throughout society, and it begins with awareness.

I was really disappointed that the briefing note for this debate did not make reference to foetal alcohol spectrum disorder. It made some really good points about other issues that we have discussed today, but it did not mention FASD. Given that FASD was one of the topics clearly indicated in the bid for the debate, that was really unfortunate—I shall not say anything stronger.

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[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to speak in this important debate and I warmly thank the hon. Member for Congleton (Fiona Bruce) for securing it.

The costs that alcohol imposes on our society—the social cost, the health cost and the cost to families and communities—simply cannot be counted, because of course that cannot always be measured in pounds and pence. Across the UK, alcohol accounts for 10% of our burden of disease and death, and it is one of the three biggest lifestyle risk factors for disease and death. Alcohol is 60% less expensive now than it was in 1980, and everyone knows that when the price of a commodity goes down, consumption goes up.

I will share with the Chamber today the alcohol-related challenges that we face in Scotland. NHS Health Scotland has reported that in 2014 retail sales data demonstrated that alcohol sales in Scotland were 20% higher than in England and Wales. Scottish sales of low-cost vodka are more than twice as high as those in England and Wales. It is estimated that one in three Scots are affected by a mental health problem each year, with depression and anxiety the most common illnesses. Alcohol and problems with mental wellbeing are closely related.

We in Scotland therefore have much greater and more pronounced challenges than the rest of the United Kingdom. The damage that alcohol is doing to our population is extreme, so bold solutions are required. In Scotland, such bold solutions have not been shied away from. The overall strategic approach in Scotland is different—I would argue that it has to be different—from that of the rest of the UK. A whole-population approach is required to reduce the harm caused by alcohol.

The important point is that, in addition to analysing existing data such as alcohol-related deaths and hospital admissions, our approach uses sales and price data from market research organisations to examine the relationship between price, consumption and harm. The effects of specific policies have also been examined, such as the policy on multi-buy discounts—it is worth noting that such discounts are now banned in Scotland. Scotland is the only part of the UK to produce such detailed information on alcohol, including sales data.

Whether we are talking about alcohol, gambling, obesity or lack of physical activity, we need to consider how all of our high streets and neighbourhoods can support good health, rather than contributing to our ill health. For example, we know that deprived areas have 40% more places to buy alcohol than more affluent areas. The more widely available and easily accessible alcohol is, the more we drink, and therefore the more harm that is caused.

As well as knowing that 20% more alcohol is sold in Scotland than in England and Wales, we know that Scottish male death rates are approximately 50% higher than those of other UK countries, while women’s mortality is 30% higher in Scotland than in other UK countries.

[Kelvin Hopkins]

I think this statistic is true: life expectancy in central Glasgow is the lowest in the United Kingdom.

[Patricia Gibson]

Indeed. That appalling and very sad statistic is one that has touched my own family, as I will come on to explain. Alcohol continues to cause premature deaths in some of our most socioeconomically deprived areas and we must take action—I will go on to say how the Scottish Government have taken action.

The hon. Gentleman’s intervention came at a very personal moment in my speech. Indeed, I have a very personal stake in this debate. By all accounts my own father, of whom I have no memory, was an extremely heavy drinker. Was he an alcoholic? He probably was, but alcoholism was not readily talked about in working-class communities in Glasgow in the 1960s. I did not witness my father’s heavy drinking, because he died when I was nine months old, not least because of his heavy drinking. My husband’s father was an alcoholic, which led to his early death. In Glasgow, where both my husband and I grew up, such deaths were not unusual in the past, and even today alcohol-related deaths are still more common in our communities across Scotland than many people would think.

Here is the main point: I am extremely proud of the fact that against much opposition—some of it, unfortunately, on tribal grounds—the Scottish National party Government in Scotland took a very bold decision. They decided that the damage that alcohol was doing to our population, our families and our communities could no longer simply be measured and talked about and that action was needed. What else could kill 22 people each week in Scotland, cause 670 hospital admissions each week in Scotland, cost Scotland £3.6 billion each year and not require bold action?

Such action came in the form of minimum unit pricing. In our supermarkets and similar outlets, alcohol can cost less than bottled water; in some cases, it sells for as little as 18p per unit, which is disgraceful. There is clear evidence from research that shows there is a direct link between changes in minimum pricing, and changes in alcohol harm and consumption. Estimates show that a 10% increase in the minimum price of alcohol is associated with a 32% reduction in the number of deaths that are wholly attributable to alcohol. Work undertaken by the University of Sheffield shows that a minimum unit price of 50p is estimated to result in 121 fewer deaths a year, a fall in hospital admissions of just over 2,000 a year, and a fall in hospital admissions of just over 2,000 a year by year 20 of the policy.

Minimum unit pricing is more effective than taxation, because it is better able to target the cheap, high-strength alcohol favoured by the heaviest drinkers. Such a public health measure is supported by Ireland, Norway, Finland, Sweden and the Netherlands. I know that England is looking at this measure and I urge everybody in this Chamber to support its introduction. It is bold, but it needs to be bold to help deal with the blight that alcohol has cast over too many of our communities.

Global corporations in the alcohol industry fought a hard legal battle against Scotland’s introduction of minimum unit pricing, but the measure was passed with overwhelming support in the Scottish Parliament. It has been tested in the European courts. The appeal against it in the Supreme Court, following victory for the Scottish Government when the measure was tested at the Court of Session, is the final stumbling block to the introduction of the policy. I hope and believe that it will be resolved by the summer at the latest and introduced in short order thereafter.

Responding to the points made by the hon. Members for Congleton and for Luton North (Kelvin Hopkins), in Scotland we have already reduced the drink-driving limit to 50 mg per 100 ml of blood. That means that the rest of the UK—this is a cause for great alarm—has the highest limit in the EU, alongside Malta. I urge the Minister to follow the lead of Scotland and the rest of our EU partners. Reducing the blood alcohol level for drivers saves lives.

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[Liam Byrne]

The hon. Lady is absolutely right. There are a million and one ways in which we can do this. Someone called Gemma contributed to the report and said:

“Going down any street with a pub on it in the UK and there will be a sign outside with a quote such as ‘Drinking at 9 am doesn’t make you an alcoholic’. Well, to be honest, it probably does.”

There are common-sense restrictions that I think we should be debating.

[Kelvin Hopkins]

My right hon. Friend is making a very good point about the opening of pubs at all times of the day. I am one of those who opposed the relaxing of licensing hours. Sadly, it was our party’s Government who did that, and I think that was a mistake. I hope that one day we shall get into power and reverse that, if it is not done before then by the present Government.

[Liam Byrne]

Let us hope it changes even before then.

The Prime Minister has put great store on two things: first, restoring social mobility in this country, and, secondly, children’s mental health. I understand that it will not be too long before the social mobility strategy, or the social justice strategy, is produced. I do not mind or particularly care what it is called, but I look to the Minister for a cast-iron commitment that children of alcoholics will be discussed at the Cabinet Committee next week, and that we will insert into the strategy that is published in the weeks to come a commitment to develop some of the ideas I have talked about this afternoon.

The Government are well aware of our ambitions. We have written to all and sundry about them, including the Prime Minister. If the Prime Minister is in any doubt about the importance and urgency of this debate, I will close with a word from His Grace the Archbishop of Canterbury, who said:

“We all know that having a parent who abuses alcohol is one of the most disruptive experiences for any child and leads frequently to long-term effects in one’s self confidence, one’s capacity to relate, and even for some people in their own relation to alcohol itself. My experience, whether easier or more difficult than that of others, was fairly difficult...One of the things I most missed was the company of others who understood the issue.”

He concluded in the most powerful of ways:

“We are never ourselves when we are solitary, but in all of human history and community it has invariably been the case that it is in relationship that we become most fully what we are called to be, provided that relationship is healthy.”

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[Kelvin Hopkins]

Another horrifying statistic is that Russia’s population has been in fairly serious decline in recent years, and the major factor in that is alcohol consumption, which is epidemic.

[Martyn Day]

I thank the hon. Gentleman for making that point.

There is sufficient evidence to show a clear link between levels of consumption and of harm. My hon. Friend the Member for North Ayrshire and Arran has already given several examples. It is particularly worrying that retail sales data show that sales in Scotland are higher than in England and Wales—they were 20% higher in 2014—particularly for low-cost spirits. It might surprise Members to hear that since 2008 vodka has outsold blended whisky by about 20% in Scotland. In 2015, 10.8 litres of pure alcohol was sold per adult in Scotland, which is equivalent to 41 bottles of vodka, 116 bottles of wine or 476 pints of beer. When I consider my consumption rates, or those of my friends and family, many of whom take less than I do, the average means that there are people out there consuming a phenomenal amount of drink. On average, alcohol misuse causes about 670 hospital admissions and 22 deaths a week, and it is costing Scotland £3.6 billion each year, or £900 for every adult in the country. How much better that would be spent on other aspects of the NHS.

I served for 13 years on the West Lothian licensing board and in that role learned a lot about the licensed trade and alcohol issues within many of the communities that I now represent in Parliament. One of the more encouraging developments that I saw during those years was the Best Bar None award scheme, which is a great example of partnership working. It has operated in West Lothian since 2008 and has 20 accredited venues, with the Glenmavis Tavern in Bathgate nationally winning overall best bar at the awards in 2015. Best Bar None is administered by the Scottish Business Resilience Centre, whose remit is to create a secure Scotland for business to flourish in. It promotes responsibly managed licensed premises in Scotland, with the aim of partner agencies working together with licensed premises to create safer and more welcoming city and town centre environments. The crux is that it is also about changing Scotland’s relationship with alcohol—something that I believe can be achieved only by working together as a society.

The Scottish alcohol strategy, published in 2009, recognises that a whole-population approach is needed to reduce alcohol harm. Harry Burns, who was the chief medical officer of the Scottish Government at the time, said:

“Every one of us must ask frankly, whether we are part of the problem and whether we are going to be part of the solution.”

I wholeheartedly agree with that comment. The approach is correct, and indeed we have encouraging signs that it is working. Scotland had the steepest fall in alcohol-related deaths between 2004 and 2014. The rate fell from a staggering 47.7 per 100,000 to the current 31.2. Significantly, the fall in death rates over the period was greatest among the lowest income groups, which helped with some of the country’s inequality issues.

A measure that has been particularly effective is the multi-buy discount ban, which has accounted for a 2.6% reduction in consumption, as my hon. Friend the Member for North Ayrshire and Arran has pointed out. In December 2014 the drink-drive limit was reduced from 80 mg to 50 mg, bringing Scotland into line with the majority of European and Commonwealth countries. There is international evidence that lower limits are effective in preventing alcohol-related road accidents.

Controlling availability through licensing has also been a feature of the Scottish strategy. There is a presumption against granting 24-hour licences to on-trade premises, and off-sales are allowed only between 10 am and 10 pm. There are also strict controls for displays and marketing materials, which are limited to single designated areas in supermarkets and shops. I agree with the point made by the right hon. Member for Birmingham, Hodge Hill about sports advertising, and the UK Government should take that on board. We have seen the effectiveness of limiting marketing in supermarkets; cutting it out of people’s bedrooms would have a massive effect. Scottish licensing legislation puts the objective of protecting and improving public health into the mix, and licensing boards may consider that when making decisions. My understanding is that there is no such public health objective in England and Wales. That is something that UK Ministers might want to consider.

Several hon. Members have mentioned the fact that pricing to reduce affordability is a key component of tackling alcohol harm. I believe that taxation is a means of doing that, but it does not deal with the reality that the availability and relative affordability of the cheapest and strongest drinks is at the heart of the problem. Minimum unit pricing is a more effective tool in targeting those cheap, high-strength products that are excessively consumed by heavy drinkers.

As my hon. Friend the Member for North Ayrshire and Arran informed us, evidence from Canada suggests that there is a direct link between changes in minimum price and changes in consumption. It is estimated that a 10% increase in minimum price might be associated with a 32% reduction in wholly alcohol-attributable deaths. That is significant, and it is an approach worth taking. As we heard, using updated modelling from the University of Sheffield, it was estimated that a minimum unit price of 50p would result in 121 fewer deaths and a fall in hospital admissions of about 2,000 per annum in Scotland. Significantly, 51% of off-sales are sold for less than 50p per unit—some for as little as 18p.

The Scottish Government will ensure that a minimum price policy is implemented as soon as possible. The policy had overwhelming support in the Scottish Parliament and it has twice been approved by the Scottish courts. The Court of Session’s Inner House granted the Scotch Whisky Association and its partners permission to appeal to the United Kingdom Supreme Court in December 2016. The appeal will be heard in 2017.

In conclusion, our nations have a long history with alcohol, and somewhere along the way things have got out of hand for many in our society—often those from the most disadvantaged areas. There is much that can be done, and we must all take responsibility. There are many reasons why we need to take action, including the impact on police workloads and the weekend A&E admissions, all fuelled by alcohol. Perhaps the most important reason is premature death—20 years earlier than the average for a heavy drinker—and its impact on families and communities. Tackling that issue alone would greatly help reduce inequality in society.

--- Later in debate ---

[Nicola Blackwood]

The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.

In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.

[Kelvin Hopkins]

To be specific, will the Minister look carefully at what I suggested in my speech? We should have notices in all medical establishments and all areas where alcohol is consumed or purchased with the wording used in America about birth defects, and we should ensure that all medical professionals know about that problem and tell all women about it.

[Nicola Blackwood]

I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.

By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.

That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.

Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.

Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.

The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.

We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.

The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.

Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.

One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.

We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.

Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.

I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.

This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.