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Alcohol Services (Plymouth)

Volume 448: debated on Tuesday 27 June 2006

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Alan Campbell.]

I applied for the debate as a direct result of concerns that have been raised in my constituency in recent months about the extent of alcohol dependency, and the related services that are available in Plymouth. Monday’s headline in the Plymouth Evening Herald encapsulated the issue. It asked “Is your Social Life Killing You?”, and a consultant hepatologist at Derriford hospital, which is one of the largest hospitals in the south-west, clearly believes that it is. Dr. Jonathan Mitchell set out the extent of the problem in a meeting with Plymouth Members last month. The picture that he drew for us was shocking. He is seeing an increasing number of people presenting with alcohol-related end-stage liver disease; they account for the majority of his in-patient work and a significant proportion of his out-patient work.

The truly worrying factor is that the average age of patients is dropping. Children in their teens are now being admitted. Nationally, about 1,000 under-15s are admitted to hospital with alcohol poisoning each year. Liver disease is no longer associated with elderly and hardened drinkers. The people who are now being seen are not just the street drinkers of old and binge drinkers, but people who think that they are casual drinkers. They have perhaps a glass or two at lunch, a gin and tonic in the early evening and half a bottle of wine each night at home. If such people then drink heavily while out at the weekend, they are very likely to be candidates for liver disease. Young people are not aware of the health implications of such a level of drinking. As one 30-year-old former binge drinker said:

“I thought liver disease was something that happened to old men”.

The social life that these people are apparently enjoying, until their liver gives out, is costing the taxpayer about £20 billion. That amount includes the cost of treatment, which is rising, as we know from the Plymouth consultant. Hospital accident and emergency departments throughout the country have to cope with people who are under the influence of alcohol. The Department of Health’s figures show that 35 per cent. of all A and E attendance and ambulance costs may be alcohol-related. In some A and E departments at peak times, the percentage of people who test positive for alcohol reaches almost 50 per cent., and the figure climbs to 70 per cent. between midnight and 5 am. Alcohol-related diseases account for one in eight NHS beds—about 2 million—and one in 80 NHS day cases. At least 150,000 hospital admissions each year are linked to excessive drinking.

Other costs associated with alcohol misuse are due to antisocial behaviour. Although we have an excellent antisocial behaviour team in Plymouth, it has finite resources and is stretched. Our police spend far too much time dealing with the after-effects of drink on the city’s streets on a daily basis, and I am sure that my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) and the hon. Member for South-West Devon (Mr. Streeter) will bear witness to that from their experience in their constituencies.

My hon. Friend mentions the police. We in Plymouth need not only more resources, but a preventive drive. Will she join me in asking the Minister what discussions she is having with her colleagues in the Department for Communities and Local Government and the Department for Culture, Media and Sport on pushing prevention, as well as addressing questions of cure?

I would wholly support that drive. I am sure that the Minister will answer my hon. Friend’s excellent question when she responds to the debate. Our local council in Plymouth is already working closely with the police and local publicans to try to cut down the number of alcohol-fuelled incidents.

If we also consider the cost incurred by business because of lost work days and poor productivity, and the often hidden costs that alcohol dependency can have on family life—a high prevalence of domestic violence is linked to the consumption of alcohol—we begin to understand why support services in this field are so vital. However, there is hope. Although the mortality rate from acute alcohol-related liver disease is very high—up to 60 per cent. in severe cases—patients do survive. If they remain abstinent, their clinical prognosis is surprisingly good. The liver will regenerate, and many patients do well in the long term. The key is for them to reduce their alcohol intake to zero, or near zero.

Numerous studies have shown that when patients are properly followed up and receive counselling, up to 50 per cent. of those who are admitted with alcoholic liver disease remain abstinent. Significantly, patients maintain those levels of success 12 months later and report improvements in their mental health and general well-being.

There is evidence from other parts of the UK of the benefits of proper follow-up care. A service that was set up in Southampton resulted in extremely high follow-up rates and rates of sustained abstinence. The Southampton group—

It being Ten o’clock, the motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Heppell.]

The Southampton group estimated a drop of 80 per cent. in in-patient bed days following intervention, which represents a saving of approximately £100,000 in the one-year period studied. However, that estimated saving takes into account only patients with established liver disease; in reality, if those with all alcohol-related conditions were included, the savings would be much higher.

The United Kingdom alcohol treatment trial study estimated that £5 could be saved from the public purse for every £1 spent on treatment, yet the finance being offered for alcohol services falls well below that for those who are drug dependent. That is despite the fact that there is generally a more positive self-referral level among people who are alcohol dependent and, therefore, a much greater likelihood of their moving towards abstinence and better health. Action on Addiction tells me that £1.5 billion is spent assisting 160,000 drug users in the UK—the target is to reach 250,000 of them—while the amount spent on helping the equivalent 160,000 people known to be alcohol dependent is a mere £217 million. There are probably more than 1 million alcohol-dependent people in the UK. It has been estimated that if alcohol treatment were provided for another 10 per cent. of that dependent drinking population, the public sector could save between £109 million and £145 million each year.

The balance appears to be skewed, and the net result is that centres such as the Harbour centre in Plymouth—it was set up in 1984 and put in place an alcohol services team approximately two years ago, heralding a new era in alcohol services in the city—are now struggling. The Harbour centre attracted no ring-fenced funding, cost pressures are threatening its closure, and all staff are on notice. Is that perhaps because alcohol rehabilitation does not attract the Government targets that drug rehabilitation does? I would like the Minister to answer that question.

Although I accept that there is a need to invest in support for those who are drug dependent—indeed, in Plymouth significant funding is available in this area, for which I am grateful—there is also a clear and ongoing need to fund the expertise that deals specifically with alcohol addiction. I am also reliably informed that where drug addiction is to be found there is also alcohol addiction, but the latter is clearly the poor relation in terms of Government funding.

A review is being carried out locally on how we can best take forward these services to tackle addictions across the piece, and I welcome the fact that the commissioning process is being looked at; we probably all accept that it could be improved locally. The review will examine whether the Harbour centre as it stands offers the best way to take matters forward, or whether we need an alternative vehicle. I hope that that review will identify needs better and allow us to deliver the service that we in Plymouth need to provide for people who are struggling to defeat their demons.

At present, we are still only scratching the surface. All the evidence suggests that rehabilitation, particularly for alcohol-dependent people, works. It reduces hospital admissions and morbidity, and saves huge amounts of money throughout health and social services in the long term. I genuinely hope that the review will conclude that we in Plymouth need an expansion of community and hospital-based services and a targeted Government drive to address this increasing problem.

Part of the process has to include an expansion of education programmes. Government programmes flagging up the dangers to young people are vital, and I know that my hon. Friend the Minister and her Department already support such campaigns. We also need to reach parents, because it is often in the home where children first gain access to alcohol. Given the more stringent action being taken against retailers who sell drink to under-age drinkers, young people are likely to start their addiction by raiding their parents’ drinks cabinet or fridge. Children in families where heavy drinking is the norm are likely to follow suit. Sending messages to parents via their children’s school is perhaps a possible route.

My hon. Friend the Minister will be aware that alcohol abusers are far more likely to self-refer than drug users, as is evidenced in Plymouth. Self-referrers, according to the Department of Health, do not use the primary health care system as their first point of entry to access care, unlike those with medical disorders or diseases. It is therefore critical that alternative routes to treatment continue to be made available and are well financed. That is why the loss or cutting back of alcohol services in Plymouth would be a serious setback in the fight against alcohol-related illness.

The Harbour centre provides an outreach team offering prevention and risk management services, and it is that team that has had to be scaled back. Last year staff at the centre dealt with 356 referrals, of whom 176 have been successfully treated, but now the centre can no longer operate a waiting list, so people are not able to self-refer in the same way. Staff have to limit their advice and support to only 140 clients, and they will have to turn away people who genuinely want to break their habit. After the public consultation on the Government White Paper “Choosing Health” the Minister said that people wanted to take responsibility for their own health, but required and expected support services to enable them to make the right choices, and it is the Government’s responsibility to provide the right environment for people who want to make those informed choices to live healthier lives.

Plymouth city council has been able to offer a short-term rescue package, but only until October, and it does not allow for self-referrals which, as I have said, are high among alcoholics. From an overall budget of £2 million for drug and alcohol services, the Harbour centre has been able to use £160,000 specifically for its alcohol services team. That funding is available only because of the link between drug and alcohol addiction. Only one of the posts on the team is a staff position funded by the local primary care trust to provide specific advice for those who self-refer with alcohol problems. I do not want to see the loss of the expertise that staff at the Harbour centre have. Services may need to be reconfigured, but we need to keep those people in our city. The people of the city who are affected by alcohol greatly value the support that they give.

It is right that both drug and alcohol services in the city should be reviewed, but I cannot for the life of me accept that they should be diminished further, given the size and nature of the problem that we have in Plymouth. We know that at Derriford hospital over a two-year period, alcohol withdrawal treatment admissions doubled. One day in January, across Plymouth hospital units there were 80 in-patients being treated for alcohol-related problems. We shall not be able to reduce those figures if we do not invest in the services necessary to support those who are alcohol dependent. That means funding services of the type currently provided by Harbour and retaining that expertise in the city.

I urge the Minister to consider carefully the funding gap between drug and alcohol services, both nationally and in Plymouth. To paraphrase a letter that I received from a recovering alcoholic living in my constituency, and still visiting the Harbour centre, we should do something about it. We need to understand better the outcomes that are achievable through funding alcohol services and therapeutic counselling and, if necessary, to apply targets. I am sure that that would be welcomed by the hepatology team at my local hospital. I look forward to hearing the Minister’s comments on an issue that I know she cares deeply about.

I attended the same meeting as the hon. Member for Plymouth, Devonport (Alison Seabeck); the three Plymouth MPs work closely together and we often attend the same briefings. We were shocked by the alarming increase in the number of people, particularly young people, who are now suffering from alcohol-related diseases.

It strikes me that one of the key things that must happen in this country is the development of greater awareness of the difficulties and dangers of excessive drinking. When those who still smoke reach for their packet of cigarettes, they see huge warnings telling them that smoking kills, and smoking can damage their health. I wonder whether we are many years away from putting similar labels on bottles of alcohol. I am not necessarily advocating a similar approach, but we need to have a debate on the advertising of alcohol and the suggestion that it is now part and parcel of life. So many young people today go out at the weekend just to get drunk, not, as we used to—I sound like my father—to have a good time. They go out with the express intention of getting drunk—becoming legless, getting blasted—without realising, and perhaps not knowing, the serious health risks involved in that sort of activity.

We have seen from our excellent local hospital, Derriford, that the evidence of alcohol-related diseases is spiralling, and that is alarming. I support the hon. Member for Plymouth, Devonport (Alison Seabeck) in her comprehensive outline of the arguments in that respect. I am concerned that when the incidence of alcohol-related diseases is increasing and more and more young people are drinking to greater and greater excess, the only specialist team in Plymouth that can counsel people who are caught up in heavy drinking or addiction to alcohol is, as we have heard, under threat.

We have the excellent Harbour alcohol and drug services team. Those who work on the alcohol side of it are on notice that unless new funding arrangements can be found, come September they will not be in a job. That means that the many people who have benefited from their services in Plymouth over recent years will no longer be able to benefit from them.

That would be bad enough on its own, even if it were not for the fact that, as the hon. Lady has demonstrated, rehabilitation for those who are addicted to alcohol works. Counselling and support services can get people off alcohol or encourage them to drink less.

I appreciate the fact that the Minister will not have tremendous knowledge of the local scene in Plymouth. She may rightly say that discretion is given to the local primary care trust and to the local hospital in deciding how they spend money to provide for the services that we are discussing. I am here to support the hon. Member for Plymouth, Devonport. We have a particular problem in Plymouth. Will the Minister do what she can to look into the situation and put in place adequate funding arrangements to provide the alcohol-related support services that the people of our region so desperately need?

I congratulate my hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) on the strong case that she has made for resourcing the services in Plymouth. We have always been proud of the Harbour centre. It has done a good job, but it has had to struggle against the rising tide of the problems that people bring to it. It has been somewhat better resourced on the drugs side but there has always been underfunding in dealing with alcohol. That is something that is reflected not only in our city but elsewhere.

In my earlier intervention, I asked my hon. Friend the Minister whether she would consider what she could do on the preventive side. That could pay huge dividends in the longer term as well as the urgent need for resourcing for which my hon. Friend has made such a strong case.

In Plymouth, we are already trying to help ourselves in that respect. The city council is working alongside the local strategic partnership. It is considering the possibility of having a plan for our evening and night-time economy, so that we can develop an approach to our wonderful city centre, which is often hijacked at weekends by young people who flow into the empty space that is left. Those young people come not only from Plymouth itself but from round and about. My hon. Friend the Member for Cleethorpes (Shona McIsaac), the Parliamentary Private Secretary who is supporting the Minister, knows Plymouth well. She knows the case that we are making, having spent some of her younger years in Plymouth.

I ask the Minister to talk with her colleagues about the possibility of bringing in some funding to employ managers of the evening and night-time economy in places such as Plymouth. We are struggling with these issues. My hon. Friend knows that we face many challenges across the piece in Plymouth in health, antisocial behaviour and education. Our local strategic partnership has four theme groups—healthy, wealthy, safe and wise—and the healthy group as well as the wealthy are keen to try to support the development of the evening and night-time economy and to emulate the successful business improvement districts that we have in the city centre.

We hope that we can encourage businesses to cluster around the idea of a managed evening and night-time economy. I have been championing the cause of alcohol disorder zones, as that is something that we face in Plymouth on occasions. I feel that we need the new measure recently introduced by the Government to act as a fall-back for us, so that we can bring some sense of order to some of the wilder parts of Plymouth.

I congratulate my hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) both on securing this debate and on the support that she received from the hon. Member for South-West Devon (Mr. Streeter) and my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy).

The misuse of alcohol, not just in the past few years but over a steady period of time, should give us all cause for concern, and I wish to explain how we are trying to tackle that difficult problem, which presents a range of challenges, including the need to prevent the problem and improve people’s understanding of the dangers of alcohol misuse. We have focused on the need to increase awareness of the strength of drinks on the market, compared with their strength some years ago. We must improve people’s understanding of information on the units of alcohol in different drinks, but that task is made more complex by the fact that wine, beer and alcopops each have a different alcohol content.

When providing treatment, we must weigh the needs of chronic alcohol dependants against the needs of people who need a different service, because their excessive drinking may become hazardous over a long period. It is a challenge both nationally and locally to identify the way in which we can best deal with that group—more commonly known as binge drinkers. To take up the point made by the hon. Member for South-West Devon, people are not aware of the dangers 10 years down the line of their over-indulgence, even if it only takes place on a Friday and Saturday night every week, and we must attend to that.

I should like to talk about the problems in Plymouth before I make some general points about our national strategy. I am concerned about the problems that have affected the Harbour alcohol service in Plymouth, which I visited a couple of years ago. I was pleased that with the support of the drug and alcohol team, the project was trying to find constructive ways to provide both drug and alcohol services because, like services in many other parts of the country, it has become increasingly aware of the connection between the two substance addictions. Having met people with a substance addiction, I know that a number of individuals addicted to class A drugs are addicted to alcohol, too. The pooled treatment therefore allows for the treatment and support of people with those different addictions. Dual diagnosis can help to identify mental health problems and alcohol abuse, and we have published good practice guidance on services for individuals with co-existing mental health and substance misuse problems, aimed at people who commission and provide mental health and substance misuse services to help them understand how the problems are connected.

I share the commitment of my hon. Friend the Member for Plymouth, Devonport to improving the provision and quality of services in Plymouth and elsewhere, and we must try to understand the problems faced by the Harbour project if we are to do so. I am pleased that the Plymouth drug and alcohol action team, which oversees the planning and commissioning arrangements for both drug and alcohol services in the city, is leading the development of an alcohol harm reduction strategy for Plymouth. We conducted our own audit of alcohol treatment and, in some cases, there was good news on treatment services, particularly for chronic alcohol dependants. Around the country, the picture was patchy, but the audit allowed us to consider how we could contribute to strengthening commissioning in this area. I understand that the work in Plymouth will lead to an integrated alcohol commission strategy, linking investment in health, social care and criminal justice, to tackle some of the concerns that have been raised this evening.

Alcohol treatment in Plymouth is predominantly centred around Harbour, an active partnership between the NHS, social services and the non-statutory sector, and it has carried out some important and beneficial work for the people of Plymouth. I understand that the team at Harbour has reduced dramatically the previous waiting list for those with alcohol problems, working closely and meaningfully with different sectors to achieve this reduction, and they are to be congratulated on that.

As the PCT and others are exploring how a more strategic approach to the delivery of services for those with alcohol problems will be developed for the future, it is clearly rather early for me to suggest what form that should take. But I am sure that Harbour’s contribution will be taken into account as will where that might fit in a future service providing stronger commissioning and stronger identification of the problems. That takes me back to my point about the issues that affect chronic alcohol dependence compared with those for whom drinking is becoming perhaps not even unsafe, but a ritual that can lead to some particular medical problems, such as liver damage and a host of others, as has been outlined. I understand that Harbour is also considering steps to improve its own financial arrangements, and that is to be welcomed.

The Government have sought to assist local areas in the commissioning of these vital services, which I hope will be seen as supportive of the review in Plymouth. In 2005 we published the alcohol needs assessment research project and, as I said, that provided the first ever comprehensive picture of alcohol-related needs and the availability of treatment, which before that mapping exercise had been anecdotal. We are now much clearer about the level of demand for alcohol treatment services and the task and challenge facing us. We know, for example, that £217 million is invested in alcohol treatment, with 63,000 people receiving treatment for alcohol-related disorders. However, we also know that the level of provision varies widely, with some areas being able to provide services for those that need them, but others having much lower levels of provision when compared with local needs.

Supporting local commissioners and partnerships in addressing those variations is a priority for the Department. At Alcohol Concern’s conference in November last year, I was pleased to be able to announce the publication of guidance for developing a local programme of improvement for alcohol misuse. I hope that those working in this area in Plymouth will find that useful. It provides detail on the evidence of alcohol harm to individuals, families and communities, and our ideas and aspirations for identifying the problem and improving health.

The guidance also presents some very clear economic arguments for action. That is important when PCTs and local authorities, perhaps through the local strategic partnerships but also local area agreements, are thinking about how this fits in the context of the wider needs of the community in terms of regeneration and the economy, but also the social cost of doing nothing.

Every £1 spent on alcohol treatment would save £5 on wider public sector costs. My hon. Friend the Member for Plymouth, Devonport referred to the issues around time spent in hospitals and bed days due to admission for a wider range of chronic conditions, including diabetes, heart disease, cancer, hypertension, and, of course, cirrhosis of the liver, all of which can be linked to alcohol. I am sure that each of us here this evening could add many more examples of where alcohol is part of a bigger problem in our communities.

We have also set out in the guidance some practical steps for local health organisations, local authorities and others seeking to work with the NHS to tackle alcohol misuse. We are providing practical guidance to improve screening and brief interventions for those who are drinking at hazardous and harmful levels, but do not necessarily see it as a problem that requires treatment in the traditional sense of that word. In doing that, we can assess local need, identify the local service gaps and examine the partnerships between primary care trusts, local authorities, accident and emergency departments and others in delivering some of the screening and brief interventions in a way that is, I believe, good value for money.

A database, developed with the North West Public Health Observatory, was made available in December 2005. It will help regions determine local levels of misuse and identify gaps in treatment. Later this week, I will launch “Models of Care for Alcohol Misusers”, which the Department commissioned from the National Treatment Agency for Substance Misuse. It sets out a framework for commissioning and providing intervention and treatment for adults who are affected by alcohol misuse. It sets out how we can strengthen the arguments for commissioning and the success of commissioning in what is purchased and tendered for by organisations that believe that they can play a part in providing services.

My hon. Friend the Member for Plymouth, Sutton made a point about prevention. We are working closely with the Home Office on a joint campaign to promote responsible drinking among young people through clearer and better targeted information. That is planned for later this year. We are also working with the alcoholic drinks industry and non-industry stakeholders such as the British Liver Trust on promoting more responsible drinking and preventing alcohol misuse.

In answer to a point made by the hon. Member for South-West Devon, I have asked a group of industry representatives to work with Department officials to consider sensible drinking messages. The position is not the same as that on cigarettes but it might be helpful to explore sensible drinking messages and clearer unit information on the products and at the point of sale. Of course, alcohol should be included when schools deal with substance misuse, alongside illegal drugs, cigarettes, prescription drugs and glue. Part of dealing with the problem is understanding the way in which alcohol misuse has changed, and promoting a better understanding among young people of the dangers that they present to themselves.

The balance of funding between drugs and alcohol is difficult to achieve. Separate funding in the NHS is given only to drug expenditure because it was believed to be a poor relation in NHS priorities. That expenditure is supported by Home Office investment. That is not to say that we have not been able, more recently, to take stock of what is happening with alcohol and ascertain where we can achieve better connectivity between the different forms of substance misuse and the different levels and perceptions of misuse. We need to pay attention to that.

My hon. Friend mentioned schools. We have an active students union in Plymouth. It had a good campaign to help with the problem of spiked drinks. Will she also try to engage student unions in her work?

That is a good idea. We have engaged student unions on several matters, including sexual health. Involving student unions as one of the partners is well worth exploring in areas where there is a large student population.

A message that we want to try to convey to young people is that one of the consequences of consuming too much alcohol is the danger in which one puts oneself, whether one is a man or a woman. Sometimes the more traditional health messages do not cut any ice with a young person who cannot imagine what it is like to be 30. Talking about personal risk of, for example, getting involved in fights or being sexually assaulted, has a resonance with young people. We do not want to scare people, but we should talk about such things and how to protect oneself in the best way possible.

I hope that I have identified some of the ways in which we are exploring how we can strengthen services and identify the gaps for which funding could be sourced for better use. We are considering piloting some of the brief interventions, for example, in identifying appropriate treatment, especially for binge drinkers. Perhaps treatment is the wrong word and engagement is preferable initially, so that people feel that they can talk about the matter and how it affects them.

My hon. Friend the Member for Plymouth, Sutton also mentioned town centres—

The motion having been made at Ten o’clock, and the debate having continued for half an hour, Mr. Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o’clock.