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Alcohol Services and Rehabilitation Centres

Volume 471: debated on Tuesday 29 January 2008

It is always a delight, Mr. Marshall, to sit under your chairmanship, because, with your great experience and understanding, you know how important it is that Members of Parliament get the opportunity to raise individual but important questions in Westminster Hall.

On 8 March 1736, Mr. Pulteney rose to his feet in the House of Commons to speak against Sir Joseph Jekyll’s motion for a duty of 20 shillings per gallon to be laid on all spirituous liquors. He said:

“I believe it will be admitted by every Gentleman, that the constant and excessive Use of spirituous Liquors among the inferior Rank of our People, is a Practice which has of late Years grown to a monstrous Height, and it will be as generally and as readily admitted, that this Practice is dangerous and mischievous to the Health, Strength, Peace, and Morals of the People; and that it tends greatly to diminishing the Labour and Industry of his Majesty’s Subjects; therefore I believe we shall all agree in this, that some Method ought to be taken for putting a Stop to this Practice...The Distilling Trade is a Business which has been earned on by Royal Authority for about an hundred Years, and that it has been not only highly approved, but very much encouraged by several Acts of Parliament passed since the Revolution…There is not now an Inn, an Alehouse, or a Coffeehouse in the Kingdom, but what owes a great Part of its Profits to the Retail of such Liquors: By which Means there are now such Multitudes of Families in the Kingdom who owe their chief, if not their only Support to the distilling, or to the retailing such Liquors, that they very well deserve the Care and the Consideration of a British House of Commons.”

In other words, not a great deal has changed and the liquor industry still has an extraordinary powerful lobby in the House of Commons.

Some time ago, the Cheshire coroner, who is a most caring and considerate man, became so concerned by the rise in alcohol deaths within the county that he commented publicly. He made it very clear that, in his view, the doubling of deaths from alcohol, particularly among women, was not only a public health matter of great concern but something that should concern us all. He linked that doubling of deaths specifically to the numbers of cases that he was being required to deal with among young people, as well as among those who might be said to have reached the age where their abuse of themselves was somehow inevitable. Not only should his views be taken extraordinarily seriously but we ought to think about the impact of what we have been doing in this area.

Addiction is never easy to deal with. When I was a young and impressionable doctor’s wife, I had a rather sad feeling that, if one gave people support, that support would automatically lead to their ceasing to be addicted to particular substances, and of course alcohol is even more addictive than some drugs. However, the reality is, of course, that those who need a particular support or crutch and have become wholly dependent on alcohol need a lot more than encouragement. They need specialist services and consistent support in their homes, and then, over a period of time, if they are lucky, they will hit that moment when they can at least be weaned away to the point where they are no longer destroying themselves. That is not an easy moment to find, but it will never be found if, as a nation, we are not capable of producing those support services that are absolutely essential.

We accept that we have a very real problem with drugs and the Government not only discuss that problem quite consistently and openly but seek, with great vigour, to make it plain to the general public what the implications of drug addiction are. However, somehow or other—I believe that it perhaps began with my generation—alcohol is not regarded in the same way as a deadly poison.

Please do not misunderstand me; I like a drink. I like good wines, good brandies and good whiskies, although they do not always like me. Perhaps the advantage of living long enough is that one’s constitution begins to deal with things that one’s brain ought to have dealt with but has not.

However, the reality nowadays is that people not only routinely drink much more heavily than people did when I was young but they indulge in specific, targeted and I would have thought enormously boring bouts of binge drinking. One no longer needs to look too harshly at what is going on in Crewe and Nantwich to wonder about the changing social ethos and habits of people. It is almost impossible to walk from my office to the station in Crewe without passing 50 bars and pubs and they are all, of course, open for many more hours than they were originally.

One of my constituents came to me because, very sadly, she had lost a dearly loved son in a very sad set of circumstances; his death was due, of course, to alcohol abuse. He was young and she felt, rightly, that if there had been support services at the moment that he desperately needed them, he would have had at least a fighting chance of surviving. She then began to ask me what we were doing about the coroner’s remarks; what attitude the Government were taking to the provision of support services, and what was happening in my local health services. After all, the Government will not escape responsibility; if the Government are responsible for lowering the taxes on alcohol and for making it easier for people to drink, they must also seriously consider the downside of those policies.

How much are we spending in the education services for young people to encourage them to understand the damage and the very real destruction that alcohol can bring to individual families? How many beds are available, for use by consultant psychiatrists and by others within the hospital service who are specifically trying to deal with alcohol as a problem? Is it possible to admit people from accident and emergency departments into particular beds?

In parentheses, I would say that it is not just in Crewe and Nantwich that we have this problem. While dealing with someone in the London system within the last 12 months, I was told that the advice that he was given—in this case, it was from a consultant physician—was, “If you have sufficient money, admit yourself to this private unit, because there is no mental health or alcohol service available within the London region.” I must say that I would not admit a dog that I was fond of into the private unit that that doctor recommended, so I have very grave reservations about whether we are dealing with this problem on the best possible basis.

In Crewe and Nantwich, we have, with the agreement of the local county council and the local health services, very specialised assistance. It is, of course, provided on a voluntary basis. Central Cheshire Alcohol Services derives its money both from the local county council, which is soon to be dissolved, and from the health service partnerships. Because of the Cheshire and Wirral Partnership NHS Trust, there are two nurses who are paid directly by the trust but who are managed on a day-to-day basis by the charity.

Those nurses cover a very large area and they have a lot of experience of providing support services. They also try very hard to work in partnership with the health service, the local authorities and the third sector organisations. However, the rise in the number of referrals to them paints a very alarming picture. In 1991-92, they had 182 referrals; that rose by 2003 to 590 referrals; it rose further in subsequent years, first to 687, then 807, and by 2006-07, the number of referrals had risen to 905. Furthermore, those referrals are just the smallest percentage of the cases that the nurses have to deal with.

It is clear that the demand for services totally outweighs the resources. There are 70-plus people on the Central Cheshire Alcohol Services waiting list for support. Although the organisation receives uplift money from the health service, there has even been some debate about whether it should still have access to the same number of beds.

There is clear evidence that binge drinking is on the increase, but there is no consistent education programme in the schools in my area. Furthermore, the mental health issues created by alcohol mean that mental health services are constantly being called on, but they will intervene only if the client has a severe and enduring mental health problem. Yet, alcoholism can result in real mental problems.

There appear to be no national targets for alcohol, and nor does there appear to consistent funding to support such targets. What is more, the Government have made it easy to access cheap alcohol. In Crewe and Nantwich, there are now many superstores where it is easy to buy not only beer and spirits, but any kind of alcohol, no matter how damaging it is. We are told that the supermarkets do their best to monitor trade, but only last week, a gang of youths, including several small children as young as 10, endeavoured to knock down the back door of my constituency office—luckily, it is made of steel—and all of them were drinking vast amounts of alcohol. Whatever safeguards we have in place, therefore, they are clearly not working.

Staffing numbers have not kept pace with the demand for services, and large numbers of volunteers are being used. When I raised the issue of alcohol services with the PCT, it was concerned. It has just opened a health centre in the middle of Crewe, so it is aware of the need to respond with all sorts of services. However, when people say, for example, that an alcohol liaison service is available in accident and emergency, we have to ask what it is doing. Does it have the right routinely to refer people to beds after triage? Does it accept that people have a long-term problem and will need specific detoxification and residential provision? Is such provision available? Have we looked at the need for services or at the commitment of the various partners to address alcohol harm across Cheshire? Are we convinced that services are co-ordinated? Unless there is a specific, targeted and well-understood commitment to provide highly specialised services, we shall allow large numbers of people to destroy themselves without having attempted to rescue them when that was still possible.

This is not a new problem, as the House of Commons record shows, and nor is it not understood. There is a powerful drinks lobby in this country, which has persuaded this Government and previous Governments that the extension of licensing laws and the availability of cheap alcohol are not only acceptable, but that they are the way forward, if we are not to be overtaken by events. The industry spends a fortune on advertising its wares, so it is aware of the need to recruit more drinkers.

Above all, the industry has created problems in many of our small towns and cities on Friday and Saturday nights, when groups of people—they are not only young people—inevitably become involved in all sorts of public disorder. We are familiar with the sight of young girls and young men who are virtually insensible. There are constant problems for the police, and there are the difficulties faced by those who want to use their town centres without experiencing the atmosphere created by drinking. Many of my constituents experience problems simply because of the general disorder that drinking creates, and that should not be acceptable in this day and age.

I am not saying that we should nanny people or organise their lives, but we must accept that the cost to this country’s economy and social ease and the effect on the quality of our constituents’ lives is largely determined by social problems to which we have contributed. We desperately need to accept—certainly in my area—that more money must be spent on alcohol services and that more problems must be confronted. Above all, Her Majesty’s Government must take responsibility. There is a direct link between the decisions taken by the House of Commons on fiscal and national health service matters and on the provision of services and what happens on the Crewe road on a Friday night. However, I know that this very intelligent and helpful Minister is going to say that she will solve some of those problems for me immediately.

I wish that I could give such absolute commitments to my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody). However, let me congratulate her on securing this important debate.

I want first to look at what is happening locally and to set that in the context of regional and national plans. I also want to look at each of the levels that my hon. Friend rightly identified: discouraging excessive drinking and ensuring that services are available in the community, that interventions take place to discourage drinking where it occurs and that the appropriate treatment is available in the complex and often tragic cases that my hon. Friend mentioned.

I am aware that Her Majesty’s coroner for Cheshire has raised concerns about the number of cases with which he has dealt involving alcoholic liver disease or alcohol as the primary cause of death. His experience contributed to his critical view of the services being provided, and he urged Cheshire county council to ensure that there was appropriate funding.

It might be helpful if I quickly describe the services that exist and say what will happen next, before moving on to the wider issues. Services based in the community receive referrals from GPs and others, and staff see clients at the service or in the client’s home, depending on the circumstances.

The care pathway is delivered in several different ways: through information provided in GP practices, by Turning Point, to which I think that my hon. Friend referred, in the custody suites used by the probation service and in hospital wards. Identifying problem drinkers and where brief interventions should take place is a comprehensive way of tackling the issue. As my hon. Friend said, however, we also need hospital-based intensive care or an appropriate parallel residential setting.

All of that was in place, but since the coroner’s letter, the PCT has been working to identify additional resources, and those include another £100,000 for this financial year and £250,000 for next year. Before the coroner’s intervention, the PCT had a contract for in-patient beds with providers. As I said, we need to ensure that the right balance is struck and that people have access to both the community service and residential provision, because we need a complete care pathway and complete support, where that is necessary.

The PCT must consider, and is considering, the number of beds that it needs and where the appropriate care should be provided. Evidence shows that community detox is more effective under certain circumstances, but that when other related medical complications are involved, and needs are far more complex, residential care supported by community services is necessary. The PCT is taking forward its budget and local delivery plans, including through local area agreements, which will address wider activities, such as work with schools and young people, in appropriate locations, as my hon. Friend mentioned. It should continue to invest more money in this problem.

A few of the questions that my hon. Friend raised remain unanswered, particularly those on the interaction with accident and emergency admissions of people needing those beds. I have asked the regional director of public health to look into, and report back to me on, that matter specifically, the relevance of which extends beyond the problem before us today. I shall be happy to share that information with my hon. Friend when I receive it.

We would all agree that a variety of support services must be available across the board. My hon. Friend touched on the unfortunate increase in the number of health complications and deaths, many of which are preventable, resulting from alcohol consumption. We must look very carefully at the interaction between community care services and support and, increasingly, at such treatment and rehabilitation in a care setting. I admit that the level of service provision does not meet these emerging and complex needs, not only in her area, but elsewhere.

Let us consider more widely what we can do about the direct transmission belt, so to speak, that my hon. Friend mentioned, from strategic health authorities back to central Government. The NHS in the north-west undertook a stocktake of alcohol services and is now working with local primary care trusts to find ways of taking forward some very positive plans for tackling alcohol harm. The report confirmed that excess consumption of alcohol has a major impact on the lives of those in the north-west and identified a reduction in the number of deaths in the region caused by alcohol as a very high priority. However, it also found that PCTs in the region felt that there was a culture of excessive drinking, which created major barriers to addressing the health problems caused by alcohol.

The Government office for the north-west and the Department of Health are working together through local area agreements and through local alcohol strategies, which are a priority for the NHS. They will continue to build on and develop local partnerships and to prioritise action at all levels, to encourage those who enjoy a drink to drink sensibly and those who feel that their drinking is becoming hazardous or harmful to seek help. If possible, that will be done in a community setting, but of course the acute treatment of complex cases should be dealt with in rehabilitation centres.

Has anyone calculated the cost of such provision to the NHS—not only of the straightforward services, but as a result of attacks on staff and the effects on accident and emergency departments?

I do not have a figure to hand. However, my hon. Friend is absolutely right; over the course of people’s lives, the cost of excessive alcohol consumption is huge, whether as a result of higher hospital admission rates, alcohol-related crime, absence from work, school exclusions of young people consuming alcohol—regrettably—teenage pregnancies or road traffic accidents. In fact, I have just been handed the figure: the approximate cost to the NHS is £1.72 billion. That is truly phenomenal.

Regrettably, my hon. Friend’s views are well-founded. At 23 per cent., the north-west has the second highest level of binge drinkers in England; more people in the north-west die from alcohol-related illnesses than anywhere else in the country, and it has the second-highest number of alcohol-related hospital stays. There is no doubt that excessive alcohol consumption contributes to poor quality of life, shortens many lives and results in huge costs to families and communities, and eventually to the economy and the NHS.

To understand the breadth of the problem, the Government undertook an alcohol needs assessment research project—the first ever assessment of specialist alcohol treatment in England and of what needs to be done to improve available treatment. As a result of that study, the Department intends to monitor every year the availability of services in each PCT and to look specifically at collecting information for the first time on the specialist treatment that needs to be provided. That will begin on 1 April 2008.

What do we need to do here in Westminster? Although the collection of information, the commissioning of services and the investment of money are important steps, it will take time to turn the problem around. It has been a long time in the making. However, the Government are taking a number of other steps. The joint public service agreement target with the Home Office will address the more complex and wider problems associated with excessive alcohol consumption and interventions at that level. Furthermore, a new education campaign will start in the spring aimed particularly at encouraging young people to drink more sensibly.

Last week, the Department announced that an independent review is to be carried out of the relationship of alcohol pricing and promotion in off-licences, supermarkets, pubs and clubs to alcohol consumption and harm. I hope that the review’s finding will be received from the experts in July of this year, at which point we will assess the need for action, including regulatory change. We have agreements with the alcohol industry on the labelling of alcohol products, particularly in regard to health advice. In addition, the Prime Minister has made it clear that he is reconsidering the 24-hour licensing laws, which have been operating for number of years now, and evidence of whether they are connected to the problems that we are discussing.

Locally, a great deal is being done with extra investment, examining the issues that my hon. Friend has raised, and I shall be happy to discuss further developments. The strategic health authority will keep an eye on the situation and ensure that not only in her primary care trust, but in others, matters are taken forward. The Government are taking the necessary steps to get proper advice to people.