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Alcohol Harm and Older People

Volume 600: debated on Thursday 15 October 2015

Motion made, and Question proposed, That this House do now adjourn.—(George Hollingbery.)

It is a pleasure to be here and I welcome the opportunity to speak about the very real and damaging effects of alcohol harm on older people. I am pleased that the Minister for Public Health, my hon. Friend the Member for Battersea (Jane Ellison), is present and commend her for her passionate commitment to ensuring that key public health matters, and a strong preventive health agenda, remain high on the Government’s set of priorities for this Parliament.

I should perhaps clarify at the outset that I am seeking not to promote further legislation or regulation in this sphere, but to highlight the need for more education and information to help people make positive choices about their drinking; to enjoy it but at the same time maintain their own health and wellbeing. We all want to live longer—and we are—but, importantly, we want to live longer and healthier so that we can enjoy those later years. That is why this subject is so important.

I thank the hon. Lady for giving way so early in her speech—I indicated to her before the debate that I intended to intervene. The theme that she is talking about, which many Members of the House, including me, would agree with, is this: everything in moderation. In other words, people should be careful about what they take and how often they take it.

The hon. Gentleman is absolutely right. Although most people are able to drink in moderation and enjoy the benefits of the socialising and relaxation often associated with drink, for many others it comes with significant costs.

Before proceeding any further, I ought to clarify what I mean by “older people”. Depressingly, I am referring to those of us who are over 45. A huge amount has been done in the past few years to tackle excessive drinking by the young, and encouraging figures show that drinking among young people is falling. I am also referring not so much to binge drinking, which perhaps is what we all associate with drinking among young people, but to harmful drinking. That does not have to mean getting wildly drunk and being hungover the next day; it can be continuous drinking, perhaps every day of the week, which does not allow the body’s organs to have a break from alcohol. People are often unaware that that can be extremely harmful.

Alcohol is a leading risk factor for death and disease in the UK; it is the leading risk factor after smoking and obesity. As a toxin, it is the cause of many acute and chronic diseases, and—Members might be surprised to hear this—it affects almost every organ in the body. The relationship between alcohol and liver disease is well known, but alcohol is also a risk factor in a number of cancers, in cardiovascular disease and in gastro-intestinal diseases such as pancreatitis, and of course it is also a leading cause of accident and injury. On that topic, the all-party group on alcohol harm, which I chair, is currently conducting an inquiry into the considerable impact of alcohol on the emergency services. I look forward to being able to update the House on that work in due course.

Given its associations with so many and such serious health conditions, it is unsurprising that the impact of alcohol on NHS services is considerable. In 2012-13 there were more than 1 million alcohol-related hospital admissions, where an alcohol-related disease, injury or condition was the primary reason for the admission or a secondary diagnosis. As the Minister will be aware, the costs of this to the NHS are estimated to be at least £3.5 billion per year—on its own, more than a third of the Treasury receipts from alcohol—yet estimates for the wider personal, social and economic costs of alcohol vary from £21 billion to £55 billion in England alone. We therefore have much to address.

I must emphasise, though, that recent trends in the decline of underage drinking and drinking among young people are encouraging, which leads me to believe that we can similarly address and support improved positive drinking among older people. The proportion of 11 to 15-year-olds who have ever had a drink fell from 61% in 2003 to 38% in 2014, and the proportion of those who got drunk in the past week declined dramatically from 26% to just 8% in the same period.

Encouragingly, this positive trend is beginning to extend to the 18 to 25-year-old age group, many of whom, interestingly, now choose not to drink at all. That includes my own son, a young man in his 20s. He is a sportsman who simply does not drink. A huge amount of work has been done in this area. I commend the Government and their partnership working with many agencies to educate and support this age group to reduce levels of harmful drinking. One of the successes has been the introduction of street pastors. Another has been the presence of club hosts in clubs and pubs, where people on the “older sister” model, perhaps slightly older than those who might drink irresponsibly, will approach a young person they think is drinking too much and say, “Perhaps you need to think about how much you’ve drunk.”

I thank the hon. Lady for her comment about street pastors. In the past month, street pastors have started to be active in my constituency, with 13 churches and 43 volunteers coming together on this. That is a very clear commitment by community members themselves to address the issue. I recommend those in any constituency where there are no street pastors to ask the churches to be involved, because the benefits are great.

I entirely agree. In my constituency, similarly, there are some excellent street pastor groups.

Voluntary organisations, the drinks industry, publicans and the police, together with local and national authorities, have done a huge amount to address drinking by younger people. With older people, though, much of their drinking is a hidden problem, particularly among the baby boomer generation who often drink at home, many of whom have a dangerously limited awareness of alcohol’s harmful effects. This is a ticking time bomb not just for the individuals concerned but in terms of the public cost of their healthcare in the years to come, with an increasingly ageing population.

According to the Health Survey for England 2013, 10 million people in England drink at a higher level than the Government’s lower-risk guidelines, with serious long-term implications for their health. This is particularly true of older people. Many of those in the baby boomer generation drink on an almost daily basis. The survey found that 14% of 45 to 64-year-olds drank alcohol on five or more days in the past week, compared with just 2% of their younger counterparts in the 18 to 24-year-old group. Alcohol-related hospital admissions among this middle-aged group account for 40% of all alcohol-related hospital admissions and 58% of all admissions for alcoholic liver disease. Tragically, this age group also accounts for the majority of alcohol-related deaths.

Some of the impacts of alcohol are rather less obvious but no less devastating. For example, there is a significant link between alcohol use and the risk of hypertension, which is a factor in a number of related illnesses such as stroke, heart disease and other vascular diseases. Alcohol is generally associated with poorer mental health. In later life, alcohol can be used as a comfort for many of the shocks that people experience in middle age, such as adjustment to life after divorce, redundancy, retirement, children leaving home, or bereavement. Loneliness or depression can also be a factor. These points in life can be very challenging, and they are all associated with higher rates of alcohol use. People need to be made aware that when these life shocks hit them in later life, as they do the majority of us, they need to look out to avoid slipping into harmful drinking patterns because the consequences can be catastrophic in just a few years.

The majority of older people are not aware of the potential damage they are doing to their health or relationships through unhealthy drinking. Office for National Statistics figures show that the greatest number of people who did not drink but now do drink are women over 65, many of whom live alone. That is a particularly concerning statistic that we need to bear in mind. Research by charity Drinkaware and by Ipsos MORI suggests that there is a large group of people who are sleepwalking into poor health. Only 20% of 45 to 65-year-olds think they will have health problems if they continue to drink as they do, yet more than a third are drinking at above the level of Government guidelines. Shockingly, one in nine says that they have already been told by a friend, family member or health professional that they should cut down.

Interestingly, this issue was raised in the previous debate—I do not think the Minister was here—when the shadow Defence Minister, the hon. Member for North Durham (Mr Jones), spoke about needing to address it for those who had been in our armed services, although not in a nanny-culture way. I strongly echo that.

For many, drinking is an everyday occurrence, but when confronted with it, people do not realise that even drinking at relatively low levels but on a continuous—that is, virtually daily—basis can be harmful. Here is a typical comment:

“On reflection when you look back it’s not the fact that I drink to get drunk constantly—that would be a separate issue…but as part of the relaxing process…on a daily basis at home. I just didn’t realise how many excuses I have to…drink.”

Misuse of alcohol has a devastating impact on relationships and families, and on children in particular. That should be given greater prominence. In 2012, a survey by the Children’s Commissioner, “Silent voices: supporting children and young people affected by parental alcohol misuse”, estimated that between 1999 and 2009 more than 700,000 children were affected by parental or other significant adult drinking. It said that parental alcohol misuse is far more prevalent than parental drug use and called for a greater emphasis on it in policy and practice. It is a matter of social justice that we address this, not just for children but for the poorest in our society, because research shows that those who are less well-off are less resilient and more vulnerable to the impact of harmful drinking. Professional people, some of whom drink more, are able to withstand the impacts better.

As chair of the all-party group on alcohol harm, I urge that greater prominence be given to this issue, particularly to the harms caused to older people. A number of strands could be taken forward, alongside other initiatives that I am sure the Minister will consider. One very practical example was given in an excellent report that I had the privilege of launching here in the House last month: “Under Pressure” by the Treat 15 Expert Group, which comprises doctors, nurses and other health professionals. It suggested that whenever an individual has their blood pressure taken, mention could be made, just in those few minutes, of drinking being linked to the risk of high blood pressure, and indicators of the harmful health implications associated with that. It is estimated that about 7.5 million people in this country are at risk of high blood pressure. Just identifying the link with harmful drinking could help a large number of people to improve their health prospects. In those few moments, often when nothing else is done or said, there is a real opportunity, at no cost at all, for the medical profession to provide an important service.

There is also an urgent need for public education on the harmful effects that drinking can have on older people. People need information that is simple, accessible and non-judgmental. There are some innovative resources, such as the Drinkaware app and the Change4Life booze buster programme, which help people make informed choices about their drinking and support them to make a change that could have significant benefits for their health and wellbeing.

We also need more prominent, comprehensive and consistent public health messages from Government, the NHS and Public Health England about the risks of harmful drinking. A report will be released shortly and I look forward to reading its suggestions as to how the issue can be addressed. Given that people are living longer, it is important that they are informed about how to live healthier longer lives.

The alcohol industry also has an important role to play by working in collaboration with others. It is a key partner and has made a great deal of progress working in partnership with pubs and clubs and with the Government. The Government challenged the industry to remove 1 billion units from the alcohol market over two years. In fact, 1.3 billion units were removed—the equivalent, apparently, of the whole nation going dry for one week a year. One of the means by which that was achieved was through providing house wines of less alcoholic strength and smaller glasses. I also commend the industry for the fact that almost 93% of alcohol bottles now warn women that it would be better for them to consider not drinking during pregnancy.

There has been talk in the press over the past two weeks about the best message to give to pregnant women about alcohol consumption. Does the hon. Lady agree—perhaps the Minister will say this in her response to the debate—that the best message and policy would be that pregnant women should drink no alcohol whatsoever?

That is my personal view. Women have suffered from mixed messages over the past 20 years and more. It would be very helpful to have a clear message. Just six years ago, only 17.6% of products carried a warning label about drinking in pregnancy; the figure is now 93%. I would like it to be 100% and it would be very helpful if the Government gave a clear message that not drinking in pregnancy is probably the wisest choice of all for the woman and her child.

In conclusion, I ask the Government to consider working in partnership with us to develop strategies to reduce alcohol-related harms in older people, just as they have done, with some success, to reduce unhealthy drinking in younger people. No one now questions the role of Government in promoting healthy eating. The same rule could, I hope, be undertaken in future, with similar, commendable vigour, by the Government with regard to encouraging healthy drinking.

It is delightful to be here, a little earlier than expected, for this important debate on alcohol harm and older people, and I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing it. She laid out extremely clearly some of the challenges we face.

Alcohol is one of the four biggest behavioural risk factors for disease and death in the United Kingdom, along with smoking, obesity and lack of physical activity. As my hon. Friend alluded to, it is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, a number of cancers and depression. That evidence base is growing all the time, and it is important that we highlight that. Drinking can lead to a range of conditions and, as she said, it is estimated to have contributed to more than 1 million hospital admissions in 2013-14, costing the NHS a considerable amount of money. Much of that burden of disease and death is preventable. To this day, people continue to be affected by alcohol misuse, so it is right that we give the matter our attention. A lot of that is because of ignorance and misunderstanding, and because we perhaps do not talk about it as much as we should. My hon. Friend is also right to say that getting the tone of the debate and the advice right is sometimes a challenge.

There is a lot of interest in the issue in Parliament, and we have also heard about how alcohol misuse can have a significant and devastating impact on the lives of our constituents. I am sure that all parliamentarians present will have met people who, if they are not themselves personally affected, have seen their family affected by alcohol misuse. It is very sad when we see that.

Many of the concerns were set out in the all-party group on alcohol harm report earlier this year, and I congratulate the group on that work. Obviously, I have met affected individuals and I have read many letters sent to me by colleagues detailing the concerns and frustrations of those who see the cost of alcohol harm and the impact it has on their everyday lives. They want action to be taken right across public life, including from Government, industry and beyond.

The majority of people who drink alcohol do so in an entirely responsible way. Although I welcome recent falls in alcohol consumption, we cannot be complacent, which I certainly am not. There are still many who drink above the lower-risk guidelines. As my hon. Friend has said, Office for National Statistics data suggest that the proportion of over-65s who are drinking above those lower-risk drinking guidelines is increasing. Harms such as liver disease, as well as the social impacts such as crime and domestic violence, remain much too high. This is an important public health issue, to which I continue to give attention. I regularly meet Department of Health officials to ensure that progress is maintained on cutting the number of people of all ages drinking at harmful levels. Before closing, I will touch on occasions in the next few months when we might pay particular attention to that topic.

A number of actions have already been taken. For example, sales of alcohol below the level of duty plus VAT were banned in May last year, to tackle the worst cases of very cheap and harmful alcohol, meaning it is no longer legal to sell a can of ordinary lager for less than about 40p.

In the last Parliament we worked with the industry to take alcohol units out of the market. As my hon. Friend said, more than 1 billion units were taken out of the market. I have challenged industry to build on that: it is a good start, but we can go further and I have had discussions about what that new effort might look like. We can do more to make sure that we have the widest range possible of lower strength drinks available to the public. Some of the simple substitutions my hon. Friend has mentioned can make a considerable difference to help bring people back to lower-risk drinking.

We have also introduced an alcohol risk assessment into the NHS health check. It is aimed at 40 to 74-year-olds. Health checks provide a chance to identify and manage a range of risk factors, such as high blood pressure and cholesterol levels as well as alcohol consumption. They enable identification and brief advice interventions to be provided in primary care and, indeed, non-health care settings. We know that that can work, with one out of every eight people who receive an intervention to help them moderate their behaviour responding to it. Since April 2011, 5.6 million people have taken up the offer of a health check, and I continually challenge the system to build on that, because it can provide a reality check for many people who have not noticed harmful drinking creeping up on them. That is really important.

All health professionals have a public health role and we need to make sure that the system has enough capacity and that our workforce are adequately trained to tackle challenges such as alcohol misuse and, of course, drinking in pregnancy, which we have debated often in this House. There is keen interest in the issue and perhaps we will return to it in more detail when we consult on the revised guidelines, which I will mention in a moment.

Since April, the standard general medical services contract has included delivery of an alcohol risk assessment to all patients registering with a new GP. That is another important moment at which people think about their health and there is a chance to have such a conversation afresh. That assessment has the potential to raise awareness of alcohol as a risk factor with a large percentage of the population. 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. It is important that in future doctors can give better advice on the health impact of the effects of substance use and misuse.

The Government have given local areas more powers and responsibilities to help them tackle harm in their populations. We have backed that with ring-fenced budgets to improve people’s health, and that includes responsibility for tackling problem drinking. We have given local authorities more than £8 billion in funding over three years. As I have seen during my many visits as the Minister with responsibility for public health, local authorities are very well placed to take forward the public health role. They know their communities well, often at a level of detail that the Government could never understand, and they know where to put the right services to help their communities.

The Government have continued to work with Public Health England, which is giving higher priority to alcohol issues. In looking at alcohol during the next 18 months, PHE will examine how a whole-system approach might provide a focus, particularly on return for investment. Local authorities are keen to make sure that they spend money wisely and that their budgets yield good results. That is no less true for public health than for anything else. The work is intended to assist the Government, local authorities and the NHS to invest with confidence in evidence-based policies, prevention and treatment interventions. Public Health England’s support for local authorities’ public health role will continue to be vital. I do not want local authorities to try to replicate the evidence base that national experts obtain. Such experts should provide the evidence base, and local authorities can then be in the position to take it, adapt it to the local needs and build on it.

To help local areas to target and tailor their activities, Public Health England has developed both liver disease and local alcohol profiles. Those are very important tools to put in the hands of commissioners and those who know their communities best. The profiles provide transparent, comparable information to health and wellbeing boards, commissioners, service providers and professionals, letting them look at their own performance and, importantly, at that of others to see how to improve their outcomes.

PHE will also expand the Healthier Lives web tool, which includes indicators on alcohol hospital admissions and figures for waiting times and completions of alcohol treatment. That will allow an area to build up a complete picture of how well it is doing, particularly against national averages and comparable areas. As in all things in the world of public health, there is considerable local variation—the challenges are not all the same in different areas—so we need to give local areas such tools. We have seen good practice in Lancashire, which has used local alcohol profiles to inform its joint strategic needs assessment and to look at the mix and quality of the services it commissions.

The Minister is quite right about variation. One of my concerns is about the increase in drinking among older women. Is anything being done specifically to look at how they can be helped to reduce the effect of alcohol harm?

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

The Minister knows that Members of this House, myself in particular, have the utmost respect for her and her position, for what she does and for the guidance she gives. However, the very possibility of uncertainty poses an important question for us. The message must go out from the Minister and from us as elected representatives that during pregnancy, there must be no alcohol at all. That has to be evidence-based, as she said, but there should be the same message so that there is no uncertainty.

The UK chief medical officers are extremely alive to that challenge and it is something to which they have given considerable thought. Perhaps we will return to it when the guidelines are consulted on. I assure the hon. Gentleman that I have had that conversation and that I have been at pains to emphasise how regularly the issue comes up in Parliament. I know that it is being addressed and that it will be talked about when we consult on the new guidelines.

It is clear that there is more that all of us can do. We have to recognise the contribution that not just individuals, but businesses, communities and local government can make to help people better understand the risks associated with alcohol. I agree with my hon. Friend the Member for Congleton that we need to do more. We are working to ensure that there is a better understanding of the risks.

This is an issue to which we will return. The publication of the new alcohol guidelines will provide a moment in the national debate when we can look at it closely with the public, experts, health professionals and industry. That will be a stimulus to fresh thinking, more public education and debate. Those in Parliament who have a particular interest in the issue will want to participate in that important debate. However, change will not happen overnight. I know that the hon. Members who are here will agree that raising awareness of the issue is key. We have an evidence base to show that, in some cases, raising awareness with individuals is the most important thing we can do to help them.

This debate has been an important opportunity to revisit these important issues. We will return to them in more detail in the coming months. That will be a great opportunity to reflect not just on the good progress that we have seen among younger people, but on the work that we are yet to do.

Question put and agreed to.

House adjourned.