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Alcohol Abuse

Volume 782: debated on Thursday 30 March 2017

Question for Short Debate

Asked by

To ask Her Majesty’s Government what is their most recent estimate of the cost of alcohol abuse to the National Health Service; and what steps they are taking to reduce those costs.

My Lords, I am grateful to the Chief Whip for finding a slot for this debate, even though it is the last business. I am grateful that I have so many speakers—I am surprised—and equally surprised by the number of people who have written to me in advance of the debate, which seems to indicate that we should look for a longer debate at some later stage.

After welfare, the cost of health is the biggest charge the Chancellor of the Exchequer has to deal with, yet if one examines Budget speeches one sees that it rarely gets a mention. In fairness to Philip Hammond, it did this year, because of the crisis in care, which is of course directly linked to health. Health costs continue to grow at around 4%, but the economy is down around 2%. With an ageing population, the health service, as one ex-Health Minister in the Lords recently said to me, is a car crash waiting to happen. So every action must be taken or at least explored to avoid further injury to or collapse of the health service.

Like the Queen, the NHS is one of the few remaining pieces of glue that keeps us together as a United Kingdom. People everywhere are increasingly fearful of what the future holds but, happily for the UK, at least for the moment, people do not have the fear that illness brings to many people overseas—the fear of how to pay for their treatment. That burden is lifted by the NHS, and it helps faster recovery, but it is at even greater risk if politicians are reluctant or unprepared to engage in an open and honest debate about the problems we have funding the health service. That is at the heart of my debate today—seeking changes that will reduce the burgeoning public health costs but also changes that lead to healthier, happier and longer lives. As part of that, the Government must confront the stark challenge that alcohol abuse presents for the NHS in terms of the financial costs, resources and the impact on staff time and welfare.

Alcohol is estimated to cost the NHS around £3.5 billion per year, which amounts to £120 for every taxpayer. If I have got the figure wrong, I am sure that the Minister will correct me. Even though drinking has declined marginally in recent years, there is a growing burden of alcohol-related admission problems for the health service. As our NHS tries to deal with these difficulties, there is the difference between costs rising at 4% per annum and growth in the economy at only 2%. The consequences of harmful drinking are a factor that we must address—and that is not surprising, given that Public Health England has recently reported that alcohol is the leading cause of death among 15 to 49 year-olds. There are now more than 1 million alcohol-related hospital admissions a year. Alcohol has caused more years of life lost to the workforce than have the 10 most serious cancers, and in England more than 10 million people are drinking at levels that increase the risk of harming their health. There are 23,000 alcohol-related deaths in England each year, which means that alcohol accounts for 10% of the UK burden of diseases and death, and is one of the three biggest avoidable risk factors.

Evidence indicates that ease of access and persistently cheap alcohol perpetuates these problems, with deprivation and health inequalities particularly prevalent among men from the lower socio-economic groups. Alcohol is 60% more affordable than it was in 1980, and affordability is one of the key drivers of consumption and harm. Cheaper alcohol invariably leads to high rates of death and disease. David Cameron and the coalition Government recognised this back in 2012 when they produced what I would describe as a progressive alcohol strategy. In its foreword, he talked about,

“a real effort to get to grips with the root cause of the problem. And that means coming down hard on cheap alcohol”.

Regrettably, that just has not happened. Other aspects of the strategy have disappeared, too. There seems to be a vacuum with no discernible sense of direction. I hope that today’s debate might start to move us towards a more positive approach than we have had for the past two or three years.

I will not spend much time on minimum unit pricing. I am sure the Minister’s reply will be quite predictable: we are awaiting the outcome of the Supreme Court’s decision on the Scotch Whisky Association appeal. If we did have that, I am sure the Minister would argue that we need to see whether minimum unit pricing is working in Scotland before taking any decision to bring it south of the border. If I am wrong on that, I would be very grateful if he could correct me.

What I would like to hear is whether the Secretary of State is willing to initiate talks with the Chancellor about revamping VAT and excise duties on alcohol so that low-alcohol drinks would not contribute anything, or very little indeed, in the future but we would start to tax at a much higher rate the stronger alcohol, which is particularly damaging to people’s health and which at present does not attract particularly high taxes. I am looking to see whether the Government are prepared to investigate a more differential approach to taxing alcohol.

Wine consumption has increased, particularly in recent years, and, as many people know, wine has got stronger and stronger. At one time it was 11% or 11.5%. Now it is in the order of 13%, 14% or even 14.5%. This is especially true of the red wines from the New World.

Happily, one of the positive sides of Brexit—this freedom we have—is that it will provide greater freedom for adjusting taxation. Such a change could not only raise income for the Exchequer; higher taxes on stronger alcohol could be an inducement for people to drink lower-strength alcohol, which would be better for them.

Is the Minister aware that the Institute for Fiscal Studies has recently done some research on this? Indeed, in February it produced a report which indicates that moving towards the differential taxes I have been describing could meet half the cost of the welfare bill, which of course is a major account the Exchequer has to deal with annually. Whether or not that is a starter remains to be seen, but I would be grateful if the Minister had a look at that report and let the Committee know whether he thinks the idea is worth pursuing, as well as raising the issue with his Secretary of State.

This week I have been to two parliamentary health meetings, one on gout. “Gout is not a laughing matter” was the title of the gathering. It was interesting to learn that one in 40 people in the UK now has gout, and its prevalence is rising. It rocketed between 1997 and 2012 by an astonishing 64%. Again, much of this is linked to the increased consumption of stronger red wines, and to obesity.

Alcohol is a major contributor to obesity, although many people are not aware of this. The drinks industry has managed to evade the usual labelling requirements for calories and sugar content in products. The Government have failed to effect changes here because they have prayed in aid existing EU regulations on labelling, which they say have prevented them moving in this direction. Showing calories and sugar content in alcohol is not required in Europe. There was an attempt to introduce such a requirement in Europe but it was overturned, so we must stick by existing EU regulations. Again, Brexit means we will have a freedom here we did not have previously. I have been campaigning for a long time to have calories shown on alcohol labels. People should know what they are consuming, just as they do with most other products. Why is it not happening?

In fairness, some producers, such as Sainsbury’s, which has its own brands, have shown calories. Sainsbury’s did that because research indicated that drinkers wanted to know about what they were drinking. Why should it not apply elsewhere? I would like to know what the Government are doing on this, given that they now have a strategy on obesity.

Alcohol also contributes to type 2 diabetes, which is reaching epidemic proportions. There is a direct link there. About 10% of alcohol contributes to diabetes and we need to get some movement on that.

This week I also went to a meeting of the All-Party Group on Liver Health—I declare my interest as patron of the British Liver Trust. Liver disease is now costing £2.1 billion a year, up 400% since 1970, and the upward curve continues in the UK while in Europe the cost is declining. There must be a reason for this, and we should be looking at what it is. This is a great problem for A&E departments, as mentioned in previous exchanges with the Minister. Alcohol is a contributory factor in 70% of A&E cases at the weekends, and I would like to know what the Government intend to do about that.

We need to start examining a whole range of other options, particularly given that this week, the Government are taking steps to withdraw certain free prescriptions. We need to look at the 9 million people with hypertension who are getting NHS medication for it. We need to look at the millions of people—and the number is increasing—who are on tablets for depression. Will the Minister say whether people who are on medication for depression should not be drinking alcohol, and whether it is permissible? If in fact, as I know, many people are taking tablets but still drinking, is it not time to look at that in the context of developments this week? People should have a choice: either they take the tablets for depression and stop drinking; or, if they want to continue drinking, they should pay for their tablets over the counter.

I saw the figures in a recent Written Answer from the Minister on how much is being spent on medication—it has rocketed since 2010. We have to start looking for a different approach. We need the Government to accept responsibility for the policy areas they can control. We need the industry to accept greater responsibility—I will not go on about the industry in great detail today; I will leave that for a separate debate—and we need people to take more individual responsibility, given this new world in which the NHS is under great financial pressure. I hope I will get a positive response on many of these points from the Minister, and maybe we can look forward to a wider debate on drawing up a real strategy in the future.

My Lords, this is an important debate, and I thank the noble Lord, Lord Brooke of Alverthorpe, for initiating it.

A recent study in the south-west showed that one in three adults exceeds the permitted government guidelines and that 83% of at-risk drinkers see themselves as moderate or light drinkers, whereas 69% are not concerned about how much they drink. There appears to be a common assumption that the benchmark for too much alcohol is when control is lost on the occasional bender, reliance on alcohol is required to get through the day or a bad hangover is experienced. Few understand the risk to their health, their family or the wider community. High blood pressure, mental health, accidental injury, violence and liver disease are just a few health issues directly linked to alcohol. As the noble Lord, Lord Brooke, mentioned, liver disease is arguably one of the biggest health issues facing the NHS along with deep-seated serious health problems, and the harm is being done to a large extent in the privacy of people’s homes.

Alcohol admissions and related injuries put A&E departments under huge pressure. Estimates have suggested that three in every 10 patients attending A&E are there because of alcohol. People are calling ambulances like cabs to ferry them to hospital when they become incapacitated. Those who are not injured often just need to sleep it off in a place of safety, but they arrive in A&E by ambulance or cab or are taken there by friends. Those who have sustained injuries can be aggressive towards staff, leading to staff being vulnerable and of course adding to the difficulty of treating the injury.

Alcohol harm knows no boundaries. Its tentacles can affect anyone in a community—rich, poor, young, old, the well-educated and those who are not. What can be done? There is no easy solution. Perhaps the following could help towards people being more responsible about their drinking as well as cutting the cost to the NHS. A combination of price control and taxation would successfully target those who drink more of the cheapest and strongest alcohol products.

A comprehensive cultural change is required to educate young people towards activities that do not revolve around drinking. Is an advertising campaign the way forward to educate parents and families about the dangers? Parents play the biggest role in educating their children about the dangers of alcohol abuse. Parents should know who their children are hanging around with and make an effort to get to know the parents of their children’s friends. When parents are involved, they are more likely to be able to pick up the signs of any problems. Of course, that is the perfect scenario and, as we know, many children come from homes where good parenting is not the norm, so educators have a role to play.

Effective approaches include teaching students how to resist peer influences and improve life skills, involve families and provide students with the opportunities to get involved with positive experiences. There is no point in just lecturing on the dangers. That tends to cause most teenagers just to switch off. What programmes are available in schools? Is health and well-being part of the curriculum, particularly in primary schools where recent reports suggest that one child per week is being excluded for heavy drinking. Perhaps the alcohol industry should be asked to contribute towards the cost of these classes. What training are GPs and psychiatrists being given to recognise the signs of alcohol misuse?

The Nelson Trust, a drug and alcohol treatment centre in Gloucestershire, is talking with the local CCG to consider placing workers in A&E to target frequent visitors whose admissions are alcohol related. A senior nurse told the charity that local hospitals are doing 30 in-patient detoxes a month on individuals who have come into hospitals because of a fall or a gastro problem, for example, and who are found to be alcohol dependent. They require a 10-day in-patient stay only to go out and repeat the process. We are fortunate in this country to have experienced, successful charities involved in addiction. Let us have a joined-up approach and use their expertise in medical settings and educational facilities.

We all have a responsibility to ensure that alcohol is drunk in a responsible way. As an A&E consultant pointed out, it appears that people do not make plans at the end of an evening to get home safely or look after their friends. A whole department can be disrupted from just one drunk patient. The Government’s role is to address the problems caused by alcohol and to support people to stay healthy without unfairly affecting responsible drinkers and businesses.

My Lords, I am pleased to be associated with the short debate this afternoon in the name of the noble Lord, Lord Brooke of Alverthorpe, as it enables me to make a few comments relating to my personal expertise and draw the attention of noble Lords to the effects that alcohol and excess alcohol have on the mouth, larynx, pharynx and oesophagus and the consequential costs to the NHS. I declare my interest as a retired dental surgeon and a member and fellow of the British Dental Association. I am a vice-president of the British Fluoridation Society and a life vice-president of the Society for the Advancement of Anaesthesia in Dentistry.

Alcohol and lifestyles closely associated with alcohol can have detrimental effects on dentition—dental erosion, dental caries and periodontal disease being the most common. The new dental contract reflects the aims of the UK Government to focus the attention of dental healthcare professionals on quality, treatment outcomes and how well their patients are looked after. There is now more emphasis on health promotion. Since alcohol misuse affects patients’ general health, tackling that abuse is therefore important for primary care dental professionals from a purely dental perspective. Addressing this in primary care settings also enables dental professionals to meet wider health promotion responsibilities.

As we have already heard, alcohol causes at least seven different types of cancer, and oral cancers are among those most closely linked to drinking. About 70% of people diagnosed with oral cancer are heavy drinkers. There are almost 7,000 diagnoses a year. This means that almost 5,000 heavy drinkers will be struck by mouth cancer every year. The risk is even greater for those who tend to drink and smoke at the same time. It is estimated that heavy drinkers and smokers have 38 times the risk of developing oral cancer than those who abstain from both products.

This particularly debilitating disease, which kills thousands and leaves many of the survivors with disfigured faces and difficulty in eating and speaking, is, worryingly, one of the fastest-increasing types of cancer, with cases up by almost 40% in the past decade. It now kills more people in the UK than cervical and testicular cancer combined. Yet awareness of it and of the role that drinking and smoking play in causing it remains stubbornly low.

Dental professionals are on the front line in the fight against cancer. Dentists are uniquely placed to diagnose oral cancer very early on before the patient notices any symptoms and seeks help. This is crucial, as mouth cancer patients have a 90% chance of survival if the condition is detected early, but this plummets to just 50% if the diagnosis is delayed. As dental teams are the only health professionals who see healthy patients on a regular basis, they are also in a unique position to provide brief advice and support to their patients who drink above the lower risk levels, warning them not just of the increased risk of oral cancer but also of the possible periodontal disease and tooth erosion that is associated with drinking some types of alcohol. Where appropriate, dental professionals can signpost higher-risk patients to their GP or local alcohol services, with such early intervention helping to save the NHS money further down the line.

Screening and primary dental care would involve similar strategies to those used by primary medical practitioners, using the same valid and reliable questionnaires and motivational interventions developed in psychology. These have been found to be effective and cost-beneficial in some dental settings. Although suitable screening tools and treatment interventions are available, it is unclear which of them are most effective and precisely how and when they should be deployed in primary dental care. It is clear, however, that the dental team can contribute and that this contribution fits well with its responsibilities and interests.

My Lords, I thank the noble Lord, Lord Brooke, for his persistence in keeping the matter of alcohol abuse on the parliamentary and government agenda.

Evidence and reports abound on this matter. Public Health England did a thorough evidence review in 2016, the Government’s alcohol strategy was issued in 2012 and there are numerous reports detailing the cost to the NHS, which has been outlined as £3.5 billion a year. Last year there was an excellent report by the APPG on Alcohol Harm called The Frontline Battle about the huge burden on the emergency services caused by alcohol misuse. However, there is precious little mention in these reports—or, therefore, praise or policy from Her Majesty’s Government in this regard—of how alcohol and its use varies in religious and ethnic minority communities, the Joseph Rowntree Foundation report in July 2010, Ethnicity and Alcohol: A Review of the UK Literature, being a notable exception.

What is known is that in many ethnic minority communities the rates of abstinence are higher. According to the Public Health England evidence review that I have mentioned, 15% of white women, 38% of black women and 74% of British Asian women abstain completely. There are many reasons for this, including the physiological. According to the Berkeley university well-being project, it is very common in people from Chinese, Japanese and Korean backgrounds to have difficulty digesting alcohol because of a genetic variant that impairs the production of an enzyme that helps to metabolise alcohol in the liver. Within religious communities such as the Latter-day Saints, Muslims, the Salvation Army and Methodists, and for many within the black Pentecostal churches, refraining from alcohol is advocated, which may explain the lower levels of alcohol consumption in the British black and black Caribbean communities.

While the main government messaging needs to remain around drinking sensibly as this is the majority activity, the lack of commendation by the NHS and government Ministers of religious and ethnic minority communities, particularly Muslims, who refrain is remiss. Having taken part in the parliamentary police service scheme and been out on a Friday night on Shaftesbury Avenue, it is not people in obvious religious attire such as Muslim women or Salvation Army leaders that you see literally in the gutters and then appearing at A&E—a fact that is just not mentioned. These religious and ethnic minority communities are indeed ahead of the curve as they are in tune with the rising number of young adults, the millennials, who drink in moderation or do not drink at all.

Studies have shown that where there are young adults in a college setting with a significant number from a black or minority ethnic community, overall the young people in that group drink less. It has an effect of good peer pressure within the group. Yet the lack of evidence is serious as without it there are none of the bespoke policies needed to help those in these communities who drink. There is evidence that when such people drink they do so at higher levels, hidden away and facing barriers to accessing the help they need from the NHS. Also, if you drink without the enzyme to break down alcohol there are greater health risks and a higher incidence of hypertension. I have not seen any awareness of this within the NHS.

A national piece of work, looking at the evidence and policies in Yorkshire mill towns, city centres such as Birmingham, Chinatown and boroughs such as Lambeth is well overdue. It would show how much ethnic minorities save the National Health Service but also any deficiencies so that people could then access services they need. Perhaps religious leaders could also help bring down the barriers for communities when they need to access other professional services.

My Lords, I am grateful to the noble Lord, Lord Brooke of Alverthorpe, for raising this Question for Short Debate today. I recently had the honour of serving with him on the Licensing Act Select Committee and am therefore aware of his concerns about the damaging effects of excessive alcohol consumption. I very much respect his long-term commitment to raising awareness of this matter. It is appropriate that I declare my interests as set out in the register, in particular my role as CEO of the Association of Conservative Clubs, a private members’ club group with some 850 members’ clubs located throughout the UK.

I believe that the vast majority of the population enjoys alcohol with no problems at all. In moderation, alcohol plays an important and beneficial role in the nation’s life. A society that socialises together is a stronger one. For many people, drinking provides and has always provided social cohesion. I made many points in my maiden speech about when, if used in moderation and linked with socialising, alcohol can play an important role in alleviating some life-limiting lifestyles. It is a recognised fact that people who enjoy an active social life avoid loneliness and the devastating effects that isolation can have on a person’s health. Pubs, clubs, restaurants and bars provide a significant part of most people’s social lives. Whether it is meeting family or friends, watching sport or celebrating a special occasion, the common denominator for many is having an alcoholic drink. By and large, this is enjoyed responsibly and without repercussions.

Of course, I recognise that for others alcohol can become a poison and a prison. It is undoubtable that alcohol puts an enormous strain on front-line services, not least the NHS. Would my noble friend the Minister consider updating the direct cost to the NHS that was put at £3.9 billion back in 2014? Then we would have an up-to-date figure of exactly where we stand. We know that per capita alcohol consumption has fallen by more than 17% during the last 10 years. Alcohol-related crime is down and the number of young people consuming alcohol is down by 38% since 2004. Alcohol-related hospital admissions for those under 40 has declined by 11% since 2010 and alcohol-related deaths have fallen by 10% according to the Office for National Statistics. The UK today drinks less alcohol than 16 other European countries, according to the World Health Organization.

However, I would be the first to say that there is still much more to do to prevent people who are sensible consumers of alcohol becoming the irresponsible minority who deliberately drink to destruction, to deter existing nuisance drinkers who pre-load on cheap alcohol and cause trouble in our villages and towns, and to help those who are sadly addicted to alcohol, harm themselves and their families, and greatly risk promoting the cycle of self-abuse and alcoholism on to their children and the next generation. Does the Minister feel that enough is being done to treat people who are addicted to alcohol in the UK? Does he feel that these treatments are proving effective?

There is an increasing trend of stay-at-home consumption, with large quantities of alcohol being purchased—often very cheaply—from supermarkets and off-licences. I have concerns that some of the deals on offer for beers and lager can cut down the cost to as little as 63 pence per pint. I am also concerned that recent statistics show that as much as 40% of all alcohol purchased in the UK is bought by only 10% of the adult population. Does the Minister think that more could be done to restrict offers and implement safety mechanisms within the off trade on a par with those that exist in the on trade?

Local alcohol partnerships are playing an important role in creating healthier, safer high streets. Organisations such as the Portman Group, Best Bar None, National Pubwatch and Purple Flag are working with the alcohol industry and local authorities to tackle crime, disorder and underage sales. Importantly, they are also working to improve responsible alcohol marketing and to provide education and information about the damaging effects of excessive consumption. I hope the Minister will agree with me that education on matters such as smoking has vastly improved, and the same could be achieved on excessive consumption of alcohol.

Finally, I offer a further point for consideration. Every time the police issue a fine for drunk or disorderly conduct, those funds could be shared with the ambulance service. The police do an excellent job, but so does the ambulance service, and it is rare that the two are not in partnership with each other on these regrettable occasions. We have a responsibility not to limit the freedoms and activities of people, while also providing safeguards and information for those who are vulnerable. I look forward to hearing the Minister’s response to the debate today.

I, too, congratulate the noble Lord, Lord Brooke of Alverthorpe, on securing this important debate. Last January, I chaired a seminar run by the All-Party Parliamentary Health Group on developing a long-term strategy to reduce the harm from alcohol consumption. We heard from several eminent contributors whom I shall mention as I go along. We started with Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, who described the burden of alcohol harm. He told us that, statistically, alcohol is the number one risk factor for premature death in the UK today. The BMA tells us that 60 different medical conditions are caused by alcohol abuse, and are therefore preventable. Sir Ian Gilmore said that 70% of presentations at A&E on a Friday or Saturday night, and about 20% of all hospital admissions, are related to alcohol. Interestingly, mental and behavioural disorders due to alcohol use account for almost 20% of those admissions, so we know that we are talking about mental, as well as physical, diseases. We know what the diseases are; several noble Lords have referred to them today. In addition to those physiological diseases, of course, accidents are caused by alcohol use, and there are a lot of hospital admissions because of those, as well.

Sir Ian was followed by Dr Mirza, an emergency medicine consult from West Middlesex University Hospital. He began by shocking us all with four real-life but typical situations that had taken place in his department over the past month. They included drunken patients attacking staff or police officers, running rampant and breaking thousands of pounds- worth of hospital equipment, requiring to be restrained and taking up hours of time of the staff, meaning that other sick patients were not treated for hours. The disruptive effect on the department was enormous, he said, and added additional strain to an already overstretched A&E department.

What does all this cost the nation? The Government themselves estimate that it costs £3.5 billion a year to the NHS, £11 billion a year on criminal justice and £7.3 billion in lost production, a total of £21 billion a year. What could the NHS and social care do with that money?

In addition to these costs and the burden of disease, there are costs for children and families. My daughter-in-law is currently writing a PhD thesis about the scale of domestic violence following excess alcohol consumption after major sporting events. Dr Mirza pointed out that there are many children living with one or more parents with an alcohol-related problem, resulting in mental and emotional strain and poor academic attainment for the child.

What are the options for reducing these harms? First of all, we have to ensure that young people are educated in their PSHE lessons about the harm that alcohol can do. We heard from Professor Yvonne Kelly, Professor of Lifecourse Epidemiology at University College London, that, of those adults who drink, 80% to 90% of them start in the second decade of life. Pleasingly, as someone has said, there has been a fall in the number of underage drinkers in the past 25 years, and I put that down to education. However, she told us that the amount being drunk by each underage drinker shows no sign of falling, so these are the people we need to target. A number of options were suggested to us, including those affecting price, labelling, marketing, advertising, availability, low-alcohol options, help with behaviours, et cetera. Many of these have excellent evidence of effectiveness, according to the academics.

I have a number of questions for the Minister. Has he done an impact assessment of the reduction in alcohol abuse services following the cuts to public health budgets? Is he aware that this money is well spent? For every £1 spent on alcohol treatment, £5 of public money can be saved. We know that a five-minute chat from a health professional can have a major effect on a person’s drinking habits, yet GPs do not have time to do this in a 10-minute appointment. Will the Minister publish imminently the Government’s new alcohol strategy, and will he consider including in it minimum unit pricing to tackle products such as white cider, which I was staggered to discover costs only 15p per unit of alcohol and is used mainly by very problematic drinkers? Will he ask the Chancellor to increase the general cost of alcoholic drinks? Given what the noble Lord, Lord Brooke, said, what can he do to reduce the comparative cost of low or zero-alcohol products? Will he issue guidance to local authorities which authorise licences to ensure that health is a factor in licensing decisions, so that they understand the effect of long opening hours and high density of premises selling alcohol? Alcohol action areas have already proved the effectiveness of reducing density and hours.

Will the Minister also look at what can be learned from the policies on tobacco? I agree with the noble Lord, Lord Brooke of Alverthorpe, about labelling. Labelling of tobacco products showing the health damage they can do could easily be replicated with alcohol. Alcoholic products should not only show the calories and units of alcohol they contain but also have a reminder of the Chief Medical Officer’s advice about maximum weekly consumption and alcohol free days. Perhaps we can do that after Brexit.

There is evidence that increased exposure to alcohol increases the chances of children drinking, so will the Minister also include in the policy a ban on advertising of alcoholic products before the watershed? Will he also consider banning alcohol sponsorship of sports events for the same reason? The health and economic benefits of all these actions would be immense.

My Lords, I welcome the debate. My noble friend made a very powerful statement about the major challenge that we face over alcohol abuse and the knock-on impact on the National Health Service. He opened by asking for an honest debate about funding. The report of the Select Committee of the noble Lord, Lord Patel, will be issued on Wednesday, and I hope that it will lead to an open debate. However, no one can be in any doubt about the seriousness of this situation for the NHS. This morning, the chief executive of the NHS Confederation said that there now has to be a trade-off between, for instance, fast, efficient emergency care and non-elective surgery. That shows the state that we have got to. Clearly, the impact of alcohol abuse on the NHS is significant.

My noble friend’s speech was particularly persuasive in relation to low prices. Public Health England produced a very good report on the public health burden of alcohol and the cost-effectiveness of alcohol control policies. That report had a lot of good things to say. The noble Baroness, Lady Walmsley, has already referred to the £20 billion a year cost to our society in relation to criminal justice, the economy and the health service. In addition, there is the fact that we now have over 1 million alcohol-related hospital admissions per year, and the kind of pressure it puts on the health service and the emergency services, as the noble Lord, Lord Smith, referred to. PHE points out that the average age at death of those who die from alcohol-specific causes is 54.3 years, compared to 77.6 years for death from all causes. The other very striking statistic is that more working years of life were lost in England as a result of alcohol-related deaths than from cancers of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate combined. Therefore, the scale of this disease, as we need to call it, is very striking indeed.

My noble friend obviously did not dwell much on taxation and price regulation, because he covered a much wider canvas. However, the analysis by Public Health England said:

“Implementing a minimum unit price is a highly targeted measure which ensures any resulting price increases are passed on to the consumer, improving the health of the heaviest drinkers”,

is surely right. As PHE points out:

“The MUP measure has a negligible impact on moderate drinkers”—

who we do not want to undermine—

“and the on-trade”.

I hope that the Minister will be able to say something about where the Government are on the MUP.

I pick up the point raised by my noble friend and the noble Baroness, Lady Walmsley, on labelling. Post Brexit what the Government do about labelling will be entirely in their hands. As the Minister is responsible for the Department of Health’s response to Brexit, can he say what work is now being done by either his department or Public Health England to look at what the Government are going to do when they have control over labelling? Potentially, we could be much more effective than current EU regulations allow us to be.

Finally, I acknowledge a very good briefing that I had from the British Medical Association on this issue. It has set out a number of requests—principally, that the Government should:

“Publish a new updated alcohol strategy”.

Will the Minister agree to do that? It mentions minimum unit pricing and reducing,

“the affordability of alcohol through taxation measures”.

It makes an important point about ensuring that health,

“is a key factor in licensing decisions”.

I know that we will receive a Select Committee report on the implications of the big change in licensing 10 or 12 years ago. However, this obviously needs to be considered very carefully. The BMA also goes on to ask for an implementation of,

“evidence-based measures to reduce drink driving levels”,


“a range of measures to reduce and better manage pregnancies affected by alcohol”,

and makes a number of other requests. At heart, there is a request to the Government to take stock of the pressures that we face, update the current alcohol strategy and take some courage in their hands and be prepared to move on from the rather insipid voluntary approach that we have to a tougher approach, in which they must look at taxation and a minimum unit pricing policy.

My Lords, I congratulate the noble Lord, Lord Brooke, on securing this important debate and on his obvious tenacity in pursuing this issue. I am sure that this will be the first of many occasions we will have to discuss this matter. I also thank all noble Lords for a wide-ranging, well-informed and informative debate.

I think all noble Lords accept that the vast majority of people who consume alcohol—whether in my noble friend Lord Smith’s clubs or elsewhere—do so as a pleasurable and indeed even positive part of their social lives. However, we also know there are very serious harms and health costs associated with alcohol misuse, which is estimated, as the noble Lord, Lord Brooke, and other noble Lords have pointed out, to cost the NHS around £3.5 billion a year. The recent Public Health England evidence review tells us that alcohol is now the leading risk factor for ill-health, early mortality and disability among 15 to 49 year-olds in England, causing 169,000 years of working life lost. That is more than the 10 most frequent cancer types combined—a truly alarming figure. As the noble Lord, Lord Colwyn, pointed out, that is having an effect in specific areas such as increases in oral cancers.

Alcohol misuse is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, a number of cancers, as has been said, and depression. Alcohol-related deaths have increased in recent history, particularly deaths due to liver disease, which saw a 400% increase between 1970 and 2008. As several noble Lords have pointed out, that is in contrast to trends seen across much of western Europe and, as my noble friend Lady Berridge pointed out, it is also in contrast to outcomes in many minorities in the UK. It is not so much a British problem as a problem of certain communities within Britain.

In the UK, there are currently more than 10 million people drinking at levels that increase risk to their health. Those health risks, as the noble Baroness, Lady Walmsley, pointed out, are both mental and physical. They lead to more than 1 million hospital admissions annually, half of which occur in the most deprived communities, so this is also an issue of social justice. My noble friend Lord Smith was right to point out the work that the police, the ambulance service and other public services do to deal with—mopping up, sometimes physically as well as figuratively—the results of alcohol misuse. I take this opportunity to pay tribute to their work; they often have to deal with both physical and verbal violence in doing so.

We also know the tragedies that can occur from mothers drinking alcohol during pregnancy, leading to problems after birth. This is not just a UK but a global issue. To address the challenges of the prevalence of fetal alcohol syndrome disorders, the WHO is starting a global prevalence study. We will consider lessons from this for further work in the UK.

It is also important to recognise the devastating impact that addiction has on individuals and their families. It is unacceptable that children have to bear the brunt of their parents’ conditions. I was shocked to learn that, according to Alcohol Concern, 93,500 babies under the age of one, which I make to be about a sixth or seventh of the cohort, live in a family where a parent is a problem drinker. As the noble Baroness, Lady Walmsley, pointed out, there is a link to domestic violence which affects not just children but also partners. My colleague, the Minister for Public Health and Innovation, recently met with members of the All-Party Parliamentary Group on Children of Alcoholics to set out our plans to work with MPs, health professionals and those affected to reduce the harms of addiction and support those who need it. I am sure that noble Lords will agree that that is an important mission.

However, I am glad to say that we can also observe some promising trends regarding alcohol. As my noble friend Lord Smith pointed out, the figures for alcohol crimes and deaths are down, although there are other problems which we have talked about. People aged under 18 are drinking less, which stands in stark contrast to the data for the over-65s who are drinking more—I am not looking at anyone here—and there has been a huge increase in the number of hospital admissions for the over 65s in recent years of more than 130%. Nevertheless, there has also been a steady reduction in alcohol-related road traffic accidents.

We also have social action campaigns, such as Alcohol Concern’s dry January, in which I have taken part over the past few years, as I am sure other noble Lords have too, which are starting to change attitudes. The point that my noble friend Lady Berridge made about minority and religious groups leading the way was incredibly important. I accept her point about the need for appropriate analysis of how to communicate with those communities. We were unable to get the information, admittedly at short order, that she wanted, but I shall certainly write to her and put a copy of the letter in the Library for noble Lords. She makes an important point and she may have highlighted a weakness in the current strategy.

We have also seen real progress through working in partnership with industry: 1.3 billion units of alcohol have been removed from the market by improving the choice of lower alcohol products; nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels; and we have published guidance on updating the health information contained on labels better to reflect the latest advice on alcohol published by the UK Chief Medical Officer.

Several noble Lords asked about calories and labelling. This is an area where the European Commission is looking at legislation. It is not always the fastest moving institution in the world, and we have of course just signalled our intention to leave the European Union, but we will certainly look at that legislation as it comes through. It is fair to say—although I am not in a position to make a commitment at this point—that the UK has been a leader in this kind of area, not just on drink but on smoking as well, and I hope that, looking ahead, we would continue that leadership position.

An essential part of our strategy to tackle alcohol harms is the provision of high-quality, evidence-based treatment services. Local government now has the responsibility to improve people’s health, in particular on the public health side. This includes tackling problem drinking and commissioning appropriate prevention and treatment services for the local population’s needs. Several noble Lords asked about addiction and spending on cessation services, which increased from 2014-15 to 2015-16, even within the context of challenging budgets for public health. I see this as a positive move, but it is something to be kept under review.

The NHS remains critical to preventing alcohol harms. There is a new scheme to incentivise investment in alcohol interventions. The national Commissioning for Quality and Innovation indicator has been developed, and in the way beloved of the NHS, it has been given the acronym CQUIN. It links a proportion of service providers’ income to the achievement of national and local quality improvement goals. The practical effect of that is that every in-patient in community, mental health and from 2018-19 to acute hospitals, will be asked about their alcohol consumption and, where appropriate, will receive an evidence-based brief intervention or a referral to specialist services. The noble Baroness, Lady Walmsley, pointed out that the evidence shows that people who receive a brief intervention are twice as likely to have moderated their drinking six to 12 months after the intervention when compared to drinkers receiving no intervention, so it is obviously a low-cost but highly effective action.

In addition, as my noble friend Lady Chisholm mentioned, by 2018, around 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated problems. My noble friend Lord Colwyn pointed out that dentists have a vital role in prevention and spotting early problems. The new dental contract means that there has been an increasing number of patient episodes, and Public Health England has developed an alcohol training resource for dental teams. I would be interested, as a follow-up, to find out if that has been successfully adopted within the profession that he represents.

Furthermore, the inclusion of alcohol assessment and advice in the NHS health check, which is offered to all adults in England aged 40 to 74, means that GPs and other healthcare professionals can offer advice to promote a healthier lifestyle. Since we mandated the alcohol assessment and advice component, nearly 5 million people have had a check. Referral to alcohol services following an NHS health check is around three times higher than among those receiving standard care, which is yet another example of how a small nudge in the right direction can make a great impact.

Several noble Lords talked about providing people with the right information so that they can make informed choices. Last year, Public Health England launched the One You campaign to help motivate people to improve their health through action on the main risk factors. This includes a drinks tracker app to help drinkers identify risky behaviour and lower their alcohol consumption and a new “days off” app to encourage people not to drink alcohol for a number of days a week, in line with the CMO’s recommendations.

My noble friend Lady Chisholm and the noble Baroness, Lady Walmsley, asked about education. PSHE is obviously a critical part of making sure that young people are informed about their choices. There has been a review of the PSHE curriculum—we have seen a strengthening of PSHE in recent announcements by the Secretary of State for Education. There must be, at least in part I think, some impact on the positive trends that we are seeing among young people in lower drinking, although it is of course hard to isolate what exactly causes that. We know, however, from the smoking environment that constant public health campaigns do have that impact, particularly for younger people. It is also notable that while the incidence of mental illness has unfortunately and sadly increased among young people, there has not been the same increase in drinking. That is an interesting inverse correlation that is worthy of further investigation.

Several noble Lords asked about the affordability of alcohol. In this context you think of Hogarth’s “Gin Lane” and “Beer Street”, and the important role that taxation has historically played in changing drinking habits. The UK currently has the fourth highest duty on spirits among EU member states, and higher-strength beer and cider are already taxed more than equivalent lower-strength products. In relation to a move in the direction that the noble Lord, Lord Brooke, pointed to, noble Lords may know that it was announced in the Budget that duty rates on beer, cider, wine and spirits will increase by RPI inflation. In addition, a consultation is currently seeking views on the introduction of a new band to target cheap, high-strength white ciders which are a particular problem among young people. It is also seeking views on the impact of a new lower-strength still wine band to encourage production and consumption of lower-strength wine—another point talked about by the noble Lord, Lord Brooke. It is worth touching briefly on minimum pricing. I am afraid that my answers are entirely predictable on this issue. We await the conclusion of the court case. I will, however, look at the IFS report that was mentioned and we will keep a close eye on that issue going forward.

The noble Baroness, Lady Walmsley, asked about advertising, as, I believe, did the noble Lord, Lord Hunt. The Advertising Standards Authority has a vigorous approach to preventing advertising to children and young people, but I am assured that it is kept under review to make sure that it is having an impact. Again, it is worth investigating whether that has had an impact on the lower instances of drinking among young people.

It would be wrong for Ministers to restrict the treatments offered to young people. That is a clinical decision, although I know that clinicians are increasingly trying to change the behaviours of smokers and drinkers before providing significant treatments. There is also a link between drinking and depression, as the noble Lord rightly pointed out.

I close by again congratulating the noble Lord, Lord Brooke, on securing this debate on such an important subject. Alcohol misuse has a significant impact on people’s health, the NHS, the wider care system and society in general. I also believe, however, that progress is being made. The Government remain deeply committed to ensuring that people are given the information and support—and if necessary the treatment—that they need to reduce harms from alcohol. I look forward to working with the noble Lord and all noble Lords to reduce alcohol misuse in the years ahead.

Committee adjourned at 5.58 pm.