HC Deb 21 December 1967 vol 756 cc1553-69

3.29 p.m.

Mr. W. S. Hilton (Bethnal Green)

The problem which I am raising today— the treatment of crude spirit drinkers— has occupied the House before. It has certainly occupied the attention of most voluntary organisations in my constituency of Bethnal Green, as well as the attention of the local authority. A special Review Committee on the problem was set up by the London County Council just before it went out of existence. That Committee made an extensive report which contained a number of recommendations which would be of value to those studying the problem.

I am grateful to Mr. Speaker for having given me this opportunity today to raise the problem on the Floor of the House, and particularly for having given me the chance to explain in detail to the Ministries responsible exactly what I think will happen in the East End of London if they persist in taking no official action whatever about this problem. I informed the Home Office, who are also concerned with the problem, and if there is no spokesman present from the Home Office, that is certainly not because I have failed to notify them.

I raised the question of crude spirit drinkers in the House in November last year. On that occasion the Minister of Health told me that he was awaiting a survey of the problem and that it might guide him when he made some decision on the matter. He was certainly not unhopeful that he might be able to do something arising out of that report. I waited a year, until 11th December, before putting down a Question asking him what stage the report had reached and when he expected to receive it. I also asked him whether he had taken any cognisance of the fact that in the East End of London the situation had already reached boiling point, that the local authority had met and had decided that they could do nothing in the problem, and yet the interests of their residents demanded that the Government Departments concerned did something about it.

Those were the two points which I put to the Minister of Health, and, without wishing to be rancorous in any way, I must say that I regarded his Answer as discourteous, in that he did not deal at all with any of the matters which I had raised on 11th December. He completely ignored the points which I had put to him, and in his Answer he simply said that he had taken some advice on the matter and that voluntary treatment was available. He said nothing about the report—whether the report was in process of being compiled or when the House would have the report. He said nothing about the considerable anguish which exists in the borough of Tower Hamlets. In fact, he completely ignored the problem.

When, in my supplementary question, I asked him what kind of voluntary treatment he meant, he went from discourtesy to impertinence by saying that there was a five-bed unit for alcoholics at one of my local hospitals. It was impertinence, because this reply showed either that the Minister had no desire to deal with the problem or that he knew nothing about it, because no one who knows what is happening in the East End of London among these crude spirit drinkers would seriously suggest to the House that a five-bed unit for alcoholics goes anywhere near touching the problem.

There is a difference between an alcoholic and a crude spirit drinker, and the House should get that difference quite clear. I know alcoholics—and I am not putting this forward as something on which I deserve to be complimented— who are able on a day-to-day basis to run a business and to conduct themselves reasonably. When they resort to the bottle, it is a distastrous part of their lives, but it does not completely incapacitate them from doing something useful. Anyone who has seen these crude spirit drinkers wandering around the streets of my constituency, as I have seen them, knows the difference between the alcoholic whom I have just described and the shambling and mentally and physically broken-down inhabitant of the bombed sites in Bethnal Green. Yet I am told that a five-bed unit exists for alcoholics on a voluntary basis and that that is the answer to my question.

I should like to thank the Parliamentary Secretary for his courtesy in attending today, as the Minister is not here, and to tell him that to the best of my knowledge there are 200 crude spirit drinkers in the area which I represent. That figure is to the best of my knowledge, but I now know that some organisations might quarrel with my statistics and state that there are even more methylated spirits drinkers in the East End of London. In this matter, at least, I want to be conservative and will not overplay the number. This social problem of crude spirit drinkers is taking place in an area which I would say surpasses most other London boroughs in the great social problems that exist for the residents, quite apart from the problem of the crude, spirit drinkers. This is another burden which the residents have to bear.

What does it mean to the residents? For the information of all the do-gooders and all the lady bountifuls who have been travelling into the East End by car, and who are able afterwards to slip out of the area in their cars and to leave the problem behind, I would tell them what the problem means to the residents of the area. First, there are a number of parks in the borough of Tower Hamlets which are kept going by public money for the benefit of the citizens of the area, but which simply cannot be used by those citizens because they are constantly inhabited by methylated spirit drinkers who are conducting themselves there in a way which most hon. Members have never seen.

Not only have my residents to witness such conduct, but their children have to witness it, too. The only alternative, so as to prevent the children from seeing constantly what is going on, is to say that these parks, initially provided for them, may not be used by them at all because they have been taken over by the crude spirit drinkers. Every day in the area in which they live the residents are subject to seeing all manner of public indecency committed by crude spirit drinkers, both men and women, who have completely lost mental and physical control of their faculties.

Those are the problems, and sometimes they are accentuated. At a meeting of residents the other night one of them told me that at 3.30 in the morning he was awakened by somebody banging on the door. It was a crude spirit drinker pleading to be let into the house. He said that it was not possible to let him in. The resident was a man with a wife and children and, even in a feeling of Christian compassion, no man in that position could let such a crude spirit drinker into the house. But that crude spirit drinker stayed there, and in the morning that resident's doorstep was covered in excrement and urine. No one came along and disinfected it or cleared it up for him. The family had to do it themselves. This is the fall-out which they suffer from the problem in my constituency.

Some of the residents have asked me, "Why cannot the council do something about the problem?" Naturally, the first thought of any ratepayer is about action by his local authority. He thinks that they ought to be able to do something when he is suffering a social evil in this way. In fact, the local authority are powerless. They have no powers even to clean a methylated spirits drinker. To the best of my knowledge it is illegal compulsorily to wash anybody, so that the local authority cannot legally clean up a methylated spirits drinker without committing an assault, for which no doubt some official could be arrested. Local authorities can do nothing about this problem except go to the Government Departments concerned, put the problem before them as forcibly as possible and ask them to accept their responsibilities.

This has been done. Not only have I raised the matter in the House, basically with the Ministry of Health, but representatives of my local authority have seen the Home Office. I am seriously dismayed at the lack of response which a very good local authority have had from these Departments. The borough of Tower Hamlets have had to deal with a great many social problems, and they have dealt with them successfully where that lay within their power, but when they go to Government Departments, and prove to the best of anybody's requirements that a grave problem exists in the area which cannot be dealt with by local means, they certainly deserve a better response from the Home Office than that which they received, and I deserved a better response in the House from the Ministry of Health than that which I received.

Once the residents have had it explained to them that the local authority is powerless, they ask about the police. I pay tribute to the police in my constituency, H Division of the Metropolitan Police, and part of the tribute should consist of the information that the local superintendent has the very best relations with the Residents' Association, which is complaining most bitterly and which has tried to do everything in its power to help with this trouble.

What does this problem mean for the police? There is not a single hon. Member who would like the job of an ordinary policeman on the beat when he has to arrest a meths drinker. If the policeman has to arrest him, it means that the van in which the meths drinker is taken to the police station has to be fumigated before it can be used again; the cell in which he is incarcerated has to be fumigated and there is a terrible stench all over the police station, especially if the meths drinker urinates, and the other prisoners, who may not be there for that kind of thing, also object. In addition, the policeman himself has to be cleansed. Nobody can cleanse the meths drinker, but the policeman has to suffer.

The next day the policeman has to take the meths drinker to the magistrates' court, but there is not a magistrate in London who wants a meths drinker in his court in the morning, especially because of the smell which accompanies him. He wants to get rid of him as soon as possible, and so he may give him one day's imprisonment, which means that a few hours later the meths drinker is back in my constituency, doing exactly the same kind of things. It is heartbreaking for the police to be expected to deal with such a situation, and it is heartbreaking at local level when the Home Office at national level is not prepared to do anything which would ease the task of the police.

Some hon. Members have suggested to me that voluntary bodies could do something to ease the situation, and I understand that the right hon. Member for Enfield, West (Mr. Iain Macleod) will be later saying something about what voluntary bodies can do. I want to deal with that from the point of view of someone who represents the area and who has been in close contact with the Residents' Association since he was elected, especially on this problem, and with every other organisation in Tower Hamlets dealing with it.

I have great reason to be thankful for the voluntary bodies in the East End of London which throughout many years have helped to care for some of our people who were destitute—especially in the old days—and who now deal with modern problems. But any voluntary body which tries to tackle a problem which is too serious for it to tackle successfully, a problem which is completely beyond its resources in terms of manpower or money, ceases to be helpful and becomes irresponsible. There have been voluntary associations in my area which have given crude spirit drinkers a night's lodging and some meals, and lately others have lived at the same level in order to help them. Throughout the years none of them has been successful and, because of the very nature of the problem, could not have been successful. The problem has not diminished as the voluntary organisations have come in, but in fact has increased.

The burden on the police has been increased. The local council has been prepared to tolerate perhaps more than any other council in London, and it has appealed to Government Departments for something to be done. The final result has been the growth of the Tower Hamlets Residents' Association, an extremely strong and vigorous organisation. This has all happened during the period when voluntary organisations have been given the right to tackle the problem, but during which time they have not been successful.

The Tower Hamlets Residents' Association has come in for some criticism. It has been attacked by people who believe that intellectually they have the answer to the problem and should be allowed to work it out voluntarily, people who are contemptuous of my constituents in the Residents' Association and who say that the residents should be grateful for living in an area in which there are social derelicts, that they should be thankful for having some of this terrible fallout and being able to contribute in this way to the rehabilitation of others. It is said that in some way or other it ennobles the residents. The residents of Tower Hamlets have no desire to limit the right of anybody to be ennobled, and if anyone who takes that view wishes to exchange his residence outside Tower Hamlets and come inside to be ennobled, I have plenty of constituents ready to exchange accommodation tomorrow.

The Association has done tremendous work for the borough, because it has canalised individual protests against what is happening in the area and, without it, the individual protests might have erupted into violence. I can give one example which relates to one of the parks which I mentioned earlier, Itchy Park— there is a fascinating history of why it is called that, but I shall not go into it now—a place favoured by crude spirit drinkers. There were such public scenes of indecency by meths drinking men and women not so long ago that 12 women residing in the area decided to take action themselves and to go to the park. Goodness knows what would have happened if they had got there, but the Residents' Association restrained them while at the same time telephoning the police and telling them what was happening and managing to contain the situation.

I suggest to the House in all seriousness that there is a limit to which the association can be expected to restrain people who are daily being subjected to these indecencies, and if there is any question of any meth drinker sexually molesting one of the children of these residents the association could not be responsible for the results—and that is a definite possibility in Tower Hamlets, because so far the Government have done nothing about it.

The Parliamentary Secretary to die Ministry of Health (Mr. Julian Snow)

I am listening to what my hon. Friend is describing most carefully, and I am beginning to understand the problem as he sees it, but I am not clear about what positive action by Government Departments he is suggesting.

Mr. Hilton

My hon. Friend will find out as I proceed. The fact that I have waited a year between putting down Questions shows that I am not impatient and that I am prepared to give the Ministry every chance to do something about the situation. I now want to deal with what the Ministry can do.

There has to be some compulsion. I know that any hon. Member who in this democratic assembly suggests compulsion has to be able to show that there is a great need for it and that it does not cut across the liberty of the individual. If we are discussing the liberty of the individual, I must put forward the right of my constituents, as individuals, to have the liberty to live in decency, and not be subjected to all these public indecencies.

Secondly, I have described the difference between the alcoholic and the crude spirit drinker. The crude spirit drinker has no control over his mental or physical abilities and capacities. Here is one way for the Ministry to take action. I also mentioned the L.C.C. report resulting from a committee's deliberations in 1964. The Ministry was aware of that report, and I cannot understand why it did not take action on it. Paragraph 64 of the Report states: The evidence received and discussed in this report seems to point to the need for a special unit in a psychiatric hospital or a special treatment unit, to which crude spirit drinkers could be admitted, either informally, or compulsorily under Parts 4 and 5 of the Mental Health Act, 1959, or by the use of some other legislation to be framed. I advise the Minister to study that report to see if anything can be done.

It is very galling to the residents in the area to know that their problems are caused by methylated spirits drinkers, and yet to see in the area hardware stores and every other kind of shop related to such stores, freely selling methylated spirits to these people. That is my reason for wanting to see the Home Office representative present, because control of methylated spirits sales is a matter for that Department.

If control over the sale of methylated spirits proves so great, could not the Home Office and the Ministry of Health together try to evolve a method of adding a powerful emetic or other repellent to the methylated spirits so as to make them almost completely impossible to drink?

I have pointed out that a problem exists and that voluntary effort has failed to solve it. That being so, I ask the Ministry to offer some hope. I ask for an assurance that the Ministry is seriously concerned and will try to do something about the problem. Otherwise, the Government Departments concerned will be failing the meths. drinkers themselves, who need this treatment. These people are citizens. The Departments will also tail the constituents in the Tower Hamlets area, and the borough council, and perhaps be responsible for all these parties finding themselves in an inflammatory situation. That is why I hope that the Ministry will offer a little more hope than it has done in the past.

3.53 p.m.

Mr. Iain Macleod (Enfield, West)

I am glad that the hon. Member for Bethnal Green (Mr. Hilton) has raised this particularly difficult problem. Though I speak for from my accustomed place, I want to make it quite clear that I do not in any sense speak for my party nor, unlike the hon. Member, do I have a constituency interest in the matter.

Some time ago I became associated with a number of young people who are interested in this problem. That is why, with the Minister for Overseas Development, I became a sponsor of a united appeal which, after a series of marches, held a candlelight rally at Hyde Park last Sunday which was addressed, apart from the sponsors, by the Bishop of London and by Lord Soper. The movement therefore has fairly respectable sponsors.

The hon. Member has voiced his anxiety in terms of crude spirit drinkers, and although I, too, will concentrate on that point, I know that he will agree that in many ways the problem is wider. Basically, we are considering the "drop outs" from our society. Not all of them are crude spirit drinkers. Among them, there are ex-prisoners, alcoholics, the mentally disturbed, drug addicts—people who have rejected our society and who reject us. In many ways, they are the most hopeless of our fellow citizens, but I am sure that the hon. Gentleman will agree that we must try to see that for these people, in the words of a cliché "While there is life, there is hope." I propose very briefly to pose three questions to the Parliamentary Secretary, and to try to answer them. First: how big is the problem? Second: who should tackle it? Third: how?

First of all, how big is the problem? In 1965, the National Assistance Board came to the conclusion that there were 13,000 homeless single persons. The Salvation Army put the estimate very much higher than that. The Ministry of Social Security thinks that about 900 or 1,000 people in Britain sleep rough. The estimate of the voluntary organisations of which I know anything is that that figure is, perhaps, about right for London alone. I therefore think that the figures are greater than the Government Departments recognise. That points to the need for further research.

Secondly: who should tackle it? When some time ago with the Minister for Overseas Development, I held a Press conference, I was asked this question, but in terms of an assumption that the Government alone should tackle the problem. My answer, which I hope will be endorsed by the Parliamentary Secretary was that, although, of course, the Government were bound to play a leading part—perhaps a major part—there was still room for the work of the voluntary organisations, just as in regard to hospitals there is still room for the National League of Hospital Friends, and still room in cancer research. My answer to the second question is that it is a job both for the Government Departments and the local authorities—to whom I shall refer in a moment—and also for voluntary organisations.

Lastly, we have the most difficult question, which the hon. Gentleman raised: how should this be done? Here, the main argument is whether we should have compulsory treatment. I recognise the sincerity and, indeed, the force of the point of view of the Tower Hamlets Residents' Association, which was put forward by the hon. Gentleman. Something like the opposite view is held most forcibly by the Simon Community which, as the hon. Gentleman knows, has been in conflict with his local borough residents' association.

I am no spokesman for the Simon Community, which consists of those of the Catholic faith, but I think that I understand the point of view of its members. They operate at what is called "failure level"; and on people who have been given up by most other organisations as hopeless. Therefore, they do not, in the ordinary sense, look for cure but for containment. They offer shelter and friendship to those who otherwise would have none, and they hold that that is enough justification for their work. I must say that I find it difficult to argue against that particular point of view.

What they seek to do by way of containment is to offer the possibility for the man—or the woman, as the case may be —to help himself so that step by step— and I think that any other approach is self-defeating—it is possible for him to haul himself out of the misery of Skid Row into which they have sunk.

The alternative to some such approach as this is, as the hon. Gentleman has indicated, some form of compulsory treatment; that in some way we should take these people out of their wretched shelters, where they sleep rough at night, give them forcible treatment, and try, in this way, to effect a cure.

I know of nobody who has studied this matter deeply from the point of view of the social problem who believes that compulsory treatment is the right approach. With respect to the hon. Member, who has put his view very moderately, I do not agree with him. I think that there are better possibilities than those of compulsory treatment.

To sum up, I have put three questions and tried to answer them.

Mr. Ian Mikardo (Poplar)

I am grateful to the right hon. Gentleman for what he is saying and I find myself closely in sympathy with it. But in considering this question and summing up what he suggests, will he bear in mind that the essential difference, as we have seen locally, between the crude spirit drinker and the other types of unfortu- nates whom he mentioned, is that they are so much more likely day by day to do things which are grossly offensive to people in the area in which they have pitched their tent? What would he do about that?

Mr. Macleod

I understand that. I am limited by time, but I will try in a sentence or two to answer that.

On the first point, the problem is bigger than the Government Departments think. This is inevitable, because we have to turn the stones over to find how many people are involved in this in some parts of London.

Secondly, as to who should take part in it, I have no criticism to make of the Ministry of Health. The Parliamentary Secretary knows that I have a great admiration for that Department. But I genuinely believe that there is a full part to be played both by the Ministry and voluntary organisations.

So I come to the third point, which the hon. Member for Poplar (Mr. Mikardo) has made, namely, how this should be done. I recognise that these people are deeply offensive to those who live in that part of the world. One answer to that may be a form of compulsory treatment. Everyone's instincts must be against this, and it is not good practical sociology either. If the Simon approach is thought to be too gentle— and that may be so—a more constructive step by step approach to the problems of the socially outcast is the one that offers the best hope of lifting them to a level where they can be recognised as part of our human society.

All these things point to the need for research in all these spheres. We do not yet know enough about the problems. This is one reason why I gave my name to an appeal which I hope will result in funds being made available for research into a particular difficult social problem.

4.3 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

The House is indebted to my hon. Friend the Member for Bethnal Green (Mr. Hilton), who has described so vividly the social problem caused by crude spirit drinkers in his constituency. I want him to understand that in the terms of this Adjournment Motion the title has been assumed by me to relate to the medical treatment of crude spirit drinkers. He has expressed some disappointment that no Minister from the Home Office is here. It is very difficult, if not impossible, under our procedures for two Ministers from Different Departments to answer in the same debate, except under circumstances which do not arise here.

However, I assure my hon. Friend, and, through him, his constituents, and more especially perhaps the inhabitants of Tower Hamlets, that all that has been said today both by him and the right hon. Gentleman the Member for Enfield, West (Mr. Iain Macleod) will be most seriously considered and, in so far as positive suggestions have been put forward, we will have a look at them to see what can be done.

I should not be in order in discussing amending legislation, were that one of the proposals, but I shall go on to talk in some detail about the situation as we see it.

I am sorry that my hon. Friend referred to discourtesy and impertinence by my right hon. Friend. Those who know my right hon. Friend realise that he is quite incapable of demonstrating those particular qualities in private or in the House of Commons. It is very difficult to deal with matters like this by question and answer in the House sometimes without giving the wrong impression. My hon. Friend has devoted a great deal of time and thought to this problem, as I shall explain, and recently he replied to Questions on the subject.

I agree with the right hon. Gentleman the Member for Enfield, West that, as we see things at present and with the knowledge we now have—I take his point about research—there must be a two-pronged attack. One has to start by considering what are the characteristics of the crude spirit drinker.

There has been reference to the distinction to be drawn between the ordinary alcoholic and this type of drinker. My hon. Friend, who has great knowledge of these matters, will agree, I am sure, that in addition to being a vagrant and an alcoholic, the crude spirit drinker is likely to be undernourished, dirty, infested and repulsive to most people. But the Ministry of Health not only has to exercise compassion; it has to think in terms of these people at patients. This is the essential quality of the service we hope to provide.

The crude spirit drinker of whom we are speaking lives without shelter on bombed sites or in derelict buildings. I shall come back to the point about "winkling" them out in a few minutes. His life tends to centre on the drinking of methylated or surgical spirits because he is dependent on alcohol and these are its cheapest forms. If he has the money, he may go on to cheap wine. This is a dreadful picture of a human wreck who is destroying himself and causing a nuisance to society. I am elaborating on it a little to show that we are not insensitive to the sort of experience to which my hon. Friend's constituents are subjected.

As to the numbers and location of crude spirit drinkers—incidentally, there are very few women among them—precise and comprehensive information is not available and can be obtained only with considerable difficulty. However, the survey made by the London County Council in 1964, suggested—my figures agree with my hon. Friend's—that the number is between 150 and 200 in London, mainly in Stepney, the City of London and South-wark. There are also believed to be small groups in large towns such as Manchester Birmingham and Liverpool.

Arrangements for the treatment of alcoholism by the National Health Service are in the main provided by the hospital service in psychiatric hospitals or in psychiatric departments of general hospitals. The removal of alcoholic dependence requires psychiatric treatment, and it cannot be removed by the action of drugs alone.

As regards compulsory treatment—here I agree very much with what the right hon. Gentleman said—the law as it stands, with one exception, does not permit compulsory treatment, the exception relating to cases of open tuberculosis and the like.

For this treatment of alcoholism to be successful, it must be voluntarily accepted by the patient. After an initial "drying-out", the patient usually participates in group psychotherapy designed to help him understand his personal problem and to strengthen his motivation to abstain from alcohol. Where appropriate, treatment is continued on an out-patient basis, and after-care often includes encouragement to join Alcoholics Anonymous.

In 1953, 775 patients were admitted to hospital for the treatment of alcoholism and alcoholic psychosis. In 1962, the number had risen to 3,690 and in 1966 to 6,088. There is little evidence of unmet demand for treatment, although some specialised units have waiting lists.

I am unable to say how many of these patients were crude spirit drinkers. They do not represent a separate diagnostic category of alcoholism, and the crude spirit drinker is treated in the same way as the patient with other forms of alcoholism. While no statistics are available of the number of crude spirit drinkers who undertake treatment, I understand that some do and that in one London hospital which specialises in the treatment of alcoholism there are at present 19 patients who have drunk crude spirits at one time or another.

Although one cannot deduce the national picture from the experience of one hospital, this shows that crude spirit drinkers are not always unwilling to accept treatment. There are no reliable figures for the total number of alcoholics in England and Wales, but such estimates as have been made are substantially higher than the numbers who receive treatment. It seems, therefore, that a high proportion are unwilling to receive treatment.

It is natural to feel that, if an alcoholic will not accept treatment voluntarily, he should, in the interests of himself and others, be compelled to accept treatment. This question is, I suppose, at the heart of our discussions. But the treatment of an alcoholic requires the co-operation of the patient, and even among those who come forward willingly there is a high rate of relapse.

The use of compulsory powers is not thought to offer a means of providing successful treatment. One must, therefore, look at the law. I am advised that the Mental Health Act, 1959, does not provide for this type of mental disorder to be subjected to compulsory admission to hospital. One may have a situation in which an alcoholic has a temporary mental disorder where treatment can be given in that way or there may be a lasting mental disorder. In either case, the patient may become detained in a mental unit. The scope for compulsory treatment by the hospital services is limited and does not provide a solution to the social problem.

The Minister and I would like to help, but the advice we have received so far does not get us very much further. The Standing Mental Health Advisory Committee has widely reviewed the whole question of alcoholism, including that of crude spirit drinkers. My right hon. Friend is at present considering its advice, which has been endorsed by the Central Health Services Council but it is only fair to inform the House that it contained no new proposals for the treatment of crude spirit drinkers.

The problem remains to induce these people to accept treatment. The drinker of crude spirits is generally unwilling to co-operate in any way with the statutory services, but the work of the Supplementary Benefits Commission may be underrated. The sending round of vans to collect these people may need reinforcement.

I mention this factor before returning to the question of the voluntary organisations. I think that, in some areas of this problem, the voluntary organisations can do a great deal where official activity cannot intervene or cannot get to the root of the problem. I have taken into account the provocation and the fears of the people of Tower Hamlets about their children, and so on. Although this matter involves the work of other Departments, I can give the undertaking that everything that has been said today will be carefully examined.

I am convinced that we may need more research and information. I assure the House that we will look into that matter. I also take the point, which was implicit in my hon. Friend's remarks, that the very existence of such organisations as the Simon Community Trust may, by their methods, possibly attract more people in from outside—but somewhere along the line we must regard this matter nationally and see if we can find a proper formula.

The problem is a serious one. My hon. Friend has adduced it moderately and, with his great Departmental experience at the Ministry of Health, the analysis of the right hon. Member for Enfield, West has been helpful and constructive. We will watch the matter and see to what extent further assistance can be given.