HC Deb 02 August 1976 vol 916 cc1395-406

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

12.38 a.m.

Mr. Robin F. Cook (Edinburgh, Central)

I am most grateful for the opportunity of this Adjournment debate to raise a matter that is of very great concern in Scotland, at what is, I suppose, an appropriate hour to be considering the problems of alcoholism. Certainly we consider these at an appropriate moment in the Session, because only last week the House considered and passed a Bill to reform licensing laws in Scotland—a Bill that will provide for considerably longer drinking hours than hitherto.

As my hon. Friend the Under-Secretary is aware, there are two views about the effect of that reform. There are some who fear—as I do, and as I think he does—that the decision to open public houses on Sundays may lead to an increase in the problem of alcoholism that we face in Scotland. However, I think that my hon. Friend will agree that one point that marked the debate we had both on the Floor of the House last week and in Committee was that on both sides there was a general agreement that whatever the likely effect of opening public houses on Sundays, there was a very strong case for more resources to be made available to fight the problem of alcoholism in Scotland.

It is hardly suprising that we find this consensus on the need to take further action to fight alcoholism in Scotland, because we have a frightening problem at present. I speak with a particular constituency interest in the matter, because I have in my constituency the Grass-market, which contains not only nearly all the lodging-houses in Edinburgh but one-third of all the lodging-house beds in Scotland.

While the single homeless person is not typical of the average alcoholic, nevertheless there is no doubt that the loss of family and the loss of home is associated with severe alcoholism. We can see in the Grassmarket many of the consequences brought about by this dreadful problem.

We have at the present time an admission rate to hospitals in Scotland seven times as high as the admission rate of alcoholics in England and Wales. We have a rate of offences connected with drunkenness in Scotland four times as high as the comparable rate for England and Wales. Indeed, one in three of all convictions for offences involving drunkenness are in Scotland, an area with only one-tenth of the population of the United Kingdom. Not only do we have this already serious imbalance; the problem has got worse. Admissions to hospitals for alcoholism have doubled in Scotland in the past decade and convictions for offences involving drunkenness have doubled in Edinburgh over the last 15 years. Indeed, convictions are now running at a rate of one in 100 of the population, a remarkable figure. As my hon. Friend is well aware, the most depressing feature of this trend has been that more and more young people and more and more women are involved in the problem of alcoholic abuse, and are reported as having alcoholism as a diagnosed diseases.

Clearly the problem that we face in Scotland with regard to alcoholism is really a mountain. I am bound to say that the Government's response hitherto has been something of a mouse by comparison. I have in mind, in particular, Circular 4/76, issued by the Social Work Services Group in March of this year, which I shall deal with in some detail. Before doing so I think it is worth putting on record that this circular certainly was long awaited. The comparable circular for England and Wales came out in 1973, over three years ago.

The Minister is perhaps aware that this debate is taking place, by coincidence, almost to the day of the second anniversary when I wrote to the hon. Member for Aberdeen, North (Mr. Hughes), then Minister responsible, asking when we could expect publication of this circular, which did not come out until four months ago. In addition to that delay there was a further year's delay between the production of the draft circular in April 1975 and the production of the completed circular in March this year. It is very difficult to understand the reason for this delay because so far as I am aware none of the voluntary organisations that submitted comments on that draft circular, nearly all critical, had any of their recommendations accepted and incorporated into the final draft that was produced.

I find it striking that the Clayson Report was also presented in 1973 and that in the three years since then we have managed to find the time to prepare proposals based on that Report, and to draft a Bill based on those proposals and pass it through this House quite properly and correctly. Yet, in the same length of time, with regard to community services for alcoholics, we have found time only to draft and produce a single circular.

Nor is it easy to understand why three years were taken for the production of this distilled masterpiece of departmental wisdom. If we compare the circular with the English circular produced three years ago we find no significant new recommendations, although we find some significant omissions, to which I shall refer. I am reluctant to believe that the Department spent three years deciding what to leave out of the English circular. The tragedy is that this delay means that we are discussing the circular produced in 1976 in a very different climate of opinion about public expenditure. In its very first statement the circular points out that Present and prospective constraints on the availability of resources for the development of local authority services in general mean that development of community services for alcoholics must for the foreseeable future be confined to measures which would involve little or no additional expenditure; That is a most forceful statement in what remains a notably rapid document. The irony is that it looks as though we shall have a situation in which less money is allocated to community services to fight alcoholism in Scotland, which is the area of the country in which we have the greatest incidence of the problem.

One particular contrast that I should like to make is in relation to residential hostels for the alcoholic. My hon. Friend will be aware that the circular produced by the Department of the Environment provides capital and revenue grants for the creation and support of residential hostels for alcoholics, but no such grant is incorporated into the circular issued by the Scottish Office this year. He will be aware that those who work in this field attach considerable priority to the development of proper residential accommodation for the alcoholic. At present the provision in Scotland is, as I am sure he will concede, grossly inadequate. The number of residential hostels for the alcoholic in Scotland is still in single figures, and only one of them is local authority-run. I am happy to inform the House that that is situated in my constituency, in which, as I have already said, are most of the lodging houses and hostels in the South-East of Scotland.

My hon. Friend may have seen in his office a report produced by the local work team which handles that hostel and which makes a very compelling case for this type of provision and its expansion by other local authorities. The experimental work has already been done and the conclusions from the work written up, and they are available to every local authority. There is everything to be said for making resources available for an expansion of this work.

I should like similarly to refer to the need for detoxification centres. A whole paragraph in the circular issued by the Department of the Environment is given over to warmly commending the development of such centres, and there are now three such centres in operation or approved in England and Wales. But there is no mention of detoxification centres in the circular issued this year. The irony is that not only do we not now have a detoxification centre in the whole of Scotland, but the only one that was in operation came to an end last year as it came to the end of the funds set aside for the experimental period.

I can understand the Scottish Office taking the view that this was experimental work funded for an experimental period until conclusions on the work could be made known, but, as my hon. Friend is probably aware, the report of the doctor in charge of the unit has now been published and is available to his Department. It shows striking success in dealing with those who are habitually taken to court and charged with drunken offences. There is a considerable success rate, and that makes an encouraging case for the development of such centres on a permanent basis and in places other than just Edinburgh. Once again, the circular of March this year is silent on this subject.

Lack of a positive recommendation in these respects casts some doubt on the other recommendations in the circular. In paragraph 6 there is a section on information centres. The circular warmly commends the development of information centres so that local authorities and voluntary organisations may explain what provision there is for the alcoholic and what facilities he can receive for treatment. But that suggestion is made against a background in which no such facilities are available.

What is the information centre to tell the individual alcoholic who goes for treatment—that there are only half a dozen residential hostels and no detoxification centre? The whole point of making additional information available is that is should be backed up by proper facilties and adequate services to treat the disease.

Much the same comments may be made of the present campaign being waged by the Scottish Health Education Unit, an admirable campaign, which I strongly support. It can make sense only if people who come forward, having diagnosed themselves as having an alcoholic problem, find that there are adequate facilities for treatment.

I suspect that the authors of the circular are acutely aware of the lack of concrete recommendations in it. Its language is particularly flaccid in that local authorities are not told that they should do something but are merely told that they may. There is nothing to oblige local authorities to do anything in particular.

I recognise, since there was no covering letter with the circular, that there is no requirement for local authorities to sunbmit to the Scottish Office their proposals for community facilities. When the Government issue a circular which they intend to be taken seriously—for instance, on public expenditure—there is a requirement for local authorities to respond. There is no such requirement in this circular.

Mr. Tam Dalyell (West Lothian)

My hon. Friend the Under-Secretary of State for Energy—the hon. Member for Midlothian (Mr. Eadie)—is here. I am sure that he would agree that in our constituencies local authorities have taken this problem seriously and done quite a lot over a number of years.

Mr. Cook

I was speaking generally about Scottish local authorities. I appreciate that there are authorities which recognise the problem and respond positively.

Even in Edinburgh, the work done in the Grassmarket urban aid programme in the last few years has been striking and will be of considerable importance for the rest of Scotland if adequate resources are made available for an extension of similar facilities in other urban centres.

I recognise that this debate takes place after a serious debate on public expenditure cuts, and that a voice raised for further public expenditure is perhaps not particularly welcome on the Government Front Bench.

I would reply in two ways. First, considerable work could be done which is not primarily financial. There is a serious need to look at the training of social workers and others to ensure that proper methods of diagnosis and treatment of alcoholism are included in courses. I understand that in the present two-year course for social workers, there is only half an hour's tuition on the problem of alcoholism. This is clearly imbalanced, and the solution does not depend on additional finance.

The Government could also consider following the example of the Department of the Environment and set up an alcoholism advisory committee. Such a body is already operating in England and Wales and has made recommendations of considerable importance for the time when public expenditure is not under the same constraints and local authorities are better able to meet this problem. Clearly there is a great need for a similar committee in Scotland, where the problem is much more severe.

Secondly, I cannot accept that constraints in public expenditure are conclusive, especially when we consider the grave problems resulting from alcoholism and particularly when it is associated in the minds of many people with the drinks trade, which is exceedingly profitable. Many people understandably find it distasteful to be told that the money is not there to provide additional facilities for fighting alcoholism when they see how much money is being made from the sale of drinks.

The Government also have done very well out of the sale of drinks. Over the past decade, the amount of alcohol sold in Britain has nearly doubled, and that has meant a considerable increase in Government revenue. If only 1 per cent. of that revenue were devoted to fighting alcoholism it would transform primary and secondary care. This is precisely the approach adopted in Scandinavia. In Sweden, a surprisingly high 10 per cent. of all revenue from the sale of alcohol goes to providing treatment and facilities for alcoholics.

Moreover, alcoholism costs society very dearly. It has been estimated that the cost to the industrial sector in Scotland alone is £35 million a year—a very high figure. There is a particular cost to public expenditure on social services, because alcoholism is often associated with family breakdown and the cost of taking children into care, with people becoming homeless and with battered wives. In addition, many regular offenders are frequently sent to prison.

My hon. Friend will know that over a year ago, in the debate on Report of the District Courts (Scotland) Bill, I pointed out the serious cost to the community of treating the alcoholic offender—the drunken offender—by imprisoning him for non-payment of fine. That point has been made in the House time and time again. I am indebted to a recent article in The Guardian for pointing out that as long ago as 1872 a prison governor told a Select Committee that in his view imprisonment was by no means a helpful way of treating an alcoholic and that more positive ways should be found.

The absurdity is that the practice of taking the alcoholic offender to court. convicting him, fining him and then imprisoning him for non-payment of the fine is about the most expensive way of coping with the problem, as well as being the least effective. The provision of residential hostels would not be only a more successful way of coping with the problem; it would also be far cheaper.

In conclusion. I return to where I began. If the House can find the time, quite properly, to consider a reform of Scotland's licensing laws, the workers who are associated in this field and have daily to work with the alcoholic problem and see the cost to society and individuals of the present high consumption of alcohol will think lightly of us—and they will have some legitimate criticism of us—if we cannot also find the minimal resources required to provide adequate facilities for coping with and treating the problem of alcoholism that may flow from that same reform in the licensing laws.

12.57 a.m.

The Under-Secretary of State for Scotland (Mr. Harry Ewing)

I am grateful to my hon. Friend the Member for Edinburgh, Central (Mr. Cook) for raising this question on the Adjournment this morning. It is worthy of note that I am joined on the Front Bench by my hon. Friend the Member for Midlothian (Mr. Eadie), who is Under-Secretary of State for Energy and who, during his period on the Back Benches, showed a great interest in the subject of alcoholism and raised an Adjournment debate on the subject. My hon. Friend the Member for West Lothian (Mr. Dalyell), too, is, like myself, deeply interested in the subject.

This seems like the morning after the night before, for last week—almost at this time—we were reforming Scotland's licensing laws. This week we are, to a great extent, discussing the consequences of the action that we took last week. The consequences are very serious. I am not sure that I shall be able to say much by way of encouragement to my hon. Friend the Member for Edinburgh, Central in respect of the availability of resources to deal with this very serious problem.

In dealing with the problem of alcoholism we seek to break what has been loosely described as the "Skid Row cycle". There is not only a very great cost in financial terms—my hon. Friend mentioned the estimated cost to Scotland's industry of £35 million—but there is probably the even greater cost in human suffering—the marital disputes and child care problems that flow from alcoholism. These are only too familiar to local authority social work departments.

Much still remains to be learned about the cause and treatment of alcoholism, but a great deal has been done in recent years in relation to both prevention and treatment. The prevention of alcohol dependence requires not only increased awareness by the public of the risks of the misuse of alcohol but also recognition that alcohol is a disease that can be treated. This has been one of the greatest developments in recent years. For the first time, largely through the activities of the Scottish Health Education Unit and the massive publicity campaign that has been entered upon, we are now able to encourage people to recognise that they have a drink problem and to accept that that illness can be treated, and therefore to come forward and accept treatment.

There is no doubt that the experiment that has been run in my hon. Friend's own constituency has contributed a great deal to the knowledge that we now have of the causes and treatment of alcoholism. As I say, one of the greatest steps forward has been the fact that we have been able to encourage alcoholics to recognise that they have this problem and that they can obtain treatment.

I could not help noticing that my hon. Friend did not, as he did when the Clay-son Committee Report was considered, deal with the question of advertising. I believe—we are seeking to convey this impression to those responsible for advertising—that advertising has a great deal to do with the attitude that people adopt to alcoholics. I am particularly pleased that the Independent Broadcasting Authority has imposed new safeguards and standards in relation to advertising alcohol, and it is stipulating that these advertisements must not be directed to young people.

I still believe that a great deal remains to be done about advertising. I often say that if only advertising companies would not make it appear to be glamorous, or a test of a person's virility, to be able to drink limitless amounts of alcohol, I am sure that some—I do not say a great many—of the problems that we have with alcohol and the alcoholic would not be with us. I hope that those who are responsible for advertising will read my words carefully and will see what more can be done to tighten up standards and safeguards relating to advertising.

Coming to the question of what further can be done, I know that for however long a period I happen to be in this job, when I leave it I shall do so with a sense of not having done as much as I would have liked to do to deal with this question of alcoholism. The health services, the local government social work services and voluntary bodies working in alcoholism all have a part to play in combating these problems.

I wish to emphasise the part that the voluntary bodies can play. In these times of financial stringency and economic stress—indeed, if we were not experiencing financial stringency and economic stress I would make this point just as forcibly—I honestly believe that it is to the benefit of the community that we should encourage the voluntary bodies to do everything humanly possible to help us deal with this vexed question. I hope that the question of encouraging the voluntary bodies will be given particular attention in the months ahead.

In Scotland at the moment there are five hospitals with specialised units for the treatment of alcoholism, and there are 13 other psychiatric units in general hospitals which have a special interest in alcoholism. These are all steps that have been taken in the last few years. Some patients suffering from alcoholism are admitted to hospital as in-patients. My hon. Friend knows the difficulties for those who are referred to hospitals, and how the number has risen dramatically and tragically over the past few years. There are other patients who are treated as out-patients or day-patients.

The initial approach to the health service of a person suffering from alcoholism is likely to be to the family doctor. That brings me to the circular on which my hon. Friend based most of his remarks. The local authority social work departments, as I have said, have an important role to play in the provision of the services in the community for alcoholics. The Social Work Services Group of the Scottish Education Department issued broad guidance in a circular on the subject a few months ago. It was in March of this year that the circular went to health boards and to appropriate voluntary bodies.

Alcohol abuse has many aspects, and no single body or provision can be responsible for solving the problem, but if all concerned could plan jointly more progress could be made. In planning community services for alcoholics we must remember that there is no single model of practice and that each locality, with its particular circumstances and resources, must plan services according to its own needs. The circular stresses the need for the setting up of planning liaison committees. That is one of the positive aspects of the circular. The committees are seen as useful vehicles for statutory and voluntary bodies to get together and develop local policies.

At national level there is the Programme Planning Group on Mental Disorder, which was set up jointly by the Scottish Health Service Planning Council and the Advisory Council on Social Work in 1975 to advise them on the provision of health and social services for the mentally disordered. The group is expected to include consideration of the needs of alcoholics in its future deliberations.

Much valuable work on the care of alcoholics in the community is being done by the Scottish Council on Alcoholism—a body set up and run with the help of Exchequer grant. It has the broad aim of promoting and encouraging all aspects of the campaign against alcoholism. The council, with its local councils, provides information and advisory services for people with personal drinking problems and for members of their families. It is important to remember that very often it is not only the alcoholics who have a major problem but the members of their families. It is for that reason that the information and advisory services are available.

In planning future services for alcoholics it is essential to recognise the interdependence of types of provision—

The Question having been proposed after Ten o'clock on Monday evening and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at eight minutes past One o'clock.