ALCOHOLISM

HC Deb 23 March 1979 vol 964 cc1968-82

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

4.1 pm

Sir George Young (Ealing, Acton)

In the short space of time between the bars closing after lunch and reopening in the evening, it is appropriate that the House should address itself to the problem of alcoholism.

As there are no agreed definitions of an alcoholic or a problem drinker, it is difficult to estimate how many there are. On BBC2 last week, in an excellent programme on this subject put together by an organisation called Accept, it was estimated that there were 600,000 problem drinkers in the United Kingdom. If one includes their families, close friends and colleagues at work, there are probably 2 million people directly affected by alcoholism.

According to a recent report by the Royal College of Psychiatrists, we are in the grip of an endemic disorder of frightening magnitude. In America, illness due to alcoholism is now second only to heart disease as the country's biggest ailment. Not only is the problem large, but it is getting rapidly worse. In the past 10 years for which figures are available, drunkenness offences by young men increased by more than 50 per cent. while those by young women more than trebled. More than 100,000 cases of drunkenness come before the courts each year. Admission to NHS hospitals for treatment for alcoholism has doubled. Deaths from alcoholism have trebled and those from liver cirrhosis have increased by one-third.

In the same period drinking and driving offences more than doubled, and more than one-third of all those killed in road accidents have a blood alcohol limit over the legal limit. Admissions to mental hospitals because of alcoholism have risen from 439 in 1949 to more than 13,000 in 1975. Half of all murderers are drunk at the time of the crime, and alcohol is an important factor in half of the assault and violence crimes within the family.

Alcoholism has become hideously expensive. The treatment of alcoholics in psychiatric hospitals costs £4 million a year. The National Council on Alcoholism, whose chairman, my hon. Friend the Member for Essex, South-East (Sir B. Braine), hopes to catch your eye in a moment, Mr. Deputy Speaker, estimates that the number of days lost through industrial disputes is relatively small compared with those lost through alcoholism. The council suggests that alcoholism costs industry £350 million a year. Road traffic accidents caused by alcohol cost the National Health Service £6 million a year, and if one adds to that the costs associated with these accidents the figure is about £100 million a year.

Those are the raw statistics and they do not do justice to the personal tragedies involved. These include the deteriorating physical condition of the problem drinker, the miserable family life, the unemployment and very often the early death of such a person. These are the unnecessary personal tragedies which lie behind the statistics. There are many aspects of the problem that I would like to raise but I shall concentrate on the politics of alcoholism.

Alcoholism is a good example of the new generation of diseases which the Government have not yet learnt how to tackle. The infectious diseases which used to kill or cripple the population presented no political problems. They presented medical problems. We now have medical cures, and those infectious diseases have virtually been eliminated.

The new generation of diseases, of which alcoholism is a good example, are caused not by nature but by our lifestyle. I refer to lung cancer, heart disease, strokes and mental illness. They cannot be prevented by medicine, although some can be cured at great expense. The only solution is prevention. Tackling those problems by prevention does not raise a medical problem. It raises a political problem, and the solution lies not so much in the nation's hospitals as here in the House. This is a political problem because it involves Government intervention in personal lifestyles.

Parliament is particularly involved in the problem of alcoholism because the social and economic framework for the consumption of alcohol is set down by law. Parliament is responsible, as I hope to show shortly, for the price of alcohol. Parliament decides, through licensing controls, at what age it is legal to drink in a public place. It lays down who shall run public houses and at what hours they should be open. Parliament lays down the penalties for drunkenness and other drink-related offences, particularly drunken driving, and Parliament has powers to control the advertising of drink. Parliament also has to raise, through taxation, the growing funds needed to treat alcoholism. To try against that background to argue that we have no responsibility in this matter at all and that the consumption of alcohol is a purely personal matter is unrealistic and manifestly untrue.

I believe that the Government have a more positive role to play. The resources available to the NHS are finite. More and more of those resources are being diverted to dealing, often ineffectually, with the illnesses I have mentioned. As a result, less money is available to deal with those illnesses which are not avoidable—such as kidney failure, perinatal illnesses, the need for hip replacement operations and others. Given that there is unlikely to be a great increase in the money available to the NHS, the only way in which we can tackle our waiting lists and unavoidable illnesses is to tackle avoidable illness more effectively. The major advance in the nation's health lies in prevention. In any case, we simply cannot secure better health by injecting more money into the NHS, because we have reached the point of diminishing returns.

That is the background against which I approach the problem of alcoholism. What is the cause of alcoholism? I rely on what is known as the Ledermann hypothesis. In a nutshell, Ledermann has demonstrated that the number of people in any population who have a drink problem can be accurately calculated from the average consumption of alcohol in that population. He shows that the number of excessive drinkers is disproportionately sensitive to changes in average consumption. In other words, the number of excessive drinkers will not only rise when average consumption rises and fall when average consumption falls but will rise or fall more than the change in average consumption. Ledermann's work has been elaborated and confirmed by another gentleman called Skog, whose work need not detain us this afternoon.

Basically, people become dependent on alcohol in much the same way as they become dependent on heroin, namely, by taking more than a critical amount for a sufficiently long time. The number of people drinking more than this critical amount is largely determined by the average consumption in the population as a whole. It follows from this that the number of problem drinkers can be reduced, and with it the damage caused by alcoholism, if we can reduce consumption overall. That is a very important conclusion indeed. It shows that alcoholism is not caused so much by problems at work, unhappy marriages, by the stress of modern life or by mothers-in-law. It is caused, quite simply, by alcohol.

The main determinant of consumption is the price. Put simply, the cheaper alcohol is, the more is consumed. The reason why consumption has risen so fast—it has roughly doubled since 1950—is that in real terms the price has fallen. The price of a bottle of whisky as a percentage of the average wage earner's weekly disposable income has fallen from 48 per cent. in 1950 to 20 per cent. in 1970. Between 1950 and 1976 the length of time a male manual worker had to work to pay for a pint of beer fell from 23 minutes to 12, and for a bottle of whisky from six and a half hours to two. The time needed to pay for a large loaf over the same period actually increased from nine to 11 minutes. The critical price of alcohol is fixed by the Government. So much of it is Government duty. On a bottle of whisky costing £4.25, £3.16 is excise duty, and on top of that VAT is added.

To sum up my argument so far, alcoholism is a major illness which affects society. Its impact is growing. The incidence of alcoholism is a function of average per capita consumption. That, in turn, is a function of the price of alcohol relative to incomes. The price of alcohol is made up principally of taxation. That has fallen sharply in real terms. Since alcoholism is difficult and expensive to cure, the best way to tackle the problem is to increase the tax upon it and reduce its consumption.

The Social Services and Employment Sub-Committee of the Expenditure Committee came to that unanimous conclusion in April 1977. I am delighted to see my hon. Friend the Member for Chislehurst (Mr. Sims)—who was a member of that Committee—here today. That was the most important recommendation of the Royal College of Psychiatrists' report, and it is the recommendation of the Advisory Committee on Alcoholism, which was set up by the Secretary of State in 1975. However, it is a recommendation which the Government have refused obstinately to accept or implement.

The Government's response to the Select Committee's report must have exceeded the Brewers Society's wildest dreams. Of the seven recommendations made, they accepted only one outright. I should like to examine in some detail the Government's reason for not accepting the recommendation on price. Paragraph 162 of"Prevention and Health ", Command 7047, states: The recommendation would of course involve difficulties of principle and of practice. However, the general implications for the Government's fiscal, industrial, counter-inflation and social policies would have to be taken into account as would also international considerations. In my five years in the House I have read a goodly number of Government publications. Those two sentences are the silliest that I have ever come across—particularly the implication that the impact of our foreign policy would somehow be compromised if alcohol became more expensive. However, those are the Government's reasons, and we should examine them.

I should like to deal, first of all, with the difficulties of principle and practice ". The principle of the Government linking to inflation financial factors which they determine—difficult or not—has been conceded. Pensions and benefits are linked to the movement of prices, and the Government are proud of that. The Government have also linked the rate of return from national savings schemes to the rate of inflation. Personal tax allowances are now index-linked, and the pensions of Government employees are linked to inflation. Therefore, I see no new issue of principle in saying that, for health reasons, the price of alcohol drinks should not be allowed to fall in real terms. The index-linked bandwagon is already rolling, and it is right put to put another item on board.

I turn to"difficulties…of practice ". I challenge the Minister to tell me what the practical difficulties are. The tax on drink is probably one of the easiest to collect and change. Since the war it has been changed many times, and it will probably be changed again shortly.

The second sentence is sillier still. I ask the Minister to look at what has happened to the price of milk. In November 1974 the price of a pint of milk was 4½ p. It is now 13½ p—three times higher. No doubt the Government took into account the impact of a rise in the price of milk on their social, industrial and international policies and decided that they could survive the increase. What conceivable reason is there for resisting a much less sizeable increase in a commodity which is not nearly so necessary for health reasons?

Will the Minister also examine what has happened to the prices of bread, butter, meat and bacon? Over the past four years the prices of those commodities have risen faster than the price of alcohol.

I turn to some solutions. First, in a democracy, no strategy can succeed unless it commands broad public support. The solutions that I wish to put forward are against a continuous background of public education and persuasion—of which this debate is a small part. I have just mentioned my major conclusion on price. In addition, we should secure a balance for the public image of alcohol. Last year an estimated £66 million was spent on advertising alcohol. The money was, naturally, aimed at convincing people that alcohol is good. The entire budget of the Health Education Council is £1.5 million. It is not surprising that the contrary view—that alcohol may not be such a good thing—is not so widely promoted. The Home Office should agree to release some of the £4.25 million in the licensing Act compensation fund to secure a more balanced view on alcohol.

Secondly, Blennerhassett reported in 1976 on the question of drinking and driving, and nearly three years have elapsed without any sign of legislation. The recommendations, which I understand the Government have accepted in principle, have not been acted upon, and the delay is inexcusable. The damage done to other people by alcoholics is at its worst when they are driving. The measures advocated by Blennerhassett are needed urgently, first, to deter from driving, those who have drunk too much secondly, to enable the police to arrest and successfully prosecute such offenders, and, thirdly, to ensure that the habitual and excessive drinker is prevented from getting his licence back until he has tackled his drinking problem.

Thirdly, action is needed at the place of work. If more adequate counselling were available there, the problems could be tackled before they become really serious. Fourthly, the Government have failed to respond to the reports of the Advisory Committee on Alcoholism—which, indeed, they have now wound up; they have not yet produced their consultative document on alcoholism—which the Secretary of State promised for last year—and they have taken a number of disappointing decisions about the funding of detoxification centres. There are also no plans for renewing the provisions of circular 21/73. Here again the licensing compensation fund could be a source of help.

The hon. Member for Welwyn and Hatfield (Mrs. Hayman) and I have been chairing a committee on community services for alcoholism, and most important organisations were represented on that committee. The voluntary organisations, to which I pay tribute for the role that they play in this problem, are less than satisfied with what the Government are doing, particularly on the financing of residential establishments. I hope that the Government will read our report when it comes out in May.

I end by contrasting what the Government are doing in relation to tobacco, where the tax has been increased for health reasons, with what they are not doing about alcohol. Alcoholism is a much worse problem. Those who smoke heavily kill themselves, but no one else. Those who drink a lot kill others on the road. Those who smoke do not affect their performance at work, their marriages are not affected and their behaviour to their fellow citizens is not altered. Yet heavy drinkers face all those problems.

The Government have a responsibility, and it is urgently necessary that they take a lead if the growing problem of alcoholism is to be tackled effectively.

4.17 p.m.

Sir Bernard Braine (Essex, South-East)

I rise to support my hon. Friend the Member for Ealing, Acton (Sir G. Young) and especially to make a plea for the voluntary organisations. I shall be brief because we are anxious to hear what the Minister has to say.

Voluntary organisations have a particularly important role to play in the war against alcohol abuse. They provide education, referral and counselling services, information centres, residential care and support through hostel accommodation, and self-help through organisations such as Alcoholics Anonymous.

Voluntary effort was encouraged by the Government in their circular"Community Services for Alcoholics"in 1973, which recognised the need for partnership between local authorities and the various voluntary bodies if residential care and information centres were to be established. The circular stated: It is hoped that local authorities will use all the means available to them to help voluntary bodies to try to develop services for alcoholics in their area. Further advice was offered by the Department in its document"Better Services for the Mentally Ill ". It said: It seems clear that voluntary services have a part to play for many years to come. Area health authorities and local authorities, separately or jointly, need to accept a degree of responsibility for financial liability and for the support their staff may sometimes need. I am sorry to say that the response by health and local authorities has been patchy and often acutely disappointing. Few of the voluntary services have been able to secure any significant income. Health and local authorities have been slow to pick up the pump-priming finance offered by the Government, and that has produced a great problem. The development of services has been held back, the morale of staffs has been affected, and the Government's Advisory Committee on Alcoholism estimates that there are more than 500,000 people with a serious drink problem who need help now—not at some time in the future.

The Council on Alcoholism and other voluntary agencies are in the front line, and we not only allow them to work on a financial shoestring but offer them no long-term financial security. It is disgraceful that the time of professional staff is spent in trying to raise money instead of in helping the 500,000 problem drinkers who need help. If we accept the rising levels of alcohol consumption, it is only reasonable to devote a proportion of the increased revenue to offsetting the social effects of problem drinking.

The Department has stimulated and encouraged activity. We are all grateful for that. But greater urgency needs to be brought to bear on local statutory bodies to accept their responsibility to fund adequately services needed in their areas. The Secretary of State must find an answer without making the service suffer or frustrating the morale of local voluntary helpers. A means of central pressure on local and health authorities to do more about the problem must be found.

I speak to the present financial anxieties not only of local councils on alcoholism but the work in hostels and their fears about future funding. We cannot take a cutback in this area, because it would mean no service at all.

The drink industry has a responsibility to face the problems caused by excessive consumption. I am not a prohibitionist. I would certainly never deny anyone's right to enjoy a drink. But we have a moral responsibility for those who unwisely use alcohol as a prop to help them cope with their problems, become dependent upon it and cause a great deal of suffering to themselves and their families.

I was somewhat disturbed by the LBC broadcast on Wednesday evening in which a representative of the drink industry played down the problem and distorted the position. He left the impression that those working in this field were hysterical about the problem. I wonder whether he has ever seen a battered wife or a heartbroken child with someone in the addictive grip of alcohol. Those of us in the field who have seen these things know the size and gravity of the problem. I cannot believe that that man's views represent the views of my friends in the drink industry as a whole.

I hope that the Minister will agree that the industry must take its share in the provision of proper counselling services.

4.21 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I hope that in the time that I have I shall be able to answer all the points that have been raised. I fully share the concern of the hon. Member for Ealing, Acton (Sir G. Young) about the misuse of alcohol. I am grateful to him for having given me notice of some of the points he intended to raise. I welcome this opportunity to explain what we are doing about this increasingly serious problem.

Everybody needs to realise the inescapable fact that people are increasingly harming themselves and others by misusing alcohol. Over the past 10 years for which figures are available drunkenness offences by young men increased by over 50 per cent., while those by young women more than trebled; admissions to our psychiatric hospitals for treatment of alcoholism doubled; deaths from alcoholism trebled, and those from liver cirrhosis—a disease closely associated with excessive drinking—rose by one-third.

Drinking and driving offences more than doubled. More than one in three of all drivers killed in road accidents now have a blood-alcohol level above the legal limit—compared with one in six in 1968 when the limit was introduced. An estimated ½ million people in this country have a serious drinking problem, and, taking their families into account, probably one in 25 of the population is directly affected by problem drinking.

This problem must be tackled on two main fronts: prevention, and services to provide help and treatment. The main hope for the future must lie in prevention so that, as far as possible, the tragedies due to excessive and inappropriate drinking do not occur in the first place.

Concern about misuse of alcohol led my right hon. Friends the Secretaries of State for Social Services and for Wales in 1975 to appoint the Advisory Committee on Alcoholism. The committee's report on prevention was published in 1977. Also in 1977, the Social Services and Employment Sub-Committee of the Expenditure Committee, in its report on preventive medicine, made similar recommendations. The recommendations in these two reports between them range over health education, advertisements and the media, taxation, and licensing laws.

The Government's initial response to those recommendations, in the White Paper"Prevention and Health"of December 1977, said that the Health Departments would prepare for publication a consultative document which would alert the public to the growth of the problem and outline for discussion various possible measures for improvement, including those recommended by the Expenditure Committee and the advisory committee. The document would be made available to all interested organisations and individuals, and their views would be invited. The ensuing public debate would help the Government to develop their policies in this difficult area.

Sir George Young

When will the document be published?

Mr. Deakins

I am sorry to say that it is still being drafted. Publication is still unlikely for some months.

In bringing the problem of alcohol abuse before the House, the hon. Gentleman has by deed as well as by words made it clear that it is a political problem. He is concerned that there has not been enough action on the recommendations of the Expenditure Committee and the advisory committee on prevention, and he considers that the Government should do more to change public attitudes towards alcoholics and alcohol abuse. Social attitudes are the key to the problem, and, as the advisory committee recognised—I quote and abbreviate: this is a long term programme…Those responsible…need to achieve broad agreement before they start on the sort of change in attitudes which is desirable and the kind of preventive measures which are appropriate…and their judgement…must also be likely to command broad approval from society at large ". Sir Martin Roth, in his foreword to that recent important contribution to public discussion, the report"Alcohol and Alcoholism"from the Royal College of Psychiatrists, said it was implicit in the arguments in the report that Intervention by Departments of Health and Government can achieve little unless there is a parallel change in personal attitudes. The Report is timely for there are signs of burgeoning of interest, among ordinary people, in what is known about the springs of individual behaviour and the factors which cause it to diverge into self-destructive channels ". We cannot change social attitudes simply by wanting to do so, by preaching, or by waving a wand. We attach great importance to getting it right, as a basis for well-informed and widespread discussion of important and sometimes complex issues. I take, for example, the level of taxation on alcohol, which the hon. Member for Action has urged should be increased. Both the Expenditure Committee and the Advisory Committee on Alcoholism recommended the maintenance through taxation of the 1977 real price of alcohol. The practical effects, the problems and the general implications for the Government's fiscal and industrial, counter-inflation and social policies need careful consideration.

I have taken careful note of the hon. Gentleman's comments in this context. I am sure that he will appreciate that these are not just matters for my own Department; other Departments are also involved. That also applies to the Blennerhassett committee, which is primarily a matter not for my Department but for the Department of Transport.

One of the main reasons for having a consultative document is to encourage public debate. But we are already embroiled in public debate here today and continually in the press and the broadcasting media. The upsurge in public interest and the attention given to the problems of the misuse of alcohol by the media in the last year or two have been very noticeable. There have been a considerable number of well-informed, well-presented articles and programmes which have stimulated a great deal of public discussion. Attitudes are already changing. The reports of the Expenditure Committee and the Advisory Committee on Alcoholism on prevention, and the important chapter on alcoholic drinks in the revised handbok on"Health Education in Schools ", published by the Department of Education and Science in 1977, have all played and will continue to play a part; and now the informative, interesting and controversial report from the Royal College of Psychiatrists gives further impetus to the debate.

I am not saying we should simply follow the mood of the public, but we must recognise that preaching is wasted both on problem drinkers and many people who enjoy alcohol without harm. The general public must be convinced of the need for a comprehensive strategy and given a say in what it should be if the problem is to be successfully tackled. We need to learn more about which approaches put across most effectively the dangers of alcohol abuse and the need for care in the use of drink. Here let me assure the House that action in relatively uncontroversial areas is going ahead while the consultative document is in preparation.

The Health Education Council has been running a pilot campaign in the North-East of England to alert people to the dangers of misusing alcohol and to encourage a responsible attitude towards drinking. Estimates for the current financial year, 1979–80, allow for an increase to £200,000 on alcohol campaigns. Obviously the evaluation will help to show which approaches are the most effective in putting the message across.

I welcome the comments of the hon. Member for Essex, South-East (Sir B. Braine) about the way services for alcoholics can be provided. The House will be aware that my Department does not retain national funds at the centre to provide health and social services. Most available funds are allocated each year to health authorities, and also for services provided by local authorities. It is their responsibility to decide how these funds should be used. There are always difficult decisions to be made, particularly to provide resources for emerging problems, such as alcoholism, which do not fall neatly into either health or social service categories. The 1973 legislation makes provision for joint consultative committees of area health authorities and local authorities to consider together local needs, priorities and how the resources should be used.

This has been supplemented by policy guidance to these authorities explaining how the review of need and resources can be undertaken regularly by joint care planning teams, each responsible for looking at needs of particular groups. There is provision also for emerging problems such as alcoholism to be looked at by specially constituted working parties which can include representatives of voluntary organisations, to review what is available and to identify what is needed. Their reports can then be considered by the joint care planning team and the joint consultative committee to indicate how services can be developed and to ensure that resources are allocated. I take note of the hon. Gentleman's present criticism, but it will be some time before alcoholism is covered effectively by these arrangements by all authorities.

We see the need to encourage the development of services to tackle a growing problem such as alcoholism, but very small amounts from the national funds can be allocated specifically by the Department. In this way, regional health authorities were able to provide addition treatment units in 1971–1974. In the same way, circular 21/73 advised health and local authorities that alcoholism was a major social problem and required a considerable effort from both to develop local services to respond to this growing need. It covered also the important role of voluntary organisations, ways in which alcoholics can be helped, and announced that the Department was prepared to provide some money for a limited period to stimulate the provision of services for a few years until the health and local authorities could make this provision within their programmes.

After negotiations with the local authority associations, my Department was also prepared to provide capital and revenue grants, the latter being revised each year to take account of price variations for five years so that more hostels could be provided. This was on the understanding that local authorities would then assume the Department's commitment to contribute to the revenue costs of the hostels. The scheme has been very successful in that there are now more than 60 hostels providing 720 places for alcoholics, largely where there is the greatest need.

We have extended the scheme for two years to March 1980 and reminded local authorities that it now has to be reviewed with them. We will be discussing with the local authority associations and those local authorities which have hostels in their areas how the present scheme can be ended or phased out, taking account of other funding arrangements now available, such as the joint financing programme. We are also awaiting with interest the report from the working party set up by the Federation of Alcoholic Rehabilitation Establishments to review services. I understand that the hon. Member for Acton was a joint chairman. When all the comments on this report have been studied, we expect that new policy guidance will be prepared which will also take account of the previous circular.

In the past three years my Department has also supported voluntary organisations providing treatment and rehabilitation services for alcoholics by wider use of its powers to make grants. These powers are also available to health authorities and local authorities and are being increasingly used. Since 1975, our grants to voluntary organisations have increased from some £460,000 to almost £1 million in the current financial year. The cost of the hostel scheme in this financial year will be some £450,000.

The rest of the grants are used in two ways. Some organisations, such as the National Council on Alcoholism, the Medical Council on Alcoholism and the Alcohol Education Centre, have agreed national roles to explain the need for treatment and rehabilitation services or to help in their provision—

The Question having been proposed after Four o'clock 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 twenty-nine minutes to Five o'clock.