§ Dr. Norman A. Godman (Greenock and Port Glasgow)
I should like to say first of all that I am not a prohibitionist. In this place, it would be difficult to work up support for such a policy.
I raise this Adjournment debate so that the Under-Secretary of State can answer certain questions concerning alcohol abuse and its treatment. I recognise that its treatment extends beyond his Department, so I should be grateful to him if he passed on some of my observations and questions to his colleagues.
In the light of the report of the Select Committee on Home Affairs on the misuse of drugs, which was published yesterday, there may be those who are of the opinion that my time would be better employed discussing hard drug abuse. Drug abuse is a most serious social problem in Britain today. The Select Committee's report states that cocaine has become the "drug of choice" in America, and is becoming increasingly popular in Britain. It states further:We fear that unless immediate and effective action is taken Britain and Europe stand to inherit the American drug problem in less than five years. We see this as the most serious peacetime threat to our national well-being.I readily acknowledge that drug abuse is a major social problem, but I emphasise that alcohol misuse or abuse is equally serious. For millions of British people the choice of drug is alcohol. For example, it has been estimated that in any one week over 75 per cent. of men and 50 per cent. of women will drink alcohol. Taken over a 12-month period, 50 per cent. of the population will consume alcoholic beverages. Adult consumption in the United Kingdom almost doubled between 1950 and 1980. During that period the price of drinks in real terms has more than halved. Since 1980 there has been a slight fall in consumption. I believe that that decline is due to the economic recession and fiscal policy, with the 1981 Budget increase in the price of drinks, for example.
It has been estimated by the Scottish Home and Health Department that Scots spend about £3.5 million daily on alcoholic drinks, which represents 7.5 per cent. of consumer spending. I am not criticising my fellow Scots because United Kingdom consumer spending on alcohol in 1984 equalled some £14,319 million, which is about 7.5 per cent. of all consumer expenditure. I believe that in Scotland, as well as elsewhere in the United Kingdom, alcohol is a significant element in everyday life, particularly in recreational and leisure activities. I am seeking moderation in alcohol consumption. We need a more active commitment from the Government to an alcohol health education programme.
In an excellent report called "Health education in the prevention of alcohol-related problems", produced by the Scottish Health Education Co-ordinating Committee, the authors said on alcohol consumption:Alcohol is used as a stimulant, a tranquilliser, a celebrant, a medicine, a social lubricant, a religious symbol, and as an indicator of the transition from work to play. The functions of its use are so diverse that at times they are contradictory. Our expectations about the value and effects of alcohol influence our behaviour to a far greater extent than do the mood-altering properties of the drug…Discussion about alcohol and the problems associated with its use provoke a diversity, and often a conflict, of opinions. This is never more so than when strategies for prevention of abuse are being considered.1266 While I am sure that the Minister has read that excellent report, I ask him to advise his officials to read it. The British Medical Journal said in its review of the report:The past 10 years have seen a plethora of reports on alcohol, but most have been concerned with describing the problems associated with alcohol rather than a plan for overcoming item. The only report that came close to matching this present Scottish report in the scope of its suggestions was the suppressed report by the Government's think tank (Central Policy Review Staff). The flimsy Department of Health and Social Security document Prevention and Health: Drinking Sensibly, which could be seen as the Government substitute for the suppressed report, was much stronger on platitudes than suggestions.I believe that a similar examination should be conducted south of the border with a subsequent report, I hope of similar quality, to the Scottish report. I hope that the Minister will confirm that such an exercise will take place in England and Wales in the near future. I am sure that the Minister will agree that alcohol abuse is not peculiar to Scotland. That form of drug abuse continues on its widening and destructive path throughout the whole of the United Kingdom.
I should like to refer to the economic costs and benefits of alcohol. A report of a British Medical Association conference, which I believe the Minister addressed, said:The Government refused to take the strong measures needed to curb alcohol abuse because it was afraid of offending the drinks industry, said Mr. Derek Rutherford, Director of the institute of Alcohol Studies. Ministers were defending the commercial interests of the drinks industry in the same way that they have defended the tobacco firms.The Minister may wish to respond to that allegation.
It is certainly true that the state derives enormous positive benefits from alcohol. The production, market-ing, distribution and selling of alcoholic beverages provides employment for more than 750,000 people. United Kingdom excise duties and value added tax obtained from the sale of alcohol in the financial year 1983–84 will exceed £5,200 million, which is one third of the cost of running the National Health Service.
This morning we have heard about exports of confectionery. The value of alcohol exports exceeds £900 million a year and there is a pronounced positive balance of trade with other nations. However, the economic costs of alcohol are formidable. Those costs relate to lost production and absenteeism and the cost to the social and medical services of treating those suffering from alcohol abuse. It has been variously estimated that these costs amount to about £1.2 billion. There are other costs, of which alcohol-related crime and fire are two, but there are still others which are extremely difficult to quantify.
Given the fact that alcohol is the drug of choice of millions of people, it is not surprising that the use of alcohol presents so many problems to the individual, his or her family, the community, the police, the health services and the Government. The Government have a major role to play. The type and extent of the problems will vary, but they involve problems with the law, including drunkenness, drinking and driving, criminal damage, theft, assault and homicide, social problems including aggression, domestic violence, child neglect and abuse, domestic accidents, absenteeism and road traffic accidents; and medical problems including alcoholic poisoning, drug overdose, acute gastritis, acute trauma, head injuries, parasuicide, epilepsy and amnesia.
Although there is no universal definition of the number of alcoholics in Britain, the estimates vary widely between 400,000 and 800,000. In my area of Scotland, the lower 1267 Clyde, hundreds of persons have been proceeded against for the offences of being drunk and incapable and of habitual drunkenness. In an answer given to me by the Under-Secretary of State for Scotland — the hon. Member for Edinburgh, South (Mr. Ancram) — in column 411 of the Official Report of 21 May 1985 I was informed that in 1984 in the district court in Inverclyde 797 people were proceeded against. In Strathclyde the figure was 3,456 and in Scotland as a whole it was 6,500. I am anxious to emphasise that this is not just a Scottish problem. It is a British problem, because the figures for England and Wales are equally high. An answer given in the other place showed that, in 1982, there were 107,326 findings of guilt for offences of drunkenness in England and Wales. This is a massive problem which involves a great deal of police and court time.
The same answer given in the other place provides grimmer statistics on the numbers of death from cirrhosis of the liver between 1979 and 1983. There is a remarkable consistency in the numbers of recorded deaths from this illness. In 1979, 2,676 people died in the United Kingdom as a result of cirrhosis of the liver. In 1983, the figure was 2,679. In Scotland the rates are even higher.
About one road death in five— about 1,200 a year— occurs in accidents where at least one person has consumed an amount of alcohol over the legal limit. Between 1968 and 1980 convictions for drunken driving in Scotland increased, although the numbers have declined since then. The Scottish conviction rate for drunken driving is far higher than the rates in England and Wales. In 1981, the rate per 100,000 of the population was 123 for England and Wales, whereas for Scotland it was 217. Conviction rates are, of course, determined by both police activity and the amount of alcohol consumed.
Many other costs are borne by the drinkers, their families, the community and the state. For example, statistics on days lost due to alcohol-induced sickness have been estimated at between 8 million and 15 million days a year. In some industries, this is known as the Friday afternoon-Monday morning problem.
There is clear evidence of the role of alcohol abuse in family problems. One third of all divorce petitions cite alcohol as a contributory factor. One third of child abuse cases have been linked to the regular heavy drinking of one or both parents.
I have sought to highlight some of the problems surrounding the British choice of drug. The Government have a major role to play in containing these and other problems. This Government and earlier Administrations have left far too much of the burden on the hard-pressed local authorities and voluntary associations. I criticise not just this Government but Governments during the past 20 years. The voluntary associations do a fine job with inadequate resources.
I should like to ask the Under-Secretary of State a few questions, some of which he may be able to answer during this debate. When can the House expect a joint statement by the DHSS and the Home Office on their policy on public drunkenness?
§ Dr. Godman
That is the type of answer I like—beautifully succinct. I hasten to say, Mr. Deputy Speaker, that I shall not take too many interventions.
Is there any likelihood in the near future of the Government's policy on designated places being changed? I hope that the Under-Secretary of State feels able to contain himself on that question. The Government's policy is clearly set out in a letter of 1 March 1985 which I received from the Under-Secretary of State for Scotland with responsibility for health and social work—the hon. Member for Argyll and Bute (Mr. MacKay). I have the hon. Gentleman's permission to quote his letter. He said:Thank you for your letter … about the possibility of setting up a designated place at Greenock, to which the police could take persons found drunk as an alternative to charging them.There is no danger of the hon. Member for Greenock and Port Glasgow falling into that category, despite the fact that, occasionally, he likes a glass of malt whisky, especially at the end of a fine meal. He believes that a malt whisky is far superior to a continental liqueur. The Under-Secretary of State continued:After the coming into force of section 5 of the Criminal Justice (Scotland) Act 1980, my Department issued guidelines on designated places in April 1982 … the initiative in setting up such a place is in the first instance for local authorities and voluntary bodies. The Secretary of State is prepared to offer advice and guidance on the setting up of designated places and is at present making use of his power to assist voluntary bodies under section 10 of the Social Work (Scotland) Act 1968 to pay grant for the setting up and running of Albyn House, Aberdeen"—I am sure that the Under-Secretary of State has heard of Albyn house—but before considering a scheme for Greenock … the Secretary of State … would need to establish that there was in being a group capable of sponsoring and running the project and that arrangements had been or were being made to involve, and obtain the support of, all the agencies who would be referring people to a designated place … Grants to local voluntary bodies"—and I shall be questioning the Minister about such grants—are normally time-limited (the standard period being three years) and we would also need to establish that if a designated place were to be set up … in Greenock … there should be reasonable prospects of its continuing after the end of the grant period.I have quoted extensively from that document because it encapsulates the Government's thinking on designated places, certainly north of the border.
Designated places play an important role in dealing with drunkenness offenders. We have only one such place in Scotland, Albyn house, in Aberdeen, which was opened as recently as March 1984, but already it has been a conspicuous success. Within 12 months of opening, Albyn house and its staff have gained the confidence and support of the local police, doctors, social workers, members of the legal profession and, most important, of the clients. The chief constable of Grampian, Mr. Lynn, recently said:The principal effect in so far as Grampian Police are concerned is that arrest procedure and the accompanying administrative process, both time-consuming, are now almost non-existent. A second important feature is that the maximum supervision of drunks in police cells is not always practicable and is a matter of concern, whereas constant attention can be provided by the staff of Albyn House. Grampian Police benefits from Albyn House, as Officers, if only in a relatively small way, are less hindered in performing the more important aspects of their statutory functions, which is surely in the public interest.The chief constable raised an important point concerning the custody of those suffering from 1269 drunkenness, for it is a regrettable fact that too many have died while in police custody, death having been brought about in some instances by vomiting leading to asphyxiation. It is a real problem and the chief constable hit on an important point in that context.
Having discussed the issue of designated places with Mr. Drew Watson, director of the Inverclyde Council on Alcoholism, senior police officers — including Chief Superintendent Barry Shaw, the most senior police officer in my constituency—and social workers and doctors, it is patently evident to me that we require a designated place in Greenock and Port Glasgow. I appreciate that the Minister has no responsibility for that, but I trust that he will bring it to the attention of his Scottish colleagues. I say with regret that we need one in Greenock, but many more are needed throughout the United Kingdom. Is there any likelihood of the Government taking up more of the financial burden? For example, is there any chance of an extension of the grant period from three to, say, 10 years? Grampian region will have serious problems concerning Albyn house once the three-year period is up.
Designated places can tackle only a small area of alcohol abuse and hence much more needs to be done. In the time remaining to me, I can outline only some of the areas where the Government can do much more to tackle the social evil of alcohol abuse. Close and continuing co-operation between the Government, local authorities, health and social services, employers and trade unions is vital for the containment, and I hope prevention, of alcohol abuse.
What are the Government's plans for the development and extension of health education programmes? Such programmes concerning alcohol abuse must be brought into schools. There is far too much alcohol abuse among teenagers, both north and south of the border. It is a real problem. Indeed, it is more serious in some respects than solvent abuse and certain other forms of drug-taking. Do the Government believe that such educational programmes should be organised by local authorities and voluntary organisations, or do they believe that the Government have a more comprehensive role to play? What Government-sponsored research is being undertaken in the vital sphere of health education?
I appreciate, as I come to fiscal policy, that the Minister may not be able to answer for the Government on many of the points that I raise. The Scottish report to which I referred contains the argument that an increase in excise duty reduces the average per capita consumption of alcohol and, in particular, the consumption of the heaviest drinkers. In terms of fiscal policy, what is the Minister's response to the observation that the Government should, as a positive health measure, regularly increase the duty on alcoholic beverages in line with the retail price index or, better still, add an extra 3 to 5 per cent. each time an increase is made?
The authors of that report argue that recent evidence supports their point of view. They mean by that that in the 1981 Budget the excise duty on alcoholic beverages was increased dramatically and that that decision, in tandem with price increases introduced by the breweries, meant that for the first time for several decades, the price of alcoholic drinks increased by much more than the overall rise in the retail price index.
Between 1978 and 1981, the RPI of alcoholic drinks increased by 61 per cent., whereas the RPI of all products increased by 52 per cent., and personal disposable income 1270 rose by 55 per cent. In other words, drinks were more expensive to buy. In 1981–82, for the first time for 30 years, the per capita consumption of alcohol in Britain declined, from 10.4 to 9.3 litres of pure alcohol per adult. That decline was accompanied by a 10 per cent. reduction in convictions for drunkenness and an 8 per cent. decline in convictions for drunken driving. Clearly, that was more than coincidental.
There are other areas in which the Government could play a more decisive role. For example, are Home Office Ministers satisfied with the education and training that police officers receive in dealing with alcohol problems and their prevention? Is education concerning alcohol problems a prominent feature of police training programmes? If not, why not?
I appreciate that the Minister has no responsibility for police training, but do social workers receive any trairing in the detection and prevention of alcohol abuse? That is important, given that alcohol abuse features so largely in, for instance, child abuse cases. Are social workers equipped to tackle alcohol problems, or are they simply encouraged to pass on those problems to the local special alcohol unit?
I appeal to the Government to encourage more actively the development of joint employee policies on alcohol abuse. In a growing number of companies, members of senior management and trade union representatives negotiate alcohol recovery programmes which have as their objective the early identification of alcohol-related problems. Many companies have adopted that policy and found that it reduces the incidence of alcohol-induced inefficiency, gives health and sport to employees and their families and discourages the felt need to lie, conceal or deny the existence of a problem. As a major employer of labour, the Government could exercise a considerable influence throughout the country.
I know that this is nothing to do with the Minister, but is there an alcoholic recovery programme for hon. Members and employees of this House and the other place? It is some time since we had a drunken Parliament. The Scottish Parliament which sat in Glasgow on 1 October 1662 had only one sober Member on its first sitting day. The Minister ought not to hold that against us when we demand a Scottish Parliament.
The nation needs a public health policy on alcohol abuse. There is a staggering growth in alcohol-related problems and we must ask whether the Government are doing enough and whether their policies are likely to contain or reduce this social disease. I believe that much more could be done.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
The hon. Member for Greenock and Port Glasgow (Dr. Godman) has given the subject of this debate a good airing and I have listened carefully to him. We do not always get time to debate this matter in full. I am grateful to him for the style and content of his speech.
The hon. Gentleman was extremely courteous to my hon. Friend the Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food in allowing her to encroach on his time. I must reply rather briefly so that I do not go into the time of my hon. Friend the Member for 1271 Lewisham, East (Mr. Moynihan). I shall speak rather fast and try to be succinct, along the lines of my intervention in the hon. Gentleman's speech.
The hon. Gentleman asked many questions on matters which are not my ministerial responsibility. I shall try to reply across ministerial boundaries. It is not very helpful to say that a matter is one for my right hon. Friend for this or my hon. Friend for that, although it is a rather good defensive line when the temperature is raised. The hon. Gentleman is quite right to say that alcohol and certain drugs can be benificial in tightly controlled circumstances. For example, heroin is still used for the relief of pain. It is important that, while being rightly worried about the threat of heroin and cocaine abuse, we do not forget other substances such as alcohol, tobacco or solvents, the abuse of which can also cause mayhem. My Department is keen not to fall into that trap.
I cannot speak with authority about Scotland, so I shall have to seek advice from my colleagues in the Scottish Office. I shall also ask for advice from colleagues in the Home Office and the Department of Transport to compose the omnibus letter that I shall have to write to the hon. Gentleman.
The Government are determined to do as much as possible to mitigate the effects of heroin and cocaine coming into the country. That is why, in 1984, we spent an extra £19 million on the police force, why every police force has a regional drugs squad, why we spent an additonal £10.5 million in 1984 on customs activity against heroin and cocaine, why we put an extra 160 officers in the drugs squad —there is now a cocaine squad — why we mounted a £2 million educational publicity campaign and why we have customs and intelligence officers in countries such as Holland, Pakistan and India in an attempt to cut off the lines of supply.
At a recent meeting, I talked to Ministers and other people from countries such as Pakistan, Taiwan, Bolivia and Mexico where drugs are grown, refined and exported, to stress to them, eyeball to eyeball, how strongly British people feel about their export of drugs. The World Health Organisation must get on faster with its programme of drug education.
I shall not refer to the hon. Gentleman's suggestion that there should be advice available in this place about 1272 alcohol. That is a matter for my right hon. Friend the Leader of the House and the usual channels. It is not water into which I shall put my toe as I fear that it would be badly burnt. I am sure that the whole House agrees that alcohol is not bad unless it is abused. Indeed, some medical advice suggests that small amounts of alcohol taken regularly can be beneficial for some people in certain circumstances. I am told that the odd glass of wine taken daily is good for men with heart problems. Other medical authorities maintain that four or five glasses a day is bad for everything from the liver to the brain and back again, never mind work patterns.
Moderation should be encouraged. The hon. Gentleman quoted the British Medical Journal or a speech by a member of the British Medical Association. Our document entitled "Drinking Sensibly", which has been widely welcomed, does not give flimsy advice. Indeed, its advice is good and straightforward — be sensible, be moderate. The problem is getting that message across. The hon. Gentleman gave us statistics covering everything from days of absence from work to road accidents. We all know what the problem is and the answer — do not abuse alcohol. That is why health education is so important and why the Health Education Council in England, Wales and Northern Ireland and its equivalent body in Scotland are so active. That is why a new body called Alcohol Concern is being funded at such a high level. It brought together all of the voluntary bodies of substance—one or two chose not to join—in an attempt to deal with the problem nationally. We sometimes give substantial funds to local projects.
The problem of alcohol abuse must be worked out by each individual in the world in which he lives—his family, his place of work and so on. While we can prime the pump and fund national bodies concerned with health education, in the end the necessary services are best provided at local level. We can prime the pump and fund national bodies for a while—three years appears to be the norm—but thereafter it is better dealt with locally.
I pledged that I would not speak beyond 11 o'clock. The hon. Gentleman may not have appreciated the integrated nature of the Government's approach to alcohol abuse. If so, that is my fault for not having put it across more clearly. I shall try to put right that misapprehension in the very long letter — that is both a threat and a promise—that I shall write to him in a few weeks.