HC Deb 31 January 1997 vol 289 cc648-56

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

2.33 pm
Mr. Simon Hughes (Southwark and Bermondsey)

I am grateful for the opportunity for a short debate on the question of rehabilitation from alcoholism, and for the Minister's attendance to reply. This is not, it might be thought, the most populist subject, but it is very important. I want to explain why I chose this subject for debate and to set it in context.

The Minister is aware, I think, that an organisation called the Alcohol Recovery Project is based in my constituency. I was privileged to be invited to speak at its 31st anniversary event in November last year. I have had many dealings with the organisation before—it is based near the Elephant and Castle in Newington Causeway—and that event coincided with the launch of a document it had commissioned, called "Preventing Homelessness Supporting Tenants with Alcohol Problems", which was written by Shelter and paid for by British Telecom—it was very much a partnership enterprise.

The request to speak set me thinking about issues that—like many people, probably—I tend to put to one side because they are both challenging and disturbing. I shall begin by sharing three examples with the Minister and the House. First, the Alcohol Recovery Project distributes a good leaflet, which has the following question on its front page: What is the common factor in: up to half of all social work caseloads; up to one quarter of occupied hospital beds; one quarter of accidents at work; over 8 million lost working days each year; half of all juvenile crimes; three deaths every hour? Think about drink. The answer is self-evident from the context of this debate. Drink has a huge impact on vast areas of our public life.

The second example concerns a man who came to my constituency surgery about five years ago. He was relatively the worse for wear when he came in and told me the story of his circumstances. Within two years he had gone from having a professional job as an officer in the Army, with a stable marriage and home circumstances, to being on his own, on the street and an alcoholic. He had already tried to commit suicide and he made a further attempt subsequently. We can all be stable human beings one day or one year, but be thrown considerably off beam by circumstances.

The third example is a current constituency case. A family in my constituency suffered a terrible tragedy in the summer a year and a half ago, when one of the three adult sons lost his life diving into Greenland dock in the Surrey docks to save a friend who was drowning—both of them drowned. Not long after, the mother, who was disabled, had to go into a home, which left father—a pensioner—and the one son who was still at home looking after themselves. The result of the death and the loss of the mother from the home indirectly—I do not pretend more than that—meant that both father and son started to drink more heavily. They got into financial difficulties and, last year, lost their home. Some months later, we are still trying to find them housing. It has been terribly depressing. Again, I do not have to tell the Minister or colleagues that such cases are often nearly intractable and yet the people may be really deserving—they may be difficult sometimes, but they are deserving.

Those are examples of the issues that come the way of an organisation such as the ARP and many of the public services every day. I shall flag up the issues that are on the agenda of a project that caters for the wide range of organisational concerns and share some thoughts, reflections and requests. I do so entirely constructively and, I hope, in a way that can influence what the Government do—even during the remaining time of this Parliament—irrespective of who is in government after the election.

In the autumn, I asked people at the ARP what the issues were for them. First was funding, which will always be an issue. The second concerned advice, education and information about alcohol and alcohol-related products. The topical example last year was alcopops, which very much hit the headlines. The third issue was housing and all hon. Members know from their constituencies how under strain public sector or rented housing is, let alone housing for people with alcohol problems.

The fourth was how to deal with people who are homeless and have alcohol problems—very much a marginalised group. They are often seen as a threat and are not popular—in some senses, they are not nearly as appealing as young people who are homeless, or people who have come here as asylum seekers, for example.

Fifthly, as we often see in urban surgeries, there is a growing link between alcohol abuse and mental health problems. I am conscious that we are having this debate three or four working days before the Government are to produce their Green Paper on mental health, with which there is a strong link.

Alcohol abuse is self-evidently drug abuse. "The Oxford Textbook of Medicine" regards alcohol and drug abuse as a single issue, as both act on the mind. Most of us partake of alcohol and we know that it has an effect; it becomes a drug when it takes control of us, as other drugs do.

People's reasons for starting to abuse alcohol are multiple, as with other drugs: social attitudes, social changes, the quality of the social environment, family relationships, home, work, pressures and other factors impact on people in a way that may result in alcohol abuse and alcoholism.

A study in 1993 of people seeking admission to an in-patient alcohol treatment research unit found that 51 per cent. of the men studied, and 48 per cent. of the women, reported the use of one or more drugs in addition to alcohol. There is often multiple drug abuse by people who use alcohol to excess. All the evidence is that people who are simply abusers of alcohol are a minority of those who present themselves with drug abuse and dependency problems.

I understand—this is the really telling statistic—that there are 10 times as many alcohol abusers as other drug abusers. That is not an absolutely scientific figure, but if that is the order of the problem, we need to spend more time on the issue; but we seem to give more public prominence to other drug issues, as has been evidenced in the past few days.

A Scottish Office report in 1993 showed that research into the links between alcohol and offending is contradictory, unevaluated and often based on crude interpretations of data. It is also sometimes fairly subjective. That is unacceptable. We all have experience that suggests a close correlation between alcohol abuse and crime.

There is no lack of evidence, and that evidence is telling. The British Medical Association estimates that alcohol is associated with 60 to 70 per cent. of homicides—one third of victims are intoxicated at the time of death—75 per cent. of stabbings; 70 per cent. of beatings; and 50 per cent. of fights or domestic assaults. The Police Superintendents Association of England and Wales says that alcohol is present in half of all crimes. The National Association of Probation Officers found in 1994 that 30 per cent. of probationers and 58 per cent. of prisoners had severe alcohol problems, and it argued strongly for a clear strategy to reduce alcohol-related crime.

The all-party group on alcohol abuse, in a 1995 report, said that, in the view of all the professional agencies engaged in the criminal justice system, there is a need for a more concerted and coherent response to alcohol-related crime. It is estimated that alcohol abuse costs employers £2 billion a year. I support "The Health of the Nation" programme, but according to the evidence we are missing the target set in 1991 to reduce over-the-limit drinking in women to one in 18 of the population, and in men to one in six, by 2005. The National Audit Office's report last year said that it was unlikely that we would meet the target. There is no net downward trend in over-the-limit drinking among men, and a rising trend among women.

There is a philosophical and attitude problem to alcohol abuse compared with the abuse of other illegal drugs and of cigarettes. The social services inspectorate says that there is a built-in prejudice against people who abuse alcohol, but not against cigarette smokers or people addicted to tobacco or other drugs. That is one of the reasons why low priority has been given historically to those who abuse alcohol, as it has to those with mental health problems. There is a general perception that people with alcohol problems are less deserving; that they have brought their problems on themselves.

The recent record has not been good. The Office of Population Censuses and Surveys figures showed that the proportion of children in England aged 11 to 15 who said that they drank every week was 17 per cent. in 1994, compared with 13 per cent. in 1990 and that weekly consumption—not just the numbers but the total consumption—had increased. We now have alcopops, alcoholic lemonade and artificial insertion of alcohol into other drinks.

The Government used to ring-fence alcohol rehabilitation in their budget allocation process. In 1992, the then Secretary of State announced that ring fencing would end. The ARP took the Government to court and lost. Ring fencing finished with the introduction of community care. Although many local authorities previously ring-fenced voluntarily, budgetary pressures are driving them away from doing so.

The structure of the community care budget, which does not allow for ring fencing at national level, is unhelpful and undermines much of the work which difficult, deserving but not potentially popular projects such as the ARP are doing. They compete with other projects, funds and services. The National Health Service (Primary Care) Bill which is in the other place and will come to the House next month does not look as if it will make the position any better because the problems are particularly prevalent in inner-city areas and there is no guarantee that projects will be funded.

I commend—I have said so publicly before—the Government's "Tackling Drugs Together" initiative. It has been focused on specific drug issues. I do not think that it was intended to include alcohol. It has concentrated on other things. The all-party group recently called for a ministerial group on alcohol misuse based in the Home Office to co-ordinate policy in response to alcohol-related crime. The Government could make a similar commitment to tackling alcohol as they did to tackling drugs and launch an initiative later this year called "Tackling Alcohol Together". That would be to everyone's advantage. I am aware of what the latest parliamentary answer said. Such an initiative should have the same high-profile leadership as the Leader of the House has given to "Tackling Drugs Together". We need that sort of commitment and leadership.

We must have authoritative statistics. In one of its main recommendations, the all-party group said: The single biggest barrier faced by those who would wish to see an on-going strategy for concerted action to tackle alcohol-related crime is the absence of detailed statistical evidence. I am not being over-critical, but we need to get a grip on the facts.

Perhaps most important—I think that this is in the Government's mind, but I want to make sure that we are clearer on it—we need much better collaboration between the relevant agencies, including Departments, social services departments, housing departments and health authorities. The social services inspectorate reported about 18 months ago: In most cases services were inaccessible to service users who often had to jump through a number of hoops, and express high levels of motivation before gaining access to a service at all. My advice from the ARP is that we are struggling with the lack of 'joined-up thinking' between Central Government Departments, local government and NHS planning structures which don't consider the knock-on effect of proposals for change". The King's Fund report on mental health which came out about 10 days ago concluded that there was a lack of coterminosity in London. The Government intend to come up with proposals on mental health. I welcome that. I ask that we have a seamless service on alcohol-related issues, as we are to have for mental health, and that legislation be introduced which will allow the merging of health and social services so that they can co-ordinate and work together, pool their budgets and share responsibility for joint commissioning. We have to deal with these things together. I ask that we take on the thinking that has already been applied to the Green Paper on mental health.

I now come to my last two points. In November, soon after his appointment, the Minister answered a parliamentary question about what plans there were to assist general practitioners in detecting and treating patients suffering from alcohol-related illness. The Minister replied: We are currently considering what support we might give to purchasers of treatment and care for people with alcohol misuse problems. This would include general practitioners involved in the purchasing and planning of such services. We aim to produce, by next summer"— now this summer— guidance equivalent to the guidance we issued this year to purchasers of services for drug misusers".—[Official Report, 7 November 1996; Vol. 285, c. 626.] I welcome that as the peg and I would be grateful if the Minister could confirm that the Government see these matters as a priority. I would encourage him and offer to work for the maximum all-party support, even before the election, to ensure that we instate alcohol abuse and alcohol-related problems as a high priority on the social, parliamentary and Government agenda. There are many people out there who would benefit from such action and society would benefit incredibly.

2.50 pm
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns)

I am grateful to the hon. Member for Southwark and Bermondsey (Mr. Hughes) for raising this important issue and I pay tribute to the constructive, thoughtful and thought-provoking way in which he has dealt with a very sensitive subject.

The Government's record on the provision of alcohol services is a good one and I am pleased to have the opportunity to comment on it, to mention some work that we have in hand to assist the provision of an even more effective alcohol service, and to address several of the hon. Gentleman's points.

First, I add my own tribute to the hard work and dedication of the staff of the Alcohol Recovery Project. We are well aware of the good work that they do—indeed, we currently fund from our drugs and alcohol specific grant two projects run by the ARP.

Some of the issues that the hon. Gentleman raised about alcohol service provision in London were summarised in the King's Fund London commission report on mental health, which was published last week and to which the hon. Gentleman referred. That report made a number of recommendations about substance misuse service provision generally which we are studying very carefully. However, many of the issues that the report raised were also examined during our review of effectiveness of treatment services for drug misusers which we published in May 1996. The recommendations in the King's Fund report are similar to those in the effectiveness review and we are still considering how best to implement many of the 80 or so recommendations that it made. Although the review dealt with drug services, there are many themes in it which might also be relevant to alcohol services.

We are aware that one of the biggest concerns in the alcohol field is that the support for provision of alcohol services has not had the kind of strategic attention from the centre that has been given to drugs since the publication of the White Paper, "Tackling Drugs Together," and more especially since the publication of the review of effectiveness and our draft circular in August 1996 on purchasing effective treatment and care for drug misusers.

We have been considering in the Department what further support we might provide for statutory purchasers of alcohol services, in the light of the warm welcome that our drug effectiveness review and purchasing guidance received. Department of Health officials consulted representative purchasers both from local authorities and from health authorities on such issues and received a number of representations which we took very seriously indeed. We are particularly concerned to ensure that the emphasis on drugs is not interpreted as giving reduced priority to alcohol—a point that the hon. Gentleman made which I would wholeheartedly endorse.

Therefore, as I announced in my speech to Alcohol Concern's annual conference in November last year, we shall be issuing draft guidance in the summer on alcohol service purchasing so that purchasers of such services can use it in drawing up their purchasing plans for 1998–99. We aim to produce a document covering similar ground to the drugs guidelines and intend that it should cover effective purchasing, the range of service options, possible performance indicators and recommendations about local co-ordination, although its eventual shape will depend very much on the views of a working group that we shall be putting together to prepare the final draft.

The production of the guidance will be in two phases. The first stage will be to draw together existing evidence and knowledge on types of service provision and their relative effectiveness and to prepare a draft review document by the end of April to enable the second phase to begin—the preparation of practical guidance for purchasers by a small working group of representatives from the alcohol field. The review document from the first phase of work will be published alongside the draft purchasing guidance. Through the first phase of work, we hope to be able to address an issue that has received much debate in the field: which types and combinations of treatment are most effective.

There has been criticism—although not so justified as I suspect that some people who make that criticism would claim—about apparent lack of provision for in-patient and residential detoxification. Research studies summarised in a 1994 publication by the Centre for Research on Drugs and Health Behaviour failed to show any overall advantage of in-patient or residential treatment over out-patient or community settings. However, this is one of the issues that our review will address and I would not wish to prejudge that review by pronouncing in favour of a particular regime. Different patients have different needs and we are keen to ensure that treatment is effective and addresses those needs.

In our review, we shall consider the whole question of effective co-ordination between various bodies. We are anxious that organisations in the health and social care fields working for health authorities and local authorities, and the voluntary sector work together as effectively as possible to provide the best possible service for patients in need. We want to consider not only different types of treatment but the possible desirability of a city-wide or pan-London approach to services, and other issues relating to alcohol services generally. We shall gather together evidence such as that produced by the King's Fund and the Centre for Research on Drugs and Health Behaviour and would welcome contributions and examples of good practice from the field for consideration for our review.

That is all for the near feature. For the present, there are still several areas in which alcohol service co-ordination is actively being improved. The hon. Member for Southwark and Bermondsey mentioned drug action teams, which we established following the publication of "Tackling Drugs Together". We made it clear in the White Paper that drug action teams have the option of looking at prevention and treatment issues more generally by bringing other forms of substance misuse, including alcohol misuse, within their remit.

The widening of the DATs' terms of reference to include alcohol—where they choose to do so—can bring local alcohol services within the remit of a body with a much higher profile than before. It represents a valuable opportunity to ensure that all concerned work more closely together to develop and provide services. We regard such local partnerships as a vital key to tackling substance misuse problems effectively. Our latest reports show that more than a quarter of DATs nationally have decided to do that, and several other teams are reviewing their position. We are encouraged by such developments, and I hope that that reassures the hon. Gentleman.

We are aware, however, that the DAT model for alcohol services is not the only one. Where other local arrangements exist which address the problems just as well, there is clearly no reason to disrupt them, although we would wish them to co-ordinate their activities with local DATs in areas of shared interest, such as the provision of services for young people. Where such arrangements are not yet in place, and where the DAT is clearly preoccupied with issues surrounding illegal drugs, we would expect purchasing authorities to consider what else can be done to develop better, more co-ordinated standards of provision for alcohol services. Overall, our priority is a high standard of service provision, no matter what the exact arrangements are for delivering it. That is what we shall seek from our purchasing guidance.

As the hon. Member for Southwark and Bermondsey will fully recognise, the voluntary sector has a crucial part to play. Support for developments in voluntary sector service provision is considered by the Government to be equally important as part of our national policy. One way in which we have helped to stimulate local initiatives is through the Department of Health's drugs and alcohol specific grant. Since 1991–92, the Department of Health has grant-aided more than 100 drug and alcohol projects, giving out about £13.2 million, and we are making available a further £2.5 million for the next financial year.

The grant has enabled us to encourage new forms of service development. For next year, we have identified a single national priority in response to valuable feedback from the field. We are giving priority to projects supported by local authorities providing services for the homeless with drug and alcohol problems, in areas currently designated by the Department of the Environment either as rough sleepers initiative zones or else as zones eligible for funding from the rough sleepers revenue fund. We have £1.65 million available for new projects, which will be supplemented by a further 30 per cent. of funding from other sources. We hope that through the grant we will be able to fund a number of innovative projects dealing with this most unfortunate group of our society.

While we accept that services for alcohol misusers are under pressure, especially in London, developments in alcohol services since the introduction of community care have made considerable strides. Obviously, we cannot be complacent, but it seems to me that much of what needs to be done is a matter of fine tuning rather than wholesale reform and the upheavals that that causes.

Finally, I thank the hon. Gentleman once again for the timeliness of this debate. It comes as we are about to embark on our review of the effectiveness of alcohol services, which we hope will provide some useful pointers for statutory purchasers about how they might co-ordinate and purchase alcohol services more effectively. We shall certainly consider the hon. Gentleman's observations and comments very seriously as we take that review forward in the next few months.

Question put and agreed to.

Adjourned accordingly at one minute past Three o'clock.