§ Mrs. Marion Roe (Broxbourne)
As vice-chairman of both the all-party group on alcohol misuse and the Conservative health committee, I welcome this opportunity to bring the issue of alcohol misuse to the attention of the House. I have long been aware of the role played by alcohol misuse in public health and the health and social costs to individuals, families and business, not to mention the cost to our health and social services in picking up the pieces.
Alcohol is an extremely complex policy area, not least because it is, as the Royal College of Psychiatrists puts it, "our favourite drug". I accept the drinks industry's argument that many people drink without causing a problem for themselves or for others, but my experience as former Chairman of the Select Committee on Health, my contact with the local alcohol service in my constituency and my knowledge of the facts available from a range of national organisations tell me that there are many people who misuse alcohol and cause problems for society as a whole, but who do not see themselves as misusers.
I was pleased to see in the recently published Green Paper "Our Healthier Nation" that the Government are
"preparing a new strategy on alcohol to set out a practical framework for a responsible approach".
There is a little more detail than that, but I hope that the eventual White Paper will be used as an opportunity to tackle the whole range of alcohol-related problems in a strategic and co-ordinated way. Alcohol policy is not only about how much individuals drink and whether they are below the recommended safe levels. That forms an essential part of the strategy, but it is only part of the jigsaw. The jigsaw needs to include the whole range of alcohol-related harm and the whole range of solutions. It should address the impact that drinking can have on families, its contribution to violence, its role in accidents and its net impact on the efficiency of British industry. Let me highlight just a few of the issues that are at stake.
Children, as is so often the case, are the biggest losers when alcohol problems occur, both as drinkers themselves and as sufferers from the effects of a parent's drinking. Educating young people about alcohol and how to drink safely is of the greatest importance, especially in light of increasing levels of drinking among 11 to 15-year-olds and, it would appear, increasing levels of harm.
I was perturbed to read of a study published in the British Medical Journal conducted by Dr. Joan Robson, a consultant in accident and emergency at the Royal Liverpool Children's hospital. Dr. Robson monitored the accident and emergency department for 12 months; in that time, about 200 children and adolescents under the influence of alcohol were brought in requiring either resuscitation after a large overdose of alcohol, or treatment for injuries sustained in assaults or accidents while they were intoxicated. Similar results have been reported by studies in hospitals throughout the country.
Finding the most effective way of teaching young people about alcohol should be a priority, given how easily they can get hold of it to experiment. The example set by adults around them is also important for teaching children and teenagers how to use alcohol, especially as 289 research has shown that the children of parents who drink sensibly or moderately are more likely to develop less risky patterns of drinking behaviour themselves.
Many children suffer because of a parent's drinking or the drinking of other adults in their life. Before Christmas, hon. Members may have seen some of the publicity for two excellent reports on the children of problem drinkers, by Alcohol Concern and Childline. The two charities point to the fact that nearly 1 million children are living with a parent whose drinking has reached harmful or risky levels.
Some of those children are coping without help with parents who abuse them physically or sexually, neglect them emotionally, or fail to feed and clothe them properly. Those children often have nowhere to turn and they feel to blame for what is happening; inevitably, that adversely affects their own behaviour and emotional development. Helping those children and their parents requires a multi-agency approach: local authorities, health professionals, teachers and alcohol service providers, to name but a few, are the key players.
Domestic violence is another example of an issue that is often alcohol-related, but where the alcohol factor is often overlooked or else not directly addressed, and a wide range of agencies need to be involved to develop an effective joint approach. Violence against women has been highlighted by the Cabinet Sub-Committee on Women as a priority area for action. Alcohol, which is a factor in about 40 per cent. of domestic violence incidents, should be taken into account when considering what action to take, but discussions about alcohol's role in domestic violence—or in any of the other problems that I am highlighting—should also be conducted with one eye on the bigger picture.
A strategic approach would look at the issue of violence against a partner or relative in conjunction with all the other issues, such as the impact on children of a parent's drinking. It would also look at the financial and work problems that alcohol misuse can bring to a problem drinker and their family; and the availability of specialist counselling and treatment services for the drinker and support for the family.
Mental health has rightly been identified in the public health Green Paper as a priority area for action. The role of alcohol misuse in depression and suicide—particularly among heavy-drinking young men—is well documented and should be addressed in suicide prevention activities. The mental health of those around a problem drinker must also be considered. I have already talked about the children of problem drinkers and the impact on their emotional development, but other family members who suffer violence, stress or exhaustion as a result of an individual's alcohol problem are an extremely important group. Their mental health, as well as the mental health of the drinker, is at great risk.
Social exclusion is another important problem being tackled by the Government. In assisting individuals to live healthier lives, to participate in society and to improve their own economic and social circumstances, issues such as alcohol misuse need to be tackled. With one in 20 adults in Britain dependent on alcohol and 2 million people drinking at risky levels, everyone needs to have access to high-quality services that can help people to combat an alcohol problem, look at the underlying problems that lead them to misuse alcohol and support their families through a difficult time.
290 I have strong links with the Hertfordshire Alcohol Problems Advisory Service—HAPAS—in my constituency and am pleased to serve as vice-president to the organisation. When I visit HAPAS, I am always impressed by the range and quality of the services that it offers. The dedication of the staff and the many volunteers who work with HAPAS is commendable, especially as they are not working with an easy issue. They have to spend a lot of time trying to persuade health and local authorities and probation and prison services to fund not only the provision of counselling and treatment services for problem drinkers but preventive and educational activities to reduce alcohol-related harm.
While many local purchasers understand the importance of tackling alcohol problems, they inevitably have restricted resources with which to address a whole range of issues. However, a powerful joint statement issued in February by the Association of Directors of Social Services, the NHS confederation, the Association of Chief Officers of Probation, and Alcohol Concern clearly shows that those organisations recognise the impact of alcohol misuse and the consequent drain on community resources. The statement calls for a cross-governmental co-ordinated strategy to provide a framework for the joint planning and implementation of local alcohol strategies.
Alcohol misuse features largely in another target area identified in the public health Green Paper—accidents. We hear a lot in the media about drink-drive accidents, and I am very pleased that the Government are consulting on new measures to reduce further the number of deaths and injuries from drink-driving. However, we hear very little about the major role that alcohol plays in other accidents. For example, alcohol is involved in 26 per cent. of drownings, 39 per cent. of deaths in fires and 25 per cent. of workplace accidents.
If one were to extend action on accidents to include injuries, it would become obvious that the role of alcohol was even bigger. I have mentioned the alcohol-related injuries that arise in many cases of domestic violence. Another good example is the role that alcohol plays in facial injuries. Recently, the British Association of Maxillo-Facial Surgeons launched a campaign to highlight the number of serious, and often permanent, facial injuries caused by excess alcohol. Its survey shows that nearly 70,000 people a year suffer injuries to their face because of alcohol—some from falling while drunk, others from attacks by someone who is drunk, often with a broken beer-glass. In addition to the disfiguring scars, nerve damage and lasting psychological effects on their lives, the costs to the health service of treating those injured is high.
I hope that, in targeting accidents as an area of activity, the Government will take account of the role of alcohol, but I also hope that the fact that alcohol has such a big role in accidents, violence and mental health, not to mention social exclusion, will lead the Government to put their weight behind developing and implementing a worthwhile, really effective alcohol strategy, instead of simply conducting a paper exercise that will have no real impact.
In putting together the pieces of the alcohol policy jigsaw, there are very many key players whose contribution is essential but who need to be co-ordinated both locally and nationally. Jointly, they need to decide where the most impact can be made and what the main 291 objectives of an alcohol strategy should be. Separately, they need to acknowledge the seriousness of alcohol problems and make a commitment to working together toward agreed aims.
I include the Government in that equation. About 11 Government Departments have an interest in alcohol issues. The obvious ones are the Departments of Health and of Social Security, the Home Office and the Department for Education and Employment, but there is also the Treasury, which is responsible for alcohol duty; the Department of the Environment, Transport and the Regions, which has an interest in reducing drink-driving; the Department for Culture, Media and Sport, which has an interest in sponsorship and advertising; and the Department of Trade and Industry, which has an interest in the impact on business of alcohol problems. In developing alcohol policy, there must be co-ordination across Government, with a view to reducing the health and social costs of alcohol problems while taking account of industry and tax revenue concerns.
As work begins to develop a new strategy on alcohol, as promised in the Green Paper, it is important for the Government to recognise that half-measures will not be good enough. Fiddling around at the edges of alcohol-related problems will not make a significant difference. Not only do properly considered and constructed objectives need to be established, but the means of achieving them, and clarity about who will be given the lead in achieving them, are essential.
The obvious parallel to this process is found in the structures set up under the "Tackling Drugs Together" initiative, which are being continued in the new drugs strategy launched on Monday 27 April, "Tackling Drugs to Build a Better Britain". The experience of "Tackling Drugs Together" proves that progress can be made on such an issue. Clear objectives with a time scale were set, support and guidance from the centre were forthcoming, and the necessary resources were provided. The Government's high-profile commitment to "Tackling Drugs Together" resulted in an equal level of commitment from all the key agencies at local level that became active members of the local drug action teams set up to drive the work forward. Those teams—with members from, among other sectors, the police, probation, health and local authorities—have been, and will continue to be, instrumental in achieving progress.
However, while alcohol has been given a minor mention in the new drugs strategy, but specific action on alcohol lags far behind that on drugs. The majority of drug action teams decided some time ago to include alcohol in their brief. They did so because their members recognise the level of problems that alcohol causes and the need to address those problems in the multi-agency way that the drug action team provides for.
Adding work on alcohol to the work of drug action teams is better than nothing, but why should alcohol always be tacked on to drugs? Some areas of education and treatment overlap, but there are very many areas where there is little or no overlap, and where different approaches are needed. The Hertfordshire drug action team in my constituency is a case in point. While welcoming the fact that it has embraced alcohol in its structure and work, the local alcohol service, HAPAS, has 292 told me that it has a major concern about the lack of firm national direction on alcohol, and the lack of formal support for the alcohol work that is being undertaken.
If the existing drug structures are to be used to address alcohol issues, the process needs to be done properly, with alcohol-specific objectives set at national level to take account of priority areas of activity, and evidence of what works. Teams tackling alcohol need to be provided with the necessary information, support and guidance on alcohol to do the job. Finally, they need to have the all-important backing that comes from explicit Government commitment as well as the necessary resources to make real progress. For drugs, that was forthcoming in the high-profile appointment of a drugs tsar. I ask the Minister: will there be a similar high-level appointment for alcohol?
Hopefully, with the Government's new commitment to developing a national strategy on alcohol, we shall see some long-overdue attention being paid to alcohol problems. However, it would be all too easy for the present Government to pay lip service to tackling alcohol misuse in all its forms, but not to come up with any real commitment or action to reduce the great amount of harm caused by alcohol in our society.
§ The Minister for Public Health (Ms Tessa Jowell)
I am grateful to the hon. Member for Broxbourne (Mrs. Roe) for raising this important issue, which the Government take very seriously indeed. In less than a year since taking office, the Government have made considerable progress; moreover, we have already marked out the scope of development to come. There is an enormous amount of common ground between us, in the analysis of the problems and in our views on the nature of the solutions needed to tackle alcohol misuse effectively.
Alcohol misuse is a significant public health issue. We treat it as such now, and shall continue to do so. However, we are not interested in depriving of their drink millions of people whose moderate consumption causes no harm to themselves, their families or society. If policies to combat abuse are to be effective, we need widespread public support. There is no place for crusading zealotry against alcohol as such.
In dealing with such a complex subject, we need a balanced, realistic, sensible and practical approach to policies on alcohol. We need to address the harm that it causes, not the substance; that means no nannying lectures. We must recognise that the action that the hon. Member for Broxbourne proposed so clearly will come about not only as a result of the right type of partnership, led by Government, delivered locally, but as a result of a high level of individual understanding about the difference between sensible drinking and alcohol abuse.
The hon. Member for Broxbourne is absolutely right when she identifies the issue as one of those wicked, cross-Government issues. At least a dozen different Departments have responsibilities that are relevant to alcohol. No single Government Department can take action on it without immediately affecting the interests of other Departments. We aim to draw all those interests together, into a more coherent framework, and to tackle alcohol abuse on a more consistent basis across Government, recognising that it is, in essence, a cross-departmental concern.
293 That is what we meant in the Green Paper "Our Healthier Nation", when we said that we were preparing a new strategy on alcohol to set out a practical framework for a responsible approach, harnessing the resources of Government to deliver the range of action that is necessary for a meaningful and effective approach to alcohol abuse.
We have already made a significant start. When we came to power, the alcopops problem was reaching a new pitch of public concern. The Home Secretary promptly took action and established an interdepartmental ministerial group under the chairmanship of the Under-Secretary of State for the Home Department, the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth), to tackle not just the problem of alcopops but the under-age misuse of alcohol in general. The hon. Lady gave us the figures behind the real anxiety about the increase in drinking among very young children. Let me add to her list of evidence by saying that the Health Education Authority survey of 1996 found that almost one in eight of all 13 to 14-year olds and half of all 15 to 16-year-olds who usually drink at least once a month reported having felt drunk in the previous month.
We should not underestimate the significance of this problem. Our success will lie in recognising that we must tackle the problem, not the substance. We must focus on the misuse of alcohol, not on drinking generally.
I am pleased to say that the inter-ministerial group on which I represent the Department of Health has had a significant impact, with an encouraging response from the industry. The revised Portman Group code of practice on the naming, packaging and merchandising of alcoholic drinks, launched last July, took on board our suggestions for an additional range of controls. To reinforce this self-regulation by the industry, we also announced an additional package of complementary measures, including measures to allow the police to confiscate alcohol from people under the age of 18 drinking in public, and the creation of an offence of adults buying alcohol from a shop or off-licence at the request of an unsupervised youngster.
The ministerial group will review progress later in the spring and again in the autumn, after some of the industry's self-regulatory measures have been given time to operate. I refer, for instance, to the revised code of practice and the revamped proof of age card. If the results do not show that significant progress is being made in tackling the problems that we have identified, the Government will act—we have made that clear to the industry.
That is just one example of cross-departmental work in action. In addition, other Government Departments are engaged in major new work relating to alcohol. The Department of the Environment, Transport and the Regions issued a consultation paper on drink-driving in February, while Customs and Excise recently completed a review of alcohol and tobacco fraud. There has also been considerable interdepartmental co-operation with the social exclusion unit, as it consulted on its project to reduce the number of people sleeping rough, many of whom have substance misuse problems, to as near zero as possible.
In the Department of Health, too, we are taking forward a wide range of measures that reflect the importance which ministerial colleagues and I attach to alcohol 294 misuse as a major public health issue. As the hon. Lady said, "Our Healthier Nation" identified four proposed priority areas: heart disease and stroke, accidents, cancer and mental health. Alcohol is recognised as a significant factor in all those priority areas, and action to reduce their impact, at local level supported by Government leadership, must inevitably involve reductions in the alcohol misuse that so often contributes to them.
I endorse the hon. Lady's comments about accidents. I was delighted to support the launch of the campaign by the Maxillo-Facial Surgeons to alert people to the risks of facial injury through alcohol misuse. I pay tribute to the work that that organisation has done to raise public awareness of the issue.
The Green Paper is adamant that we must not simply focus on disease; we must get to grips with the underlying causes of the diseases that will be represented in headline targets. We must also encourage local areas to identify their own priorities for action. Only they can know what the key issues are for them. We have to strike the right balance between a clear national framework and local action fitting in with local needs and priorities. That will enable us to get the public health strategy right and to engage a range of partnerships and alliances to translate promises into practical action. I believe that a number of local areas will want to set local targets for the reduction of alcohol misuse.
We are also establishing 11 health action zones—the Secretary of State announced them two weeks ago. They will comprise local partnerships between the health service, local councils, local businesses and voluntary organisations. The idea is to get rid of the bureaucratic boundaries that so often impede the effective delivery of health care and action to tackle health inequalities. In short, we want to tackle local problems by means of local partnerships in the health action zones. That is why we have provided £5.3 million for the coming year to promote joint working, with a promise of a further £30 million for the next financial year.
On the services side, we already have work in hand that seeks to respond to the repeated calls from the field for additional support to suppliers and commissioners of local alcohol services. We are attempting to do this in three ways: first, through the development and dissemination of alcohol commissioning guidance which we hope to publish this summer—thereby meeting a demand from local commissioners. Secondly, and associated with that, we shall publish a review of the effectiveness of treatment for alcohol problems which we hope will provide a further useful resource for commissioners. In other words, we want to show what works in practice and what has proved to be effective. Finally, the Substance Misuse Advisory Service, which became fully operational from October 1997, will mean that, for the first time, alcohol and drugs will be equally treated in terms of the advice on key matters available to workers in this area.
We are also developing policy on the difficult issue of dual diagnosis—a source of major concern to those working in the field. I refer to the concurrent existence of a substance misuse disorder and one or more psychiatric disorders. Such complex problems do not fit conveniently into the administrative boxes that we so often establish to tackle them. It is said that joined-up problems need joined-up solutions—that is what we are determined to achieve. 295 Money from the 1998-99 drug and alcohol specific grant will be available to fund demonstration projects on dual diagnosis. From them, we hope to develop in due course guidance for local authorities and health authorities on how best to tackle their joint responsibilities for this group of problem drinkers.
I can also reassure the hon. Lady: the Government's new drugs strategy, launched on Monday, confirms that alcohol will be dealt with under that strategy as appropriate—once again, looking for co-operative solutions to associated problems.
As "Our Healthier Nation" stressed, partnership is the way to make lasting progress. The healthy schools initiative and the forthcoming healthy workplaces initiative, both of which were outlined in the Green Paper, will help us to tackle alcohol misuse in the contexts of domestic violence and the workplace, and among children.
We see important progress being achieved through partnership with the alcohol industry. We intend to work with, not against, the industry. That is why I was delighted to join the Portman group in launching its new campaign supporting the Government's sensible drinking messages, and why last week I was delighted to support the industry's unit labelling initiative, which is complementary to the Government's approach on sensible drinking.
In the Green Paper, we intend to set out a framework that represents the cross-departmental approach to tackling alcohol misuse, and emphasises the importance of central Government and local partnerships working together to enable a coherent strategy to work. I hope that I have made it clear that the days of demarcation disputes—