HL Deb 21 January 1971 vol 314 cc675-94

7.45 p.m.

LORD SOPER rose to ask Her Majesty's Government whether they are aware of the urgent necessity of taking immediate steps against the growing evil of alcoholism, and when they will make the statement on the subject which was promised in the Gracious Speech. The noble Lord said: My Lords, I beg to ask the Question standing in my name on the Order Paper and immediately to say that I fully understand the reason for which my noble friend Lord Davies of Leek finds it impossible to speak, I understand that he had a peremptory engagement. I am taking the opportunity of saying that in your Lordships' House.

Since I last ventured to attract the attention of your Lordships to the problem of alcoholism, there are three considerable developments or changes which have taken place in the general alcoholic scene. The first is an increase in the incidence of alcoholism—an increase which will be difficult to put into precise categories, but is nevertheless the overwhelming experience of all those who have some part in this field. That is perhaps best exemplified by the vast increase in the case-loads of those engaged in the information centres, in the kind of work done by the National Council on Alcoholism—an increase in alcoholism generally—and secondly, the multiplication and differentiation of the kind of efforts and services being rendered and effectively used to combat this menace. For example, there is the Merseyside Council on Alcoholism which provides an integrated and comprehensive service which I think is without parallel anywhere else in the country. There is the kind of fellowship such as the Richmond Fellowship, in close association with a hospital which in itself provides an alcoholic unit. There are 15 National Health hospitals which are now fitted out with such units; and there are various rehabilitation centres. There is the Bridgehead Organisation which has already found the money for, and caused to be opened, at least 10 hostels for custodial or semi-custodial treatment or supported housing for alcoholics who would have been sent to prison otherwise.

These are indications of a widespread interest in a growing evil. But perhaps the third of these developments is the most significant. It is that, I suppose for the first time, there has appeared in a gracious Speech a reference to alcoholism and an intention of a Government to treat it, not separately, but as an integral part of the Welfare Services. It is because of the urgency of this new development; it is because of the potential as well as the actual achievements of organisations which could be more fully stretched; and it is because of a lively sense of favours to come which is one sense of the gratitude to Her Majesty's Government for entering upon this particular and vital issue with determination and, I hope, with speed, that I venture to attract the attention of your Lordships again to this problem.

I feel that it is necessary still in talking about alcoholism to make a couple of preliminary observations, both true of the speech which I now try to make. I am a teetotaller, but this is not an extension lecture in a teetotal campaign; neither is the effort of the various organisations seeking to combat alcoholism one to become residual legatees of the Band of Hope movement. In fact it is a matter of experience now to all who have any knowledge of this very serious evil that it is clinically observable if not differentiated and that it contains (and I say this with due deference to the collar that I wear) more to do with economic and medical and environmental concerns than perhaps it does in the first instance with moral concerns.

What is the state of alcoholism as can be more or less accurately described? Alcoholism is a stress condition, so I am given reasonably to understand—and my experience would bear this out—which is marked by a compulsive attitude to, drink which is progressively accompanied by black-outs and by a deterioration, both in character and in condition, until it reaches the most pitiable stage, of which I hope that your Lordships have not personal evidence, but, if you have, you will know exactly what I mean.

It is calculated that there may be about 400,000 to 500,000 male alcoholics in the community at the moment—enough to fill Wembley Stadium five times over. We do not know how many female alcoholics there may be; they are likely to be more secretive, with bottles in the wardrobe; and though I read the other day more comforting assurances that their numbers may not be very prolific, the evidence which comes our way in the work which we seek to do would not confirm that optimism but would contradict it. It is difficult to describe in particular terms the incidence of alcoholism, but I will venture two comments, two illustrations, which are probably significant. One of them is this. The National Council on Alcoholism embarked, with the full co-operation of a large firm which of course shall remain nameless, on an investigation of the alcoholic problem that might affect members of its staff; and after careful investigation over a period of three years they are quite satisfied that between 22 per cent. and 23 per cent. of the staff of that particular industrial plant have what is called "an alcoholic problem".

There is another illustration. The Camberwell Reception Centre over the past three years has received something like 8,000 derelict people every year, of whom 2,000 are attested alcoholics. I do not know what is the relationship between alcohol and the public purse, though I remember that it was Sir Josiah Stamp who, as chairman of a Royal Commission on alcohol before the last war, reckoned that the deterioration or impairment of the gross national product was between 12 per cent. and 15 per cent. It is calculable, I think, that at least that absenteeism which is a marked feature of the alcoholic, even in a secondary and not a tertiary stage, and the "absenteeism at work", which is one of Dr. Glatt's felicitous phrases for the conduct of the alcoholic when he is at work, must be a very large drain on the national economy. When one adds to that the calculations of the relationship between alcoholism and the middle kind of crime—to say nothing of the repetitive appearances of those who get blind drunk and form almost the despair of local magistrates—when one thinks of the kind of misery which alcoholism produces domestically and in so many respects, surely it would be foolish to entertain any hopes that this is a passing phase and is not worthy of a serious debate.

What is to be done? I fully believe that Her Majesty's Government will, within a short time (I shall hope to hear this from the noble Lord who will reply) tell us of their plans. My purpose, if it is not presumptuous so to say, is to plough some fields a little and scatter some good seed, hoping that it will be "fed and watered"—perhaps I ought not to pursue that particular verse, because I believe that even the most optimistic supporters of the Government would not equate God's hard with every activity to which they are committed. Nevertheless, surely obvious advantage can come from a collation of the evidence from and an assessment of the problem by those who are engaged in day-by-day activities in relation to it; and in that regard I would say how gratified I am that the noble Lord, Lord Platt, has thought fit to take some part in this debate. I hope that what is said to-day will at least be taken into serious account by those who will be formulating a policy to spend the £2 million which I understand they have already offered to make available as a subvention.

Let me begin with preventive medicine and speak fairly quickly, as the hour is getting late. I hope that there will be a serious and radical reduction in the kind of commercial advertisement, particularly on television, that equates the drinking of alcohol with virility and generally presupposes that to be fully adult drinking is a sine qua non. One of the astonishing and most pertinent of the discoveries about alcoholism is that whereas one man can imbibe quite a large quantity of alcohol and still, so to speak, keep his head, there are others whose chemistry is such that a very small intake of alcohol will immediately cause them to behave in almost a corybantic, to say nothing of a disastrous, fashion. That is true and it ought to be said, and it ought not to be assumed that drinking is a perfectly innocent and worthwhile activity in which all can take a fairly lush part because it has no harmful effects in what people are pleased to call moderation. There are many people who are moderate drinkers who are alcoholics. It is for this reason that I believe that education should begin in the negative sense of not equating the drinking of alcohol with normal activities, but at an early stage there should be that kind of negative reduction of what I think to be a thoroughly dangerous and thoroughly powerful enlightenment, so to speak, of the unenlightened, and preparation for the activities which later on are so hard to break.

I reflect, my Lords, that if we were suddenly confronted with alcohol as we were, more or less, suddenly confronted with hard drugs, we should immediately take a Muslim attitude rather than the permissive attitude which is now almost part of our make-up. I want to see a vastly increased educative programme in the schools so that youngsters will know what it is they are going to do and be invited to do. I am sure that this is necessary. I reflect that the Cohen Report insisted that all education is imperfect and incomplete unless it contains health education. I want the facts. I am not at this moment asking for a teetotal pamphlet or that every injunction about alcohol should be preceded by the statement that it is the devil in solution. I am asking, and I believe it is reasonable so to ask, for some of the youngsters whom I see as alcoholics in the work to which we are committed, to have a chance of knowing what the facts are before they become enmeshed in the habit. I am sure that this ought to form a part of the curriculum at the teacher training colleges.

There is another aspect of this identification, or shall we say this process of education. It is preventive medicine, and it consists in the fuller use of that most magnificent kind of enterprise, now the characteristic of the National Council, whereby it is possible surreptitiously, quietly, without sentiment, without shame and without embarrassment, for the alcoholic to go and find out in the early stages of his disease what it is all about and where he can get help; or better still, in some cases his wife can so do. There is need for a vast increase in the number of information centres. There are already 10 in the large cities and there ought to be 200.

But, my Lords, preventive medicine is all very well for those who have not contracted the disease. What is to be done for those who have? I would not venture into the field which the noble Lord, Lord Platt, has already cultivated so intensively and knows so intimately; but I would comment, after a long experience now, that medical treatment, in close conjunction with hospitalisation, is probably the best method in the initial drying-out. But after that I would not put too much emphasis on Antabuse, or the various drugs which are nauseating in relation to alcohol, and I would not put too much emphasis—this, I hope, will not be misunderstood—upon moral abdurations and counselling.

In the hostels with which I am connected, I am satisfied that the best treatment for the alcoholic in the rehabilitation stage is that he should be relieved of undue stress and should feel that once again he "belongs". In the simple friendship and understanding of such hostels, in such domestication, we entertain high hopes and have reason to cherish good results. I am sure that there are a few alcoholics who can be treated where they are and without reference to this kind of rehabilitation process, but for the vast majority at least for a little while this is probably necessary. Therefore, I hope that it is part of governmental policy to deal with the general area of what we do with a man who is repeatedly drunk and disorderly or alcoholic.

It is a colossal idiocy to assume that we can do him any good by sending him to prison. What is necessary is the multiplication of the kind of rehabilitation centres which afterwards lead on to something which could be called supporting houses. Here is a magnificent opportunity for the Government to support and criticise, discipline and encourage the small kind of house in which the recovered alcoholic can stay, if he is unmarried and unprepared or unable to go back to his family or with no family to go back to. We have tried this experiment and the results are excellent.

There is one curious aspect of alcoholism—not so curious to those who know what alcoholism is—and that is that there is no cure; there is only a condition of permanent convalescence. The recovered alcoholic will remain immune from the tendency to relapse only if he has rather more support than the average citizen who is not so afflicted. So it comes about, in one of the houses for which I am responsible, where we put up some 14 residents three years ago, that we cannot get rid of them. In fact it would be wrong to get rid of them, because they are not and never will be fully able to support themselves in the hurly-burly of a world which most of us meet. It seems to me that there is a continuing problem here which has resolutely to be faced.

There are not a few of those unfortunate people for whom we seek to care who will be in permanent need of staying in a supporting house for a long time, perhaps to the end of their days. I hope that the Government will take into account the similar experience of many other splendid institutions now endeavouring to battle with this disease. In the long run, alcoholism is part of the stress and conflict of the world in which we live and, but for the grace of God there go us. That is not a pious platitude. It is a fact that every one of us has an upper limit to our endurance, and that for some people that is not so high as for others. I am in no mood to criticise, though I do not in any way reject moral principles and the value of encouragement to nobler and better ways. I should like to see a society in which the typical stress of the cut and thrust is ameliorated by a deeper sense of belonging. I know that this at the moment is beyond the competence of any Government to provide. But it is not sufficient to get people to stand on their own feet. The feet of many alcoholics are broken and their legs buckled and they find it intolerable to bear their own weight.

I hope and believe that the Government will set about the task of ameliorating their condition and of facing what, after all, is not just an occasional or evanescent problem but probably one of the greatest problems that is conjoined to the kind of society for which we have opted. While we are in process of changing that society into a more kind and friendly one, I entertain the highest hopes that the Government, having put this matter into the gracious Speech, will do what we believe they can do—that is, render support and encouragement and enlightenment to those who will be joined with them in this enterprise so that they may be encouraged to believe that alcohol is a disease which can be conquered.

8.6 p.m.


My Lords, I am sure that even at this late hour the House is grateful to my noble friend Lord Soper for raising this extremely important question. We have listened to a deeply moving and deeply knowledgeable speech, as always, from my noble friend. I am always delighted to follow him, and it is particularly good this evening that we should be tackling the question from, as it were, opposite ends of the spectrum. My noble friend told us that he is a teetotaller. I am not. I regard alcohol as one of the normal pleasures of life, so I do not follow him down the stony path of abstinence. But it is significant that although we approach the problem differently, we come to the same conclusions about the importance of the treatment of this dreadful disease. The fact that it is a progressive disease makes it worse; and it is a disease created by society.

In our society the pressures towards drinking are tremendous. The nondrinkers, especially males, are often looked upon as outsiders, as rather boring people. Alcohol is pleasant, and easy to get. But many people are unable to cope with it at the social level and go on progressively towards drunkenness, and often to alcoholism itself. At that point society, having created the problem, repudiates them. They are a nuisance to their friends. They create a private hell for their families. They are sacked by their employers. They are often viewed with distaste and despair by their doctors. A stigma is attached to alcoholism in all its forms; and because of that stigma much of it is kept hidden, and the problem is very much greater than people realise.

My noble friend Lord Soper referred to the problem of alcoholism in industry. The Medical Council on Alcoholism produced an excellent report in 1968. They estimated that the cost to industry in one year was £100 million, and that it was probably much higher. The tragedy is that neither side of industry appreciates the size of this problem, and so they do not co-operate as they should with people who are trying to eradicate it. The Council report that the Institute of Directors say that there is no problem among directors. The Institute said: We examine 7,000 to 8,000 directors each year and never find more than seven. When they are found they are booted out. This does not seem likely, or constructive, or even Christian. On the other side of industry, we find that industrial medical officers and trade union officials must often cover up alcoholism they find because of the fear of the dismissal of the men concerned.

This is the sort of problem that we are up against; and it is made worse because, as it is not recognised, industry does not give the help asked for in collecting statistics, in allowing clinics and in allowing information centres. This shows us what we are up against.

In the past, my Lords—that is, in the 18th and 19th centuries—the largest number of people suffering from this disease came from the working classes. That was because poverty created intolerable living conditions, working conditions were unbearable and the majority of people came from those classes. But to-day the disease is disproportionately high among the professional classes. This is not always realised. Further, it strikes the professional classes between the ages of 40 and 50—this is the peak period—just at the time when most men and women should be at their most productive in their professions. In other words, it is the affluent society that is now creating a different kind of alcoholic problem.

My noble friend referred especially to the increase in the rise of alcoholism among women. This is, I think, peculiarly disturbing. It is true that in the last twenty years deaths from alcoholism among women have been doubled. He also referred to environmental causes. This must be particularly true of women because of the fashion to drink "short" drinks and spirits. Surely many of those isolated blocks of flats, where the women are alone all day, smaller families with fewer children, boredom and the lack of community life which their parents used to have all contribute to the drinking problem among women. Since society is much harsher in its judgment of drunkenness in women, their drinking, as my noble friend said, is carried out alone, at home and in secret. For this reason it is not only difficult to detect but extremely difficult to help. Indeed, solitary beings in general are those who are particularly prone to this disease: widows, divorcees, men separated from their wives, and people who are not so much homeless as rootless.

This brings us again to the problem of drink and crime. As my noble friend said, it is almost crazy to send alcoholics to prison. Yet in 1967, 35 per cent. of prison accommodation in this country was taken up by alcoholics. The Criminal Justice Act 1967 makes provision to abolish imprisonment if alternative accommodation which gives treatment is available. But the operative word is "if", and such accommodation is very rarely available. We all know about the relationship between traffic accidents and drinking, but we do not know nearly enough about the relationship between serious crime and drinking. I think one of the saddest things that I have ever read comes from that remarkable book, The Frying Pan, by Tony Parker. This is what a prisoner who was also an alcoholic said to him: I do not want to stop drinking, you see; drinking is my life. To give it up I would have to be a completely different person and not preserve even the last little thing of myself at all. I would like to control it, but to give it up altogether is beyond thought.… Drunk and incapable: that is the only possible way that is for me. Noble Lords will know of the seriousness of this problem; they must have met many examples in the work they do. Although I have said that it is not now such a mass problem, I believe that it is much more insidious, and we can cope with it only through greater knowledge and, as my noble friend said, through education. We must first of all educate public opinion to see alcoholism as a disease and not merely as something immoral. I am glad to see the noble Lord, Lord Platt, with us to-night, because one of the other things I think is so important is to educate our medical students and doctors much more fully in this disease; to recognise the disease itself rather than simply its physical causes; to learn to treat the whole family as well as the patient; to learn to use the public services which are available. Above all—and perhaps this is much more difficult—they must be trained to recognise those patients who are especially at risk.

I entirely agree with every word that my noble friend said about education in the schools. We need to have more sensible education in the schools which treats this as a problem of general health education and not as something separate and special. Lastly, I think we need to educate Governments—and I mean all Governments—and local authorities in the need to spend more money on the problem. In 1968 there were only 407 beds available in the United Kingdom for treatment of this disease, and all these beds and the units were in mental hospitals. They were pitifully few. Often an alcoholic, when asked to go into hospital, will say, "I am not mad; I am not going into a mad-house", and will refuse treatment. I know that the documents that we have are often somewhat out of date, and so I have given the noble Lord the Minister of State notice of some of the questions that I want to ask him; and this is the first one. Is urgent consideration being given not merely to providing more beds but to providing them in general hospitals and in outpatients as well as in mental hospitals?

There is an excellent Paper on this problem by the Office of Health Economics (it was published in 1970), and it is interesting that they and the Medical Council on Alcoholism recommend very much the same things. They underline the almost desperate need for urgent action. They urge recognition of the problem by the public, industry and the professions, and above all, they say, it is essential that greater provision for treatment must be provided. One of their main recommendations, again as my noble friend said, has been for after-care.

Both the Office of Health Economics and the Council underline the need for more halfway houses and hostels. On the splendid work of the Richmond Fellowship which my noble friend mentioned, I should like to give an example of how things do not always work out as they should. The Fellowship runs an excellent halfway hostel in connection with two mental hospitals, and so on. It is splendidly run, and provides accommodation for 16 men and women who are alcoholics. There are many urgent cases waiting for admission, but grants are very few and some local authorities do not take up the places which are available at that hostel. Indeed, two-fifths of all referrals are not taken up for financial reasons. In this day, in this civilisation and in this country, this seems to me to be tragic and indeed disgraceful.

The Medical Council go on to say: As a public health problem, alcoholism does not seem to be receiving the attention it merits. More than half the authorities have no special scheme for public education and information about alcoholism. Little literature was available, appropriate visual aids were lacking and few talks were given to the public and school children. The House would be glad if the noble Lord could report some progress on these particular points. Everybody interested in this problem will know of the great part played by the voluntary societies. My noble friend has mentioned many of them, and it is impossible to think of the problem without also thinking of Alcoholics Anonymous, and many, many others. But we want to know whether the Government can give those voluntary societies still more support. As well as that, perhaps the top priority is to have more research. We do not really know the ætiology of the disease yet; we do not know whether the causes are cultural, physiological, psychological, or probably a mixture of all three. Even so, we do not yet know how to vary the treatment for the different patients, however the illness may have been caused.

Out of the liquor trade in general, including taxes and so on, the Government receive £1,500 million a year. If only 0.1d. could be levied off, it would give us £625,000 to spend on research. We know that this is a tragic, wasteful and increasing disease. It is the third health hazard after heart disease and cancer. We know that it is partly hidden; we know that it is curable if it can be detected in time. Surely, my Lords, it is our duty to do everything in our power to mitigate the suffering that it causes and to prevent its occurrence.

8.22 p.m.


My Lords, I have joined this debate because I felt that as a medical man I should support the noble Lord, Lord Soper, in bringing this tremendously important problem to your Lordships' notice. I have to confess straight away that because of the inadequacies of medical education, to which the noble Baroness has quite rightly called attention, I cannot speak with either the experience of the noble Lord, Lord Soper, nor the factual knowledge of the noble Baroness, Lady Llewelyn-Davies of Hastoe, on this subject.

I am an Englishman and, on the whole, I like and support things which are typically English. But we can, on occasions, go a little too far. Much as I respect the proper feelings of the noble Lord, Lord Somers, on the question of the export of animals versus carcases, it seems to me to be carrying the typically English view a little too far when we put that debate in front of the problems of alcoholism and leave them until 8.20 at night. It is quite amazing, as the noble Lord, Lord Soper, I am sure would tell you, how little the importance of this problem is recognised. This afternoon I have spoken to Members of this House who are absolutely ignorant that a problem like this even exists. This is partly because the alcoholic, at any rate in the first part of his career, is able to conceal it from his fellows, and in the later part of his career drops out of society and drops beneath the surface. It is also because alcohol, unlike certain other addictions, is a drug which the majority of people can take in moderation without becoming what society would normally call an alcoholic. I speak, as the noble Baroness has admitted she also speaks, as one who enjoys alcohol, but like a good many other people I am—with some difficulty occasionally—able to keep it in check. Having decided that, as a medical man, I should put my name down as one of the speakers in this debate and support the noble Lord, Lord Soper, in urging the Government to give us an early statement on what they intend to do about this problem, I then had to decide what aspects of the problem I could speak on at all with any authority and, at the same time, be as brief as possible.

I do not think it would be profitable to compare, or try to compare, the size, the immensity, the seriousness of the problem with that of, for instance, disease due to cigarette smoking, traffic accidents and so on. Those are totally different problems, each important in their own way. But what makes the alcoholic, perhaps, so tragic is that before he kills himself—which a person can do through contracting lung cancer or through traffic accidents—he has brought misery on so many other people, notably his own family. So alcoholism becomes an immense social problem out of all proportion to the other causes of self-inflicted illness to which I have referred.

At this late hour I do not think I should go further into the question of alcoholism as an addiction, but I should like to say something about education. It has been interesting to me to come into a society, such as we have in your Lordships' House, and learn—I will not say almost every day, but certainly every week or every month—of the inadequacies of medical education. It is quite surprising how we doctors live in a little world where what we like to see is somebody who is ill who wants our advice, whom we can help with a simple remedy and, preferably, watch getting better. We delight in making a diagnosis of a difficult case. But preventive medicine and the social problems of people do not interest us nearly as much as they should. Our education in these subjects varies from the non-existent, at one extreme, to the totally inadequate at the other extreme.

I hope that whatever we say about medical education and its inadequacies, we shall not once again point at the general practitioner and say how ignorant he is of these problems and all the things that he ought to do. I think we should point to those who have a responsibility for medical education and for the curriculum in medicine. I will say no more except to support the noble Lord, Lord Soper, in asking the Government to please give their closest and most sincere consideration to this problem, and I hope that at an early date they will be able to let us know of the measures which they think are practical that can be taken by the Government.

8.30 p.m.


My Lords, I am extremely grateful to everybody who has spoken in this debate. Short as it has been, it has been of great interest to me. May I say in particular to the noble Lord, Lord Soper, how much I appreciate the fact that he has given us this opportunity of debating the subject of alcoholism. I know, and all your Lordships know, about his very deep interest in the subject and of his very practical concern. He spoke with deep knowledge and all that he said will have made a great impression and will be taken into account. We had some words together on the day that I suppose is the busiest for him and the slackest for me—on Sunday last—and I told him that we were not yet in a position to give him many details of how the extra allocation of money would be spent. He, I think quite rightly, decided that this was a much better time to have this debate, rather than after any decisions had been made. I would thoroughly agree with that. I think it has been extremely useful.

May I say to the noble Lord, Lord Platt, that I am sorry we have kept him so late. I am glad that he has stuck the course because his contribution was most useful. But, of course, the drill with Unstarred Questions is that they are taken in the order in which they are put down, and their relative importance does not decide the order in which they appear on the Order Paper.


My Lords, I rather suspected that that might be the answer.


Only last week we were discussing here the problems of drug misuse—problems which, above all, affect young people. In that debate several noble Lords drew attention to the "generation gap" and to the danger of society's applying a double standard in its attitudes to alcohol and drugs. We should be in no doubt to-day that alcoholism is a form of drug dependence, an illness requiring the skills of doctors, nurses, social workers and others if it is to be overcome. It is generally recognised to-day that people who are addicted to alcohol require treatment. But one of the most intractable features of the disease is precisely that it is so often not recognised, or not recognised early enough, so that the social drinker slides unnoticed into the stage of addiction with its severe medical and social complications.

One reason for this is the enormous scale on which alcohol is consumed. The figures are quite startling. In the year ending March 31, 1970, we drank no less than 18 million gallons of spirits, 42 million gallons of wine, and 1,206 million gallons of beer. How are we to divide the consumers of this large quantity into normal social drinkers, on the one hand, and alcoholics, on the other? Even the heavy use of alcohol—the tradition of the "night on the town"—is, up to a point, sanctioned by society in a way that the misuse of other drugs is not. This increases the difficulty of identifying the real alcoholic who urgently needs help. Various methods have been devised of estimating the incidence of alcoholism in the community. It is extremely difficult to arrive at accurate figures. The noble Lord, I think, used the figure of 400,000. Well, my figures are upwards of a quarter of a million alcoholics as defined by the World Health Organisation.

The problem is a medical and a social one and involves the health and social services on a broad front. Guidance issued by my Department to hospitals, local health authorities and general practitioners has emphasised the need for coherent deployment of services, including those of the voluntary organisations, mentioned by many of your Lordships, which play a vital part in this field. The noble Baroness, Lady Llewelyn-Davies of Hastoe, asked me some questions about the hospital services and their provisions. The hospital services are provided at the moment by mental illness hospitals, and by psychiatric departments of general hospitals, most of which play a part in treating alcoholic patients. In addition, there are 14 specialised alcoholic units in England, with a total of 298 beds. Those figures for the United Kingdom come up to 19 units and about 405 beds, but owing to the postal strike it has not been possible for me to verify the figures from Scotland. In 1969 there were 6,689 admissions to hospitals of patients with a primary diagnosis of alcoholism or alcoholic psychosis.

Alcoholic patients have complex needs for hospital treatment. The essential job of specialised units is the treatment of their addiction as such. But sometimes alcoholism may be associated with mental illness and require treatment in a psychiatric department. Or sometimes it leads to physical complications which may require treatment in a general hospital. This points to a very flexible approach in our development of hospital services for alcoholics. Like the noble Lord, I am well aware that successful treatment of the alcoholic is only the beginning of a long and complicated process of rehabilitation. Each individual is a separate problem and community care needs to be well organised and in a combined operation, in which doctors and laymen, statutory and voluntary agencies, work together closely as a team. Hostel accommodation in a therapeutic community may sometimes be a necessary adjunct to treatment, especially for those alcoholics who are otherwise homeless.

The full range of local authority services are also available to alcoholics. These include support for them and their families, and help in rehabilitation. The guidance we have issued to local authorities in recent years has emphasised the need for close integration between all those providing services, including voluntary organisations. We have emphasised the importance of increasing the number of hostels, run either by local authorities or by voluntary bodies, specifically for alcoholics. So far no hostels for alcoholics have been established by local authorities, but a number of them are providing financial support to voluntary bodies who have made residential and other provision for alcoholics.

I readily recognise, and greatly welcome, the substantial contribution made by voluntary bodies in the field of alcoholism. The noble Lord, Lord Soper, mentioned some of them. The National Council on Alcoholism is doing a most useful job in publishing information and in encouraging the setting up of information and counselling centres, of which there are now 10 in the United Kingdom. The Medical Council on Alcoholism carries out a vital role in the instigation and co-ordination of scientific research ranging through medical, psychiatric and sociological to statistical research; and it also operates a consultant advisory service.

Alcoholics Anonymous is working quietly and with considerable effect through groups of recovered alcoholics in providing counselling and support, as also are the Al-Anon Family Groups, a fellowship of relatives of alcoholics. A number of other voluntary organisations are providing a wide range of residential care, including units which have developed to the stage where they are largely run by the residents themselves. The National Association of Voluntary Hostels provides a consultative service for the accommodation of the homeless, including alcoholics, who are in need of residential care. My Lords, these are just some of the voluntary bodies who are doing splendid work in this field. The noble Lord, Lord Soper, mentioned others. One of them I was pleased he mentioned, the Merseyside Council on Alcoholism, because I shall have the pleasure later this year of opening their annual conference.

Your Lordships will remember that when the present Government came into office we looked urgently at the whole range of social services to identify areas of special need, and that, following this review, my right honourable friend the Secretary of State announced in another place last November that he had decided to make extra money available to the National Health Service, including £2 million, over the next four years, to improve facilities for alcoholics. There will be increased expenditure by both hospital and local authorities, and an increase in grants to voluntary bodies.

My right honourable friend the Secretary of State for Social Services has initiated a specific review of existing services for alcoholics on which to base his plans. Discussions have started with the statutory authorities and voluntary bodies active in this field. Furthermore—and this applies particularly to the valid point made by the noble Baroness, Lady Llewelvn-Davies of Hastoe, on the question of drink and crime—an important report on habitual drunken offenders will shortly be available; and this, too, will be taken into account in the same review. It is in the light of all this that my right honourable friend will be formulating his policy and announcing his plans as soon as possible, and it is in the light of those facts that I warmly welcome the debate that we have had this evening.

I thank all those of your Lordships who have made valuable contributions. The seeds mentioned by the noble Lord, Lord Soper, will not fall on stony ground. The noble Baroness, Lady Llewelyn-Davies, made some very wise remarks about alcoholism in industry and in the professional classes. The noble Lord, Lord Platt, gave us his views on the medical side of the problem. All these ideas are of the utmost value, and I can assure your Lordships that they will be fully taken into account in this review before we decide how the money can best be applied. Prevention, treatment and support all have claims, and I can assure your Lordships that we are as anxious as those of your Lordships who have spoken this evening to see progress.






















Presented, and read 1a.