ALCOHOL ABUSE

HL Deb 31 October 1979 vol 402 cc410-35

4.34 p.m.

Debate resumed.

Lord PORRITT

My Lords, if I may resume this slightly staccato debate, first may I thank the noble Earl, Lord Kimberley, for introducing this subject which has already aroused considerable interest in your Lordships' House and which, I would suggest, is of increasing and very urgent importance. It interests me, too, that yesterday we should have had a debate on drugs, introduced by the noble Earl, Lord Denbigh. After all, alcohol is a drug. However, in the thoughts of most of the people who are concerned with these matters it is becoming separated from the hard drugs. It is becoming separated because it is taking the major place: not in the Press, not in the drama that it engenders in various media, but in actual fact.

Figures in respect of alcoholism are rather hard to discover and must of necessity be somewhat vague. However, I read recently in an American journal concerning the problem of alcoholism that the odds are now approximately 10 to one—that is to say, 10 alcoholics to one heavy drug addict. How genuine that is I cannot say, but it gives your Lordships some indication that the alcoholic is getting well ahead of the hard drug addict in this miserable race.

We are talking of a global subject. We are not unique in suffering from an overdose of alcoholism. In fact, the history of alcoholism is quite fascinating. It goes back well into Babylonian days, if not before. If one studies a graph of the incidence of alcoholism through the centuries, one finds that it is a quite steady graph showing a rise and a fall, a rise a little higher and then a fall, and a rise again. At the moment, we are on the rise again.

If one studies its history, it is interesting to see why the fall occurs and what stops the rise. In general, it is due to two things, both equally difficult. One is an excess of restrictive legislation which is almost self-defeating. The other is the decadence and disappearance of the country or race which over-indulges in alcohol.

As I have said, at present we are facing an increase everywhere in the world. America is suffering badly. The Continent of Europe is suffering, including even our friends in Russia who do not say much about it but who are, I believe, very seriously involved in this problem of alcoholism. Here in the United Kingdom, very sadly, we have had a sudden—and when I say "sudden" I mean in the last two or three years—upsurge in numbers. Even more sadly, this upsurge involves more women and children than ever before. I think it was the noble Lord, Lord Soper, who mentioned adolescents of 17 or 18. It goes below that age—considerably. Fourteen and fifteen year-olds are now by no means uncommon. I can give a personal example of this. I have a son who is a teacher. On several occasions he has had to send boys out of the room after the lunch interval because they were definitely under the influence of alcohol after the lunch break. That is an example of what is happening.

Your Lordships will have heard, and I believe that this is a fairly reasonable suggestion, that the total number of alcoholics known—and let us underline" known—" in this country at the moment is well over half a million: probably 600,000 to 700,000 people. Those are the known individuals, but the number unknown must be infinitely greater. If to every one of those known and unknown you add on their families, friends and co-workers, you have a large army under the influence of alcohol.

I was not intending to speak in the debate, but after what I have heard this afternoon I am glad that I decided to do so. Your Lordships have heard about a number of institutions, but not about the Medical Council on Alcoholism of which I am the humble president. The Medical Council on Alcoholism was founded by Lord Rosenheim, some 15 or 16 years ago, and I shall tell your Lordships why in a moment. He, very sadly, died and was unable to bring his enthusiasm and great knowledge to bear upon the problem. However, we have gone on. We have not struggled on; we have gone on steadily and slowly since then. And in recent years, thanks to the very marked co-operation of the National Council on Alcoholism and of Sir Bernard Braine in particular, its chairman, we have made rapid steps forward.

The National Council and the Medical Council both occupy the same building. This fact is due—let us give credit where credit is due—to the support, both financial and moral, of the Department of Health and Social Security, which, as noble Lords have heard, has sponsored a number of homes and hostels, drying-out homes, throughout the country. One hopes that they can continue. This combination of the NCA and the MCA has begun to produce results. I should like to say in passing that we have the very definite support of the Alcohol Education Council, a high powered body which works at the Maudsley Hospital and is therefore largely psychiatric. The combination of these forces has begun to show something really worth while.

The reason why I wanted to speak today—I am not being at all biased or narrow—was in order to try to underline the importance of the medical aspect of alcoholism. This has been called, and is still called in certain places, a disease. The name was quite popular but it is probably not a very good name to put to it. This afternoon somebody used the word "illness" and I think that is a far better term for it, but if we use the word "disease" it is easier to discuss because, from a medical point of view, we can speak about the diagnosis and the treatment and one cannot treat very effectively if one cannot diagnose. Before both, of course, there comes investigation and, having got that far, one can then begin to speak about prevention, which is the most important thing of all.

In this field of prevention, I want to stress the role of the doctor. I am not speaking of the specialist but of the average good, hardworking GP, on the simple basis that he is the man with knowledge—or we hope he has knowledge—who will get into the familial environment and be able to recognise early the symptoms which tend to point towards the development of alcohol dependence. That is a fairly simple statement but it is extremely difficult to do. The dividing line between hard social drinking and alcohol dependence is quite undefined and is very hard to define, but it is in that dim sphere that we hope an educated medical man will be able to help. The purpose of the MCA is to educate the doctor and the doctor-to-be. That may sound rather rude to our profession but in fact most doctors are woefully ignorant about alcoholism, just as most of them are woefully ignorant about first aid, but we try now to educate the doctor and, even more, the medical student by symposia, seminars, lectures, conferences and so on and also by publishing a journal which is sent free to every GP in the country. A marked and increasing interest is being shown by medical students, and that is very heartening. They now come to at least two—and we hope soon to have three—meetings a year in London and some provincial city and they hear eminent people talking to them in the morning and they discuss and ask questions in the afternoon. This has produced a great deal of interest. We have asked for a feedback and have got a very practical and good feedback from these students. This is not something that can happen in a day but we hope that we are going along the right lines here.

The MCA also wish to increase and improve the methods of treatment. I should like to say here that in my view there is an undue emphasis on psychiatry in the treatment of alcohol dependence at the moment. Obviously it is a very great and important factor but this is a multi-discipline trouble and it needs far more than the pyschiatrist and far more than medical people to treat it properly: the social worker, the psychiatric social worker and the clergy are all very important in the treatment of alcoholism.

The third hope of the MCA is of course to stimulate a degree of research. Research is always expensive and in spite of the DHSS help we are not a wealthy organisation. But we are on the way. I might also mention that we have produced some seven or eight films which are not only educating doctors but also the public and are being shown amid great enthusiasm at many meetings all over the country and in many schools. They are very well done, and indeed three of them are done for schools. They are highly educative. So some good work is being done, in regard to this perfectly ghastly disease.

Not only is the individual affected by this, as we heard this afternoon, physically, mentally and morally, but his family are markedly affected. Child battering and wife battering nearly always have an alcoholic background. The inability of a man to be able to support his home and his family leads to many tragedies—broken marriages and everything that follows therefrom. The effect on an alcoholic's co-workers has also been mentioned this afternoon and is vitally important. Alcohol on the work-floor—and may I say that I would include in the work-floor a surgical operating theatre—can lead to very unfortunate industrial accidents and also of course to an enormous economic loss to the country. Here again, figures become rather mythical but the sum involved in working hours lost owing to alcohol troubles of one sort and another is colossal. There is no other word to describe it.

If one wants to go further, the public in general are affected by the alcohol- dependant. By far the majority of severe accidents leading to deaths on the road now have an alcoholic factor very markedly evident in them. Violence, muggings, and so on, nearly always have an alcoholic background. So the sphere of evil—and one can only call it that—which the poor alcoholic spreads is very large. That is why I say that this is a problem which needs all the co-operation we can get from the voluntary bodies. The more they can get together, the better. I have not mentioned AA, who do magnificent work. The more these voluntary bodies get together, the stronger force they will be in dealing with this problem—particularly if they are supported, as they have been of late, by a sympathetic Government.

4.47 p.m.

Lord CHESHAM

My Lords, I do not think that I am any more qualified to follow the general tenor of this debate into the wider fields of the moral and social problems arising from the abuse of alcohol than I am to follow the noble Lord, Lord Porritt, into the medical field. As a matter of fact I could wish that I had been able to speak before him because what I am about to say might have induced him to say something more, but no doubt he will do so on another occasion.

There is one point only which I wish to make to your Lordships and it is specific to the subject of this debate. I make it because I believe it to be of great importance—indeed, of widespread importance—and also it has the demerit at times of being, I venture to think, unsuspected. It is also something to which, so far as I an aware, remarkably little consideration has been given and again, so far as I am aware, not very much action, even by way of research or investigation, has been taken.

I am speaking of the inter-relationship or inter-reaction of alcohol and drugs. The noble Lord, Lord Porritt, has just confused me by saying that alcohol is a drug anyway, so I had better explain myself. I refer to alcohol qua alcohol. The drugs I am speaking about are not the hard drugs, the harmful drugs, the anti-social drugs taken by addicts and people seeking for "kicks". The drugs in my mind are the beneficial drugs which are widely prescribed for us all by the medical profession. We are all of us subject to many ills. Things advance, new drugs are created and, in short, these days we are filled with pills. Many of these pills, particularly in the antibiotic sphere, and indeed a number of injections and inoculations which many of us customarily have in connection with travelling—much more widespread than it used to be—have a most unfortunate inter-reaction with alcohol. Everybody knows this of course. It is widely known to the medical profession; but it is not widely known to us in relation to some of the drugs we are taking. We do not know whether, having had the drug, we should abstain from alcohol for 48 hours or three days or 24 hours. I do not believe, to be quite honest, that the warning we get and the understanding of it is sufficiently widespread to be of much use.

As I say, the most obvious application of this is in driving. You do not necessarily have to be in excess of the 80 milligrams to be in a poor condition if you happen to have had a couple of flu pills as well as a lesser amount of alcohol; you may not be very capable. I think we should know a lot more about it. It may be that had I been able to ask for more information I would have got it. I shall get it in due course. I do not expect my noble friend who is to reply to this debate to come up with any answer on this because I had not the courtesy to tell him what I was going to talk about, but perhaps he will be able to enlighten me in due course. All I want to do is to stir this matter a little because I believe that very large numbers of the public are at risk. I am convinced that this must come under the term "abuse of alcohol", and that is why I raise the matter.

4.51 p.m.

Lady KIN LOSS

My Lords, I apologise for not having put my name down to speak. Having listened to many excellent speeches, I should like to refer to one remark made by the right reverend Prelate the Bishop of Southwell. Other noble Lords have mentioned this matter too. He said that in the City of Nottingham there is a supermarket which has a separated part of the store for the sale of alcohol. This is excellent. In Yorkshire some supermarkets do this, but others do not. One supermarket in York sells alcohol from open shelves, and it can obviously be bought by anyone. I realise that purchasers should not be under 18, but it is hard to tell their age when there is the usual rush to get through the check-out. I read recently that one matter of some concern to these stores is the young, very often girls. They have very often left school only a short time before and are able to buy alcohol in these stores without trouble, since it is very difficult to say whether or not they are 18. Perhaps the noble Lord, Lord Sandys, would consider this point and consider too whether it is possible for some suggestions to be made to these stores in regard to the sale of alcohol, with the possibility of a cordoned off area.

4.54 p.m.

Lord HAWKE

My Lords, I think there is time for two minutes from me, though I apologise for not putting my name down in advance. I am by no means a tee-totaller, but I recognise that there exists an awful problem. We cannot fail to recognise it as we go about the countryside. We see young men with pot-bellies doing various jobs, and the odds are that they have been caused by drinking too much beer. In fact in talking with them you find that they have all got their capacity taped to the nearest pint, and they tell you they are men of seven pints or 10 pints a day. I even heard of a foreman who went up to 20 pints a day. That is absolutely intolerable. We all know of executives who have been corrupted by the occupational hazard of having to indulge in too many business lunches, where drink, being completely free, flows freely and is imbibed in larger quantities than is really wise or necessary. We know about the absenteeism that results from over-indulgence. We see the huge rows of cars outside the pubs every night, knowing that practically every one of those drivers is over the legal limit, but they never seem to be caught. And we know that almost every act of vandalism or hooliganism in the country is caused generally by young men who cannot hold their liquor. We do not know really what can be done about it. When such people get to the stage of being pronounced alcoholics a medical society or some such organisation may get to them and try to cure them, but then it is really too late.

I think that there are one or two things that could be done. To start with, I regret to say, from the personal point of view, that drink is too cheap compared with the incomes of the young, particularly today. Then, ever since Lord Butler's Bill, off-licences have been proliferating all over the country. I do not know whether we could reverse that process. As for the drink being on separate shelves with a separate pay exit, I have never seen such a thing in all my life. Practically every village shop and all the supermarkets now have licences, and they certainly do not segregate the drink in one corner of the store—for security reasons; they do not want it stolen. The customer passes through the check-out point with bottles of drink along with the groceries.

I personally would like to see drink advertising banned from television. I think that that is probably impractical and will never come about, but it would be a very good thing. Much of drinking is prompted by example. In a television play which purports to portray middle class or upper middle class life the actors have one continual drink; if they are not drinking the one, they are pouring out the next one. And, incidentally, they do not drink like gentlemen; they pour out their whisky and drink it almost neat all the time. They do not know how to drink.

Once I had the temerity to take part in a national health debate and I made two suggestions which found some favour. I am going to repeat them now because I think they would be quite apposite. The National Health Service is very short of money and always will be very short of money. I think that there should be a levy on cigarettes to pay for the lung cancer part of the National Health Service, and I think there should be a levy on drink to pay for the road accident part of it. I know that the Treasury have disliked intensely the idea of earmarking any tax for any particular spending purpose ever since Winston Churchill pinched the Road Fund; but I believe that in our present state of affairs. when the National Health Service is in a parlous condition, those two suggestions should be tried. In that way we should be killing two birds with one stone.

4.59 p.m.

Lord WELLS-PESTELL

My Lords, there are a large number of social problems, and we might use the word "evil" so far as some of them are concerned, which do not attract a very wide audience or, for that matter, generate very much concern. They are often sunk without trace. This problem of alcoholism is one of them. That is why the noble Earl, Lord Kimberley, is to be congratulated on reminding us again of what is in fact taking place. To understand the problem fully we need to know a great deal more about what is below and beneath the surface. Statistics by themselves do not give us much of an idea.

I was glad to hear the right reverend Prelate the Bishop of Southwell speak, because it was the Church of England which, through the Church of England Temperance Society, introduced the forerunner of the Probation Service, which is a very successful public service in the country today; it arose directly out of the Church of England Temperance Society.

I was glad also to hear the speech of my noble friend Lord Soper because I suppose that there is no-one in your Lordships' House who knows more about this problem than he does. Forty-three years ago when I was in my late twenties I was posted by the Home Office to the North London Magistrates' Court as the senior probation officer, and that post took in not only the whole of North London but a great part of East London. Either four days before I arrived at Islington or four days after I arrived there, someone who still bears the same name, Donald Soper, arrived in charge of the Methodist Central Hall. That marked, I think, the beginning of our work in that particular area—he was mainly concerned with this problem and I was more concerned with delinquency. As I have said, no-one knows more about this particular problem than he does.

I do not want to go over the statistics again other than to point out that in the past 20 years admissions into psychiatric hospitals for the treatment of alcoholism have increased twenty-five fold. Now about 14,000 persons are admitted per year to our psychiatric hospitals for the treatment of alcoholism and its effect. If one were to analyse the time and money involved at a time when we need all the resources we can get to treat people for what I shall term "normal illnesses", it would give some idea of how large a part of the resources of our National Health Service is earmarked for this particular type of illness.

The annual cost of road traffic accidents due to drinking is estimated to be in excess of £100 million a year. We do not know as much as we should know about the social, the mental and the physical disabilities that result from alcoholism. We know about the breakdown in family life, but drinking is so much more private today than it was 20 or 30 years ago. As I am sure my noble friend would agree, it was quite common in places like Islington to see policemen taking people off on a curious contraption to the police station because they were drunk and incapable.

However, as your Lordships will know, not only does alcoholism often lead to crime, but it is estimated that upwards of 40 per cent. of people in prison at present have a drink problem. Even when they leave prison they are still outcasts. Mental disability often resulting in the person going into a psychiatric hospital, where a cure is extremely difficult, and physical disability resulting in serious internal troubles very often produce a person who is no longer fit to work.

We are faced with a very serious social problem arising from alcoholism—I am almost tempted to say that it is probably more serious than the problems resulting from smoking, gambling and perhaps drugs. I agree with the noble Lord, Lord Hawke, when he says that the people who are benefiting should themselves make some contribution. The brewers, I believe, are making a profit of upwards of £400 million a year. I do not know the profits of the tobacco industry or the profits of the bookmakers and the betting shops, but one ought to ask oneself whether they should not be asked to make a contribution. As long ago as 1969 the Brewers' Society estimated that the brewing industry had a capital investment of £1,700 million and at that particular time it was almost equal to the total investment in the manufacture of foodstuffs. I have no reason to believe that it is any different at present.

Over the last 10 years for which figures are available, drunkenness offences committed by young men have increased by 50 per cent., while those by young women have more than trebled. In the past 10 years, deaths from alcoholism have trebled; those from liver cirrhosis have risen by about a third, and drinking and driving offences have more than doubled. We are living in a society where more than one in three of all drivers killed in road accidents now have a blood alcohol level above the legal limit, compared with one in six in 1966, when the limit was introduced.

Advertising alcoholic drinks costs something like £30 million per annum. I do not know what the Health Education Council receives at present, hut I do not imagine that it is much more than about £1.5 million. The Voluntary Code of Advertising has a special section on alcohol, but I would like some evidence that the advertisers take notice of it. I do not think that they take notice of it at all.

As my noble friend, Lord Soper said, we need the same volume of advertising in relation to drinking as we have in respect of smoking. Somehow or other we must make the public much more aware of the problem. I can remember the time when the temperance lobby came out in reply to an enormous 16-sheet poster saying "Beer is best" with a poster similar in every detail saying "Beer is best—left alone". I do not know why that disappeared, but it did disappear.

I should like to ask the noble Lord, Lord Sandys, who is to reply, what the Government are doing as regards this particular matter. Let me say again that I am not unmindful of the question of expense, but I would like to know what the Government are doing. I would like the names of the voluntary organisations—if they are not too many—involved in helping alcoholics, and to know how much of their help is educational and how much goes in helping the alcoholic and his or her family. I would like to know—a total sum will do—how much is given by way of Government grants to those organisations, and whether the sum has been or is likely to be cut in view of the Government's policy. I would also like to know the Government's proposals for the future.

I would like to see a Government initiative in this matter with the CBI, the TUC, appropriate members of the medical profession and officials of the appropriate division within the DHSS. It is probably not generally known, but I can testify from my own experience that in the DHSS there is a very competent group of people who are extraordinarily well-informed in this particular area. I think that the noble Lord, Lord Porritt, will bear that out, because he has taken a great deal of initiative in running training sessions for doctors and he was good enough to invite me to two of them. I think he will agree that that is something that ought to have been done many years ago; nevertheless, it is happening at present. I should like to feel that the Department had some plans for taking the initiative. It is not of the slightest use to leave it to voluntary organisations to try to generate some sort of interest on the part of, for instance, unions and the CBI. The approach must be an official one by the Government. The Government took the initiative in the matter of smoking, hut many of us believe that alcohol abuse is far more serious than smoking or, if not far more serious, every bit as serious. If the Government can take the initiative in that particular sphere, as they did with smoking, they will be rendering a very important service to the community.

5.11 p.m.

Lord SANDYS

My Lords, I am most grateful to my noble friend Lord Kimberley for having initiated this afternoon's debate on the important subject of alcohol misuse, on which we have had an informative and very wide-ranging discussion. I welcome this opportunity to outline the Government's position on what is now widely recognised and (currency has been given to this in the course of the debate), both in its consequences and in its extent, as a very serious problem.

Some consequences of alcohol misuse—such as public drunkenness and drinking and driving, alcohol-related mental and physical illness—are tangible and measurable. Other aspects of the misuse problem—for example, its contribution to general crime and violence, disruption of family life, accidents at work and in the home—are less easy to quantify but certainly no less serious. The problem is not confined to a small minority. From the speeches made this afternoon I think we all recognise that.

Latest estimates by Government statisticians, given in a Written Answer in another place today, suggest that there were perhaps three-quarters of a million alcoholics in the United Kingdom in 1977, representing an increase of more than a third over the preceding 10 years. I think that that statistic is generally borne out by speeches from all sides of the House this afternoon.

Lord HAWKE

My Lords, can my noble friend explain exactly what is meant by an "alcoholic"? There must be some way of defining an alcoholic and it would be helpful to know.

Lord SANDYS

My Lords, I do not have the dictionary in front of me, but the Department's understanding of the word "alcoholic"—and I speak without the book here—is that it is someone who is known to have a recognisable drink problem. I hope that that will satisfy my noble friend.

When the families, friends, employers and workmates of these alcoholics are taken into account it is clear that a very large number of people in this country suffer the consequences of alcohol misuse directly and continuously. All measurable indices of alcohol-related harm have also risen sharply in recent years, as has the average per capita consumption of alcohol. Here many statistics have been showered upon us. I expect noble Lords have received information from professional bodies, as indeed we have, and from the trade itself. However, I should like to make one particular reference, which has, in fact, already been made by my noble friend Lord Kimberley. He referred to the report of the Royal College of Psychiatrists earlier this year entitled Alcohol and Alcoholism. That report stated that we are faced with: an endemic disorder of frightening magnitude". I think that that is the measure of the problem.

We are all greatly indebted to the noble Lord, Lord Soper, for introducing the subject to your Lordships' House a number of years ago, and to my noble friend Lord Kimberley for introducing the debate on 19th March 1975 and for the one today. Both my noble friend and the noble Lord, Lord Soper, from different sides of the House, have reminded us of the importance of this subject. We should do well to continue to regard the problem in some detail.

Although the alcohol misuse problem is not perfectly understood—and there is scope for further research into the factors which influence individuals to misuse alcohol—this does not give cause for inaction. Nor should any section of society regard the problem as one that can be left to the politicians, the medical profession, voluntary bodies or anyone else. Alcohol misuse affects us all, if not directly then—bearing in mind, for example, the economic cost of working days lost owing to alcohol-related sickness—indirectly, and we all have an important part to play. This is especially so of those in a position to influence others: employers, trade unions officials and those in the caring professions.

Measures to tackle alcohol misuse fall into two broad categories: prevention and treatment. I am glad that so many of the speeches this afternoon concentrated on the prevention aspect. In his introduction, my noble friend mentioned it and I was grateful that the noble Lord, Lord Soper, mentioned the whole aspect of treatment in its three-stage relationship, to which he gave particular emphasis in the course of the last debate.

The resources for treatment cannot stem or keep pace with this self-inflicted problem, and the main hope for the future must lie in prevention. The Government have before them several sets of recommendations—notably by the House of Commons Expenditure Committee in its Report on Preventive Medicine, the former Advisory Committee on Alcoholism in its Report on Prevention, and the Royal College of Psychiatrists in its Report on Alcohol and Alcoholism—on measures that they might take to limit misuse. Some of these recommendations—for example, those on the taxation of alcohol—are controversial. This reflects the difficulty in any free society of dealing with a commodity such as alcohol which gives harmless pleasure to most adults and which in this country generates considerable employment, export earnings and trade. However, it is misused with very serious consequences by a significant minority. That significant minority has been measured by statisticians at 750,000 but, if we take into account—as did the noble Lord, Lord Porritt—all those affected, we have a figure vastly in excess of that number.

A major aim of any preventive strategy must be to inform the general public of the consequences of misusing alcohol. To this end the Health Education Council has been running in the North-East of England, in conjunction with local organisations, a campaign to promote sensible drinking. The Government recognise the importance of health education and, as part of their general review of Quangos, will be reviewing the role and function of the Health Education Council to make it a more effective force for the promotion of good health. Health education which gives people the facts, so that they can take informed and responsible decisions about their own drinking, can address people as adults in a free society. Most people are interested in the facts, and the Press and broadcasters have been playing, and will play, an important part in presenting them.

It would be a very great mistake if we did not mention the role which children have to play in the whole of this theme. For children and young people by far the most important influences are the attitudes of their parents and contemporaries. The Department of Education and Science handbook Health Education in Schools points out that the attitudes that do most to determine the behaviour of adults are established at a much earlier age than is often realised, even in early childhood, and the responsibility of parents is fundamental and unavoidable. But this handbook also suggests that the subject of alcoholic drinks might slip naturally into various parts of the curriculum—for example, in home economics discussing types of drinks and their compatibility with food may well be most constructive as a safeguard against "excessive drinking" caused by ignorance and bravado. For older children discussions are suggested on the reasons why people drink, the dangers of excessive drinking and guidance on behaviour when in the company of heavily drinking friends. I commend such discussions to parents, as well as teachers, concerned to help young people to decide their attitudes to drinking.

The Government recognise the importance of encouraging school children to adopt a sensible attitude to alcohol. I have already referred to the advice which the Department of Education and Science has published in the handbook Health Education in Schools. The Health Education Council's Working Party, in its campaign in the North East on responsibility on drinking, is in close touch with the Teachers Advisory Council on Alcohol and Drug Education and has provided seminars for teachers and others concerned with young people. We hope to learn more from this campaign about the most effective ways of educating people about the dangers of misusing alcohol. The licensed trade and supermarkets, as well as the police, have been giving a good deal of attention to their by no means easy responsibility for preventing under-age drinking. The encouragement of responsible attitudes to alcohol in young people is a matter on which the Department of Health and Social Security and other organisations are concerned. But for all adults concerned, parents, teachers, and others, it is important to remember that example is better than precept.

I have referred to recent sets of recommendations before the Government. These are being closely considered by the Health and other Ministers concerned, who will decide their response in due course. The DHSS has brought together representatives of the drinks industry and trade and the Health Education Council to discuss the common interest in promoting responsibility in drinking. The drinks industry is also currently revising its code of advertising practice for alcoholic drinks. The DHSS has commissioned the Office of Population Censuses and Surveys to carry out a survey of drinking habits in England and Wales. This should give us for the first time a comprehensive picture for England and Wales of when, and how much, people are drinking—and hence a better understanding of why some of them misuse alcohol.

I think here I must pause to pay tribute to the noble Lord, Lord Soper, who said in the opening remarks of his speech that alcoholism was a subject which was underrated, undervalued, but not under- stood. I think that here the Government are attempting to play a full part, through all those discussions, conferences, and work in the prevention field, in attempting to make this subject become a reality to the public at large. In prevention lies the best hope of limiting the alcohol misuse problem in future. But the Government are also very much aware of the immediate importance of promoting adequate counselling and treatment services for victims of misuse.

The problems of alcohol misusers and their families are of course tackled every day by general practitioners, health visitors, social workers and others within the statutory health and social services. Specialist provision for treatment of alcoholics is also provided within the National Health Service, where there are now 32 specialist units in England and Wales and three in Northern Ireland. In Scotland, and also in the rest of the United Kingdom, treatment for alcoholism is provided in most psychiatric hospitals. I pause here because at the time of the last debate, when the noble Lord, Lord Wells-Pestell, referred to this in replying for the Government, he mentioned that there were 22 of these specialist units, very often associated with hospitals but not in all cases. It is a tribute to those who have worked in the Department and local authorities that the remit and the numbers of these specialist units have been greatly increased in the last five years.

Health Ministers will be considering, in the light of comments received from the field on the Advisory Committee on Alcoholism's report on the Pattern and Range of Services for Problem Drinkers, whether health departments should issue any further guidance in this area. The report of the Federation of Alcoholic Rehabilitation Establishments on Community Services for Alcoholism was issued on 18th September 1979. My honourable friend, the Parliamentary Secretary for Health and Social Services was, with Mrs. Helene Hayman, co-chairman of the working party. While he cannot in his current capacity as a Minister be committed to its recommendations, he will certainly be able to ensure that they are considered as part of the total policy review. The Advisory Committee's final report, on the education and training of professional staff and voluntary workers in the field, was published last month. Comments have been invited from professional and other bodies and will be considered by Health Ministers in due course.

The training, education and above all improved confidence of members of the professions concerned may well be the key to more effective services for problem drinkers in the future, but let us not overlook the contribution which the health and personal social services are already making. I have mentioned the alcoholism treatment units. In addition an increasing number of consultant psychiatrists are taking a special interest in the misuse of alcohol, and developing services accordingly. Admissions to mental illness hospitals and units in the United Kingdom of patients with a primary or secondary diagnosis of alcoholism or alcoholic psychosis totalled 22,000 in 1976. There is also a hitherto unrecognised burden in that research now suggests that between 15 and 20 per cent. of the patients in acute medical and some other wards of a district general hospital have a drinking problem. Doctors, nurses and social workers have long been treating the symptoms of problem drinking, and I am sure they will welcome additional information which may help them to do so more effectively.

But the State cannot realistically be expected to meet the full range of health and welfare demands arising from alcohol misuse. Fortunately, voluntary organizations—some with financial support from Government—have long played a major role in this area and, as the Government proceed to cut income tax, public spending and bureaucratic involvement, it naturally looks to the voluntary sector to play an increasingly important part in helping the victims of alcohol misuse. On 15th June my honourable friend the Parliamentary Secretary for Health and Social Services announced in another place that there would be no reduction in this financial year in the total level of grants provided by his department to voluntary organisations. I emphasise that in reply to a question by the noble Lord, Lord Wells-Pestell.

Thus the Government will continue to offer support at as high a level as possible, having regard to its strategy on cash limits for public expenditure and to the general economic circumstances. But I would repeat what my right honourable friend the Secretary of State for Social Services said last June: I do most emphatically urge the voluntary movement to recognise that its independence is threatened if it becomes too heavily dependent on Government finance. … finance for the project work of voluntary bodies should wherever possible derive substantially from private funds …". Moreover, the Government believe that services developed to respond to a local need must look for any financial support at local level. While the difficulties facing voluntary bodies in the alcohol misuse field should not be underestimated, those organisations that demonstrate their value and effectiveness as part of the total pattern of services available should start to make it known that they are not just "asking for charity". They have something practical to offer in exchange for local support to problem drinkers themselves, to their families, their employers and to the local community, which until now did not realise that problem drinkers can be helped to help themselves.

As I know that the noble Lord, Lord Soper, and others are particularly concerned about future funding arrangements for hostels for alcoholics, I hope your Lordships will bear with me if I explain the Government's position on this. Health Ministers are considering representations from Lord Soper and others that the department's scheme for grants to voluntary organisations providing hostels for alcoholics should be extended for two years. The clear agreement with the local authorities when the grants started was that if, after the initial five years of pump-priming by the department, these voluntary organisations needed further help they would look to the local authorities. Consequently, funds have not been set aside beyond March 1980 by the department for hostels already funded for more than five years. The amounts involved for the individual authorities concerned are not large, but there are difficulties in transferring funds intended for other priorities. We are considering how best to help these voluntary organisations, in consultation with the local authorities concerned.

I wish now to explain the Government's position on detoxification centres. The setting up on an experimental basis of two such centres was recommended in 1971 by the Home Office Working Party on Habitual Drunken Offenders. Subsequently, centres were opened, in May 1976, at Leeds and, in November 1977, at Manchester. The DHSS agreed to fund both centres for an experimental period of three years only. It was agreed from the outset that the appropriate health and local authorities would review the value to them of the centres and would be responsible for any funding beyond the initial three years. In fact, DHSS funding at Leeds was extended for six months to give the local authorities more time to reach a decision, and an urban aid grant for the centre has been arranged for the period December 1979 to March 1980.

Although the Leeds and Manchester detoxification centres have been funded centrally during their initial experimental period, it would be quite contrary to the Government's policy of devolving responsibility down to the lowest effective level for this arrangement to continue once the centres have become established as part of the local range of services for alcoholics. To do this would mean that the Government was subsidising in perpetuity these services in a few privileged areas; that cannot be right. The Government's future policy on detoxification centres will be determined in the light both of the research being undertaken at Leeds and Manchester and of any further advice Ministers may receive on the best way of treating habitual drunkards.

In the time available, I will take up some other points made by noble Lords during the debate. I wish first to stress a difficulty I am in; all spokesmen in this House answer of course for the Government as a whole and not for any particular department—a very well recognised custom. Nevertheless, in respect of this debate a very large number of departments are concerned and perhaps I may be permitted to cite them: they are the Home Office, the Department of Health and Social Security, the Department of Trade and Industry, the Treasury, the Department of the Environment, the Department of Employment and Productivity and the Office of Fair Trading. But that may not be all because of course the Ministry of Agriculture, Fisheries and Food has a special interest in the drinks industry, and there are others.

I will attempt to touch on some of the principal questions that have been asked and give some specific answers. My noble friend Lord Auckland wanted me to give a categorical statement about applications for licensing motorway cafés. I can tell him that the granting of any licence for the sale of alcoholic drinks at a motorway service area is specifically prohibited under Section 9 of the Licensing Act 1964, and the Government have no proposals to change that provision. I hope he will be satisfied with that reply.

The noble Lord, Lord Wells-Pestell, was good enough to give me advance notice of a series of questions, and I will deal with them as best I may. His particular questions related to grants to voluntary organisations concerned with alcoholism in the current year, 1978–79, and he wanted to know those voluntary organisations assisted by public funds. There are 59 hostels which are assisted on both capital and revenue account to the extent of £463,640 in the outturn. As for the other organisations—and I will not give the precise grant for each one but will total the amount at the end—we have the Alcohol Education Centre, the Alcoholics Recovery Project, Aquarius, which is a Birmingham and Midlands group specifically concerned with alcoholism, the Federation of Alcoholic Rehabilitation Establishments the Helping Hand Organisation headquarters, the Helping Hand Organisation Bedford Advice Centre at Ealing, the Medical Council on Alcoholism, of which the noble Lord, Lord Porritt, is president, the National Council on Alcoholism, of which the noble Earl who initiated the debate is an executive member, the Norfolk Council on Alcoholism, the Salvation Army Detoxification Centre at Tower Hamlets, the South East London Consortium and St. Botolph's. Taking all those organisations together with the 59 hostels to which I referred, the total funding has been £840,431 to date. The outturn, however, excludes coloration sums paid during that year, 1977–78, and therefore there is a small note to be added to that figure.

I was grateful to all noble Lords who raised the matter of the sale of alcoholic drinks, and I will reply in a general way in regard to off-licences, because I think this is at the root of so many of the selling problems. The right reverend Prelate the Lord Bishop of Southwell introduced this matter and it was echoed by subsequent speakers on both sides of the House. Perhaps it would be more useful if, rather than to reply to individual questions, I were to say that magistrates can refuse off-licences where they are not satisfied with the arrangements to safeguard against the sale of drink to those under age. That provision exists for all magistrates and it is a matter which might be drawn to their attention; one result of this debate may be that this matter will be brought to public attention.

The supermarket sections of the Wine and Spirit Association have been giving attention to preventing sales of alcohol to persons under age, and I am sure that they will have regard to the concern expressed in the House this afternoon. This situation involves constant vigilance. What we have been debating is in a sense part of a much greater problem which more specifically concerns the Home Office, namely, the subject of licensing as a whole, and I do not think that it would be profitable to continue in that sphere in the course of my reply.

My Lords, having been speaking for 29 minutes, I feel I should draw my remarks to a close, but I should like to say that in introducing the debate the noble Earl has put his finger on a subject which involves one of the three great evils in our society which were referred to yesterday by my noble friend Lady Macleod of Borve. She cited drugs, alcoholism and smoking. The noble Lord, Lord Wells-Pestell, said this afternoon that he considered that perhaps smoking was the least of the three evils. Nevertheless, these three matters will be the subject of constant interest by Her Majesty's Government.

5.41 p.m.

The Earl of KIMBERLEY

My Lords, I shall sum up very briefly. I am most grateful to all noble Lords, from a variety of walks of life, who have participated in the debate. I consider that those who have taken part represent a very good cross-section of the community. I must agree with what the right reverend Prelate said about young people drinking what he called the "hard-stuff". As the right reverend Prelate said, drink may be more expensive now than it was before the war, but on the other hand wages have gone up pro rata and in comparison drink is now probably cheaper. I was very happy to hear the right reverend Prelate's speech. I thought it a speech of great feeling and one which showed great knowledge of the whole problem.

The noble Lord, Lord Soper, is probably the most experienced person on this subject in your Lordships' House, He has been dealing with it for many years longer than I have. He realises the size and gravity of the problem, and he has probably done an indescribable amount of good in relation to it. He realises that drink can be a monstrous evil, and it can, as he said, involve a geometric progression. But we must also remember—as I am sure he does—that to many alcohol is also a great boost and gives great joy and happiness, and if not abused is completely harmless.

The noble Lord referred to a point I mentioned earlier about fines and prisons, and he spoke about how some people who are fined for being drunk cannot pay the fines and so end up in prison. When I spoke earlier about the question of prison and the alcoholic I was not referring to the hooligan who gets drunk at a football match. Obviously the young hooligan at a football match, or in a games stadium, is a very different kind of person from the alcoholic, as my noble friend Lord Auckland, said, and it is not for me to judge here today how such a person should be dealt with. When I referred to prisons I was referring to the problem drinker—or, for want of a better word, the "alcoholic". I was very happy to hear my noble friend Lord Sandys state that licences are not to be given to motorway cafes; that can be only a good thing.

I was delighted that the noble Lord, Lord Porritt, (the President of the Medical Council on Alcoholism) took part in the debate because he has made a greet study of the illness, disease, or call it what you will. I thought that the statistics he gave of there being 10 alcoholics to one drug addict were most pertinent. It probably emphasises to a large degree how great is the problem of alcoholism and of how, if we are not careful, it may get completely out of hand. The noble Lord gave one other unhappy figure. I had said that I thought the total of alcoholics was 600,000, but he put it nearer three-quarters of a million, which means that perhaps more than 2 million people are affected directly or indirectly by the problem.

My noble friend Lord Chesham mentioned a point concerning alcohol and drugs. Of course there are such things as seasick pills and tranquilisers, and it is stated on the bottle, usually in very small print, that if one takes such a pill one should not drink. My noble friend said, quite rightly, that more should be done to try to ensure that the general public absorb this warning. The noble Lady, Lady Kinloss, was probably answered by my noble friend Lord Sandys on her point about magistrates granting licences for the sale of drink in shops and similar premises.

My noble friend Lord Hawke spoke about business and executive lunches. For many years I thought it quite impossible to do one's job and go out to business lunches in case one drank at great length and in great quantity. I believe that there are many people who think this. All I can say is that if people are prepared to persist and try hard enough they can have many executive and business lunches, yet still survive and not get drunk at them. I am not implying that the noble Lord gets drunk, but it is not necessary to do so.

The noble Lord, Lord Wells-Pestell, spoke of the ominous figures of admissions to psychiatric hospitals. That did not make good hearing, and I have no doubt that it will not make good reading in Hansard tomorrow morning. The noble Lord made several pertinent statements, and one was particularly so; namely, that so often the abuse of alcohol, particularly among the younger members of our society, leads to crime. As has been said today, the only way that we can try to cope with this problem educationally is through the parents, the schools, and the various voluntary organisations, with the help of the Department of Health and Social Security, the Home Office, and other bodies.

Most of the questions of the noble Lord, Lord Wells-Pestell, were answered by my noble friend, and this has made my summing-up much easier. I was very happy to hear from my noble friend Lord Sandys that the Government view the problem in a very serious and grave way. I did not expect my noble friend to answer every question today, nor necessarily to comment on everything that had been raised; but when the debate is read and studied by the various departments and by, hopefully, one or two other Government Ministers, we might come back to the old chestnut, that perhaps a levy should be put on drink in this country, as it is in New Zealand, so as to try to make the problem smaller.

I hope that the debate has given the various departments food for thought, and I wish to thank all noble Lords who have taken part, the many who have listened to my perhaps too lengthy peroration, as well as to all the other speeches. I should like to end by saying that I have no desire to stop people drinking, but only to try to warn those who may be in peril of what alcohol abuse can do to them. My Lords, I beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.