HL Deb 27 May 2002 vol 635 cc1112-36

6.50 p.m.

Lord Filkin

My Lords, as the House will be aware, this is the final business of the day, so, in theory, we have an hour and a half for the debate. I am advised by the Table that, if the House is agreeable, opening and closing speeches can be 15 minutes in length, with all other speeches 10 minutes in length.

Baroness Masham of Ilton

rose to ask Her Majesty's Government whether, when forming their alcohol strategy, they will take into account the stress and expense which alcohol abuse causes the National Health Service.

The noble Baroness said: My Lords, on Wednesday 20th March, in a Starred Question, I asked when the Government will publish their national alcohol strategy. The answer was by 2004. I hope that this short debate will highlight some of the problems relating to alcohol abuse that involve our National Health Service. We have a little longer for the debate this evening. As I have no right of reply I want to thank, in advance, all noble Lords and the Minister for taking part. I look forward with great interest to all contributions. As the debate has started much earlier than expected, I know that some noble Lords have not yet arrived and are still on trains.

On a recent visit to Wandsworth Prison I was told that there was a serious problem because there was no alcohol strategy, although the drug strategy was helping to treat those who entered the prison as drug addicts. Alcohol is a serious drug: it causes addiction and makes people ill. Maybe some of those neglected prisoners are the very people who cause violent incidents in accident and emergency departments in many hospitals. Perhaps the Minister can speed up the alcohol strategy in prisons as a start now that the National Health Service will be more closely involved.

With the re-organisation of the National Health Service and the emphasis put on primary healthcare, it seems important to look at the problems and expense that alcohol abuse costs the National Health Service. In February, Alcohol Concern organised a conference in Birmingham in the hope of alerting doctors and nurses in primary care to the scale of the problem. In the conference report, Alcohol Concern said that the cost to the National Health Service of Britain's drinking habits is as high as £3 billion a year. One doctor stated that, The NHS will collapse unless lifestyle issues such as alcohol are tackled. Health professionals are in a state of despair". In 1997 there were 100 nurses working in a new accident and emergency unit in the Royal Liverpool University Hospital. Only a handful of the original staff are still there. Ninety per cent of the nurses in one of the most forward-thinking, hi-tech A&E departments have left because of the sheer misery.

We have simply got to look at the issue of alcohol which accounts for so much of the NHS work and for so much despair and despondency among staff. They are two to three times more often attacked at work than policemen are". A few hard-pressed A&E departments have realised the need to act. St Mary's Hospital, Paddington, where the Notting Hill carnival and St Patrick's day are annual nightmares, has identified the A&E arrivals who are most likely to be "drinking hazardously". They are those who fall or trip, collapse, suffer head or facial injuries, have been involved in an assault, have non-specific stomach problems, are generally unwell, have psychiatric problems, suffer chest pains, have had an accident or are regular A&E attendees.

Here are some of the results. Alcohol is implicated in up to 33,000 deaths in England and Wales each year. More than 28,000 people are admitted to hospital each year because of alcohol dependency or toxic effects. One in four emergency hospital admissions of men is alcohol-related. One in six people in casualty have alcohol-related injuries or problems. At peak times the numbers rise to eight out of 10. Around three-quarters of patients arriving in a typical casualty department in Manchester after midnight are drunk. A fifth of patients seeing their GP probably drink to excess. Around half of serious road crashes and half of domestic violence cases against women are linked to alcohol. Every year around 1,000 children under 14 are admitted to hospital for alcohol-related illnesses. A fifth of inappropriate ambulance calls are made by people who have been drinking. A third of injuries to pedestrians hit by cars (and 53 per cent of serious injuries to the drivers) are linked to alcohol.

Excess drinking contributes to a wide range of illnesses, including coronary heart disease, strokes, impotence, low fertility, cancer, liver cirrhosis, stomach inflammation and pancreatitis. In some cases it may contribute to the increase in diabetes 2. The number of deaths directly attributable to alcohol misuse—for example, alcohol cardiomyopathy, toxic effect of alcohol or liver cirrhosis, which is increasing in young people—rose sharply in the second half of the 1990s, from 3,853 a year in 1994 to 5.508 in 1999. Estimates of the total number of deaths where alcohol has played a part range up to 33,000 per year. The number of deaths from liver disease, including cirrhosis, rose from 2,801 in 1988 to 4,718 in 1999, a 68 per cent increase.

Among men deaths from liver disease in that period increased by 94 per cent, from 1,494 to 2,904 deaths and deaths of women increased by 39 per cent from 1,307 to 1,814 deaths. In 1998 to 1999 there were 78,900 hospital admissions with a diagnosis of mental and behavioural disorder due to alcohol.

There is a strong link between alcohol misuse and mental health problems. A 12-year study of clients in a hospital-based alcohol service reported that a consistent 30 to 40 per cent received an additional psychiatric diagnosis. Forty per cent of those who committed suicide in England and Wales who had contracted a mental health problem within a year of their deaths had a history of alcohol misuse, according to a 2001 survey tracking suicides over a five-year period. That figure rose to 53 per cent in Scotland and 62 per cent in Northern Ireland.

This is a serious matter. The absence of the long-awaited government strategy on alcohol is causing planning blight at local level. Many local commissioners in health and local authorities are waiting to see what priorities will be set as part of an alcohol strategy before committing funds to alcohol services, resulting in the suspension of many services for problem drinkers and their families. Existing funding arrangements are coming to an end as health and welfare services move towards a new primary care trust arrangement designed to meet central targets and priorities.

The lack of priority on alcohol services and the dominance of the drugs agenda are destabilising current services. Many benefits would be made by investing in alcohol services and their key role in preventing serious alcohol problems from developing, saving families and communities from alcohol-related harm and saving the resources of public services such as the NHS and the police.

NHS staff, if trained, can offer brief interventions to individual patients and help them examine how their drinking behaviour connects to their injury or illness. Primary care trusts will need to think carefully about the initiatives they introduce and fund to reduce the scale of alcohol misuse within their populations. The Royal College of Psychiatrists believes that alcohol services should be included within the remit of drug action teams and drug reference groups to ensure there is local co-ordination. I hope the Government will consider that.

Alcohol advertising is effective, with a strong lobby. Pubs and nightclubs seem to be thriving. Youth clubs and youth activities are underfunded. I ask the Minister: will the noble Lord please help to get the balance right?

7.2 p.m.

Baroness Massey of Darwen

My Lords, having just extended my speech, I am delighted that the noble Baroness, Lady Masham of Ilton, introduced the issue of alcohol and its costs to the NHS. She graphically described its impact on individual lives and on society.

The timing of this debate is highly appropriate, coming as it does one week after the House of Commons Home Affairs Committee published its report on the Government's drug strategy. The report points out that we must keep a sense of proportion and that, Legal drugs such as tobacco and alcohol are responsible for greater damage both to individual health and to the social fabric in general than illegal ones". I must declare an interest as the chair of the National Treatment Agency which focuses on improving the availability, capacity and effectiveness of treatment for drug misuse.

There is little time to go into the reasons as to why people use or misuse drugs. People use all kinds of drugs, including alcohol, safely, though I accept the argument that there is no such thing as a safe cigarette. It is problem misuse which causes the difficulties, both to individuals and society. Problem misuse occurs when physical, emotional and psychological damage takes place and when the use of drugs results in wider social consequences, such as disorder or violence with costs to the NHS and the criminal justice system.

I shall narrow my contribution today to the issue of young people and alcohol. By that I mean those between the ages of 16 and 24, though I am aware that some young people begin drinking much earlier. "Young people" are one of the four strands of the UK drug strategy and I would hope that any strategy on alcohol would include specific recommendations on young people. If addiction can be prevented or treated at an earlier age, then human and fiscal costs may be substantially reduced.

The Health Advisory Service report—The Substance of Young Needs—is thorough and helpful. It points to research which indicates that over the past decade more young people are drinking regularly, at least once a week; weekly drinkers are drinking more amounts; regular young drinkers are drinking more alcohol per session; the types of alcoholic drinks consumed by young people have changed—for example, alcopops and designer drinks are now common, under the most strange names. Boys and young men are more likely to drink heavily than girls and young women. Parents are often desperately worried about their children using drugs but are unaware of the potential or real alcohol problems their children face.

Alcohol Concern pointed out that while the proportion of 11 to 15 year-olds who do not drink has remained at 40 per cent since 1998, binge drinking is common, and 94 per cent of 15 to 16 year-olds in the UK have consumed alcohol at least once, with 47 per cent having drunk alcohol at least 40 times compared with 20 per cent in France.

The Institute of Alcohol Studies highlighted the shorter-term consequences of excessive single-session drinking, including a greater likelihood of acute intoxication, injuries and accidents. There is good evidence to suggest that drinking excessively in youth could be a predictor of further alcohol problems in later life, indicating possible long-term problems in individuals, families, the NHS and other services, as described by the noble Baroness, Lady Masham.

Worryingly, one of the problems, pointed out by the Teenage Pregnancy Unit, relates to unsafe sexual activity. One in seven 16 to 24 year-olds in the UK has had unsafe sex after drinking, and one in 10 has been unable to remember whether or not they had sex while drunk. Forty per cent of 13 to 14 year-olds report being either drunk or stoned when they first had sex. So a strategy must cross-reference health problems.

An alcohol strategy must include recommendations on prevention and treatment. The UK drugs strategy also discusses reducing the availability of drugs. But let us face it, alcohol is freely available and its pleasures but not its dangers are widely advertised. So I shall concentrate not on the availability of alcohol, which is probably unrealistic, but on an emphasis on safe drinking and the treatment of alcohol problems in young people.

The Welsh strategy on substance misuse recognises the two requirements, prevention and treatment. It says: The fundamental aim is to prevent misuse, to stop people starting…to start people stopping and to reduce harm". It is the reduction of harm which is most relevant to alcohol use, and teaching about that must be applied to young people.

In relation to alcohol use, there is evidence that a focus on teaching generic life skills, enhancing decision making and assertiveness, can be effective in enabling young people to learn about health issues, develop an awareness of what is and what is not safe, and how to resist pressure.

I can only speak for England, but we are developing interventions in schools and the wider community to deliver such types of education; for example, in personal, social and health education programmes, in the National Healthy School Standard Award, in the citizenship education and in the science curriculum from key stage 1. For example, at key stage 3 (11 to 14 year-olds) people should know about how the misuse of volatile substances—tobacco, alcohol and other drugs—affect health. DrugScope produced quality standards for drug education which read across to alcohol education. The Advisory Council on Alcohol and Drug Education—I declare an interest as a trustee—produced curriculum guidelines and teaching materials. The Connexions service also offers support to young people.

The Government signed a WHO declaration in 2001 which outlined a framework for action on young people and alcohol. The Home Office now has an alcohol action plan aimed at reducing costs related to under-age drinking. In communities, each of the 152 drug action teams has a young people's substance misuse plan. A children's task force was set up in 2000 to relate the NHS plan to children, linking to Quality Protects, safeguarding children and child and mental health services.

I am aware that a national service framework for children is being developed. Perhaps the Minister can update some of those initiatives. All are relevant to an alcohol strategy. Youth offending teams, parenting orders and youth inclusion projects are designed to support young people, including those with problems relating to alcohol and drug use.

I now discuss briefly the issue of treatment, which is clearly vital to any strategy on alcohol or drug misuse. Many young people, of course, without help, will learn to drink sensibly and safely. Some will be involved in drug as well as alcohol use. That may well become misuse of one or more drugs and require treatment.

All drug misuse in young people requires a different approach to that used with adults. A strategy must reflect that. The background to that misuse must be considered. Some young people who misuse drugs will have underlying social or clinical problems. Many may not. The treatment pathway must be carefully designed to suit the individual—from brief therapy to detoxification or residential care.

We urgently need research into what works with young people in the UK and evaluation of effectiveness. We urgently need to examine the training needs of professionals who have worked with young people with drug misuse problems. That, too, is relevant to any strategy.

We are dealing, as we know, with a highly complex issue. We are doing much. Strategies are important. Targets in any alcohol strategy must be realistic, specific, targeted to a variety of groups, including young people, and measurable in a reliable way, with potential benefits of interventions costed in.

One of our biggest challenges is that of integrating services for young people, both within and across education, and treatment, and of encouraging collaboration. Does the Minister share that concern, and how can it be addressed in a strategy? If we neglect interventions for young people, or allow piecemeal activity, we are storing up problems for the future, not only for the NHS but for families, communities and societies.

7.12 p.m.

The Lord Bishop of Hereford

My Lords, I first apologise for not being in my place when the debate began. It was a mixture of the unexpectedly early hour at which it started and the slightly tardy progress of Great Western Trains. I am very sorry that I did not hear the speech of the noble Baroness. We are certainly indebted to her for drawing attention once again to the urgent and enormous problem of alcoholism, and especially to the huge burden borne by the National Health Service in coping with those who suffer from it and—every much as serious a problem—with their victims; those on the receiving end of their alcohol-dominated behaviour.

The recently published report of the Home Affairs Committee of the other place into the Government's drug policy was primarily concerned with that very serious issue of drug abuse and ways of combating it. But that problem is set in context in the report with reference to the less dramatic, but much more widespread incidence of tobacco and alcohol consumption. The comparisons are instructive: while about 3,000 deaths a year can be attributed directly to drug abuse, the figure for alcohol abuse is hard to formulate but could well be 10 times that number. Estimates vary between 5,000 and 40,000 deaths a year from alcohol-related causes. Whereas about 4 million people use drugs, at least 40 million people drink alcohol. Nearly half of them drink significantly over the recommended levels, day in, day out, week in, week out, with disastrous effects.

It is a colossal problem. Its impact on the NHS simply cannot be calculated with any accuracy. Can the Minister tell us how much it costs the NHS? I cannot believe that that figure can possibly be calculated. But it must be very great. It is said that one in four of emergency admissions to hospitals of men is alcohol-related. Frankly, I am surprised that it is not more. Alcohol is a factor in 50 per cent of serious road accidents and 50 per cent of cases of domestic violence, which is perfectly horrible. A high percentage of those involved in road accidents and in domestic violence need some kind of medical attention. Alcohol-related episodes mean enormous demands on accident and emergency resources, on hospital beds and on the time of doctors and nurses. They frequently involve risk of serious violence towards NHS staff.

My recent conversations with GPs reflect their great concern over alcoholism, especially as it affects family life and young people. I am grateful to the noble Baroness for referring to that specific issue. There are many cases of spouses and partners—almost always the women—being assaulted and beaten up and children terrified and traumatised. Alcohol severely diminishes working efficiency and causes absenteeism and, indirectly, unemployment through unemployability.

The services available to alcoholics vary greatly from place to place. The Community Alcohol and Drugs Advisory Service can be excellent, but it is usually understaffed and therefore unreliable, underfunded and inadequate. The need is for a totally dependable service, available 24 hours a day, seven days a week and, above all, one that is available at weekends and in the evening. A nine-to-five, Monday to Friday, alcohol advisory service is hopelessly unsatisfactory. Yet that is all that exists in many places. I hope that the Government's alcohol strategy will address that and perhaps rename the advisory service with something which gives a greater sense of the urgent need for help. When people finally want to turn for help it is very sad if they find that it is not available.

I need to declare a personal interest in this desperately distressing and destructive problem, since I have come face to face with it in the context of my own extended family. I daresay that I am not the only one of your Lordships who has been caught up in the grisly consequences of alcohol abuse with our nearest and dearest.

The Bible, with its pre-scientific language, speaks frequently of demon possession. While we may be able to account for much of what is so described in terms of psychiatric illness, schizophrenia and various forms of dementia, demon possession certainly remains a vivid and accurate way of characterising alcoholism with its power to transform personality and distort behaviour.

With particular reference to its impact on the National Health Service, I can say of the particular case which I know best that alcohol has been responsible for a whole series of catastrophes: for a serious fall which required admission to A and E and 24 hours in hospital; for two drink-related road accidents, one a spectacular crash; for a particularly difficult pregnancy and a terrifying miscarriage involving several stays in hospital; for more lost jobs than I care to calculate; and for a marriage brought to the brink of breakdown. Two detoxification programmes have had only temporary success. I am speaking of one person's life, but that catalogue of tragedies adds up to an enormous National Health Service bill, especially if one adds in a quite disproportionately frequent resort to the GP's surgery for attention to minor problems.

What can be done? As with drugs, so with alcohol, we need better education, better role models, more readily available and more expert advice services and more supportive and therapeutic communities. So often what alcoholics need is ongoing support in a community. I am glad to say that there are many such Church-based groups and communities doing valiant work in this area.

To cure alcohol-related illness and to cure alcoholism is costly, time-consuming and an uncertain process. Alcoholics know that they are never really cured—only in remission. If you have ever been to an Alcoholics Anonymous meeting you will know that everyone gets up and says, "I am Bill and I am an alcoholic" because they know that that is a risk with which they live for the rest of their lives.

Prevention must be better, but that demands a shift of resources. We need a culture change from an NHS almost exclusively dealing with ill health rather than fostering good health to a system that focuses much more powerfully on the encouragement of sensible lifestyles, particularly for the young. We have achieved a transformation in the drink-driving culture, and quite new levels of responsibility on the part of most people over that issue. Now we need a similar culture change in relation to all alcohol consumption. I hope that the Minister will be able to give us some idea of how the Government's strategy will appear and where the priorities will lie.

7.20 p.m.

Baroness Finlay of Llandaff

My Lords, I. too, am most grateful to the noble Baroness, Lady Masham of Ilton, for having initiated this debate. I must also apologise as, thanks to the trains, I was late in entering the Chamber. However, I must have run slightly faster than usual because I got here a few minutes earlier than expected.

The noble Baroness, Lady Masham, outlined the problem of cirrhosis of the liver, and other diseases, as well as the problem of violence directed towards healthcare professionals. The problem is enormous. One in four deaths among men in Europe is now attributable to alcohol, as binge drinking penetrates the youth culture. Dr Brundtland, the director-general of the World Health Organisation, observed that boys in the UK have the second highest rate and girls the third highest rate of alcohol consumption of the 20 countries in Europe. Nearly one in four teenagers indicated that they had been drunk at least 20 times in the preceding year. The situation was worse among boys than girls. This pattern of teenage binge drinking reflects the adult pattern of drinking in society and is much more common in northern Europe. The total alcohol consumption of about eight litres per person per year in the United Kingdom is average for Europe and below the European Union average of nearer nine-and-a-half litres.

Among young girls, binge drinking has been linked to the "ladette" culture, with peer pressure to conform and to do what the boys do. It is viewed as amusing and hilarious to have been "legless". Many teenagers do not view alcopop drinks, such as Bacardi Breezers" as real alcohol. Youngsters in a school in Weston told their chemistry teacher that Bacardi Breezers were not real alcohol. They did not seem to grasp the association of the alcohol in the drink with other forms of alcohol. Vodka seems, anecdotally, to be the way that these youngsters get seriously drunk.

Students have told me that there is incredible pressure on them to be happy. If they have handed in an essay, they often feel flat afterwards but sense that they ought to be happy. The pressure is to block out their feelings with a bit of binge drinking. So they binge. They learn to follow the pattern that, when there is a problem, you block it out by getting blotto. They learn it as a pattern, and then they learn to drink when stressed. As they proceed into adulthood some of them do not binge drink when stressed as they take on responsibilities, but it has been estimated that about one-fifth of them continue to follow that pattern.

More women in society experience harmful effects from men's drinking than men do from women's drinking. Therefore, a strategy that targets young males makes sense. It is interesting that 50 per cent of the speakers in this debate are female. Much harm relates to physical violence and sexual aggression. The problem for the police is enormous. Many accusations of rape are associated with the girl being drunk, as well as the boy. Dr Winnie Maguire, a police doctor in Northern Ireland, gave me the data from her last two years' practice. She had been asked to see 31 girls aged from 13 to 26 for probable rape. Twenty-eight of those girls had very high levels of alcohol in their blood, 15 of them being aged between 13 to 19 and 13 within the 20 to 26 age group.

Apart from irresponsible sexual activity and the resultant unplanned pregnancies, physical violence and a catalogue of traffic deaths and injuries take their toll on the NHS in both the short and the long term. Acute services are stretched to the limit. Friday and Saturday night admissions through casualty departments are enormous. Many of those admissions are due to alcohol poisoning and/or injuries sustained. Unfortunately, that means that patients admitted with other conditions become part of the waiting statistics with which the NHS is plagued, as they wait on trolleys while someone with a head injury and alcohol poisoning is admitted as a priority. There follows the toll of those who go on to develop chronic pain, disability, or psychological sequelae from their injuries.

A study in Northern Ireland showed that the estimated risk of suicide in the presence of alcohol misuse or dependence increased eight-fold. Eighty-nine per cent of suicides with alcohol dependence had one or more concurrent mental disorders. A possible mechanism is that alcohol appears to decrease the protection against suicidal impulses by its effect on serotonin neurones in the brain. Youngsters who are feeling suicidal become less inhibited about proceeding with their suicide attempt.

One quarter of men presenting to hospital after deliberate self-harm are alcohol dependent, yet very few have had their alcohol use assessed. Even when alcohol use is assessed, intervention strategies are rarely offered. In a study of hospital admissions, alcohol abuse or dependence was recognised only among one in five of those who scored high for such disorders. Fewer than one in three was referred for appropriate follow-up treatment. However, that does not reflect fairly on healthcare professionals; it just reflects on over-stretched resources. Primary care does no better. In a study of practice nurses, a knowledge and skills gap was found in the delivery of effective advice on alcohol-related issues, with only one in two women and one in three men receiving correct advice.

The story that light to moderate drinking substantially reduces the risk of coronary heart disease and stroke is evidence based, but it has been slightly misrepresented. It seems that wine may have this protective function, as it is taken with food and is not the focus of binge drinking. However, beer bingeing is associated with an increased all-cause mortality, and may explain why middle-aged men in Scotland do not show the reduced coronary heart disease mortality seen in other parts of Europe. Nitrosamine, which is found in beer and spirits but not in wine, may account in part for the upper-digestive tract cancers seen in drinkers.

The cost to health services in France was estimated in 1996 at between 2,300 and 2,700 million US dollars. But that represents only 25 per cent of the total cost to society of the social harm from alcohol. I take the figure given by the noble Baroness, Lady Masham, of £3 billion expenditure on health in the United Kingdom. This would suggest a total cost in this country of the alcohol problem nearer £12 billion. In France, it was estimated that the cost was greater than 1 per cent of the gross national product.

A strategy needs to be concerted and to have a multi-faceted approach, based on increased knowledge about alcohol across all layers in society. Society's ambivalent message needs clarifying. It is easy to put out a clarion call for more resources, but the whole of society must take responsibility for the problem that we face. Youngsters need role models who do not drink. There are role models for young men—young sportsmen who do not drink—but there do not appear to be such role models for young girls. It is particularly important for girls because their tolerance of alcohol is less than that of boys.

The strategy in Holland has seen decreased advertising and a voluntary agreement that so-called "happy-hour" drinks shall be non-alcoholic. No alcoholic drinks can be sold at less than half of the normal price and happy-hour sessions are not to occur shortly before closing time.

In the United Kingdom, alcohol is now cheaper in real terms than it has been for many years and has therefore become more easily available to youngsters. A comprehensive national alcohol policy, such as a "defeat alcoholism" campaign, must involve government departments, but it must also involve the drinks industry, the leisure industry, health promotion agencies, employers, teachers, the media and all the clubs as well as all the healthcare areas—primary care, mental health and general hospital services. We should not forget the contribution of the voluntary agencies such as Alcoholics Anonymous and Al Anon. They are keeping a substantial number of alcoholics out of trouble, but in many respects it is like closing a stable door once the horse has bolted. The fundamental problem of binge drinking among the young must be attacked with urgency.

7.30 p.m.

Baroness Andrews

My Lords, like all the other noble Lords who have spoken so far, I should like to thank the noble Baroness, Lady Masham of Ilton, for providing the opportunity to raise concerns about what is a huge national problem. It has been an interesting debate in many respects, not least for the wealth of statistics provided so far, but also for the contrast between the scope of the picture that noble Lords have painted and the personal illustration given by the right reverend Prelate the Bishop of Hereford, which allowed us to see the real, deep and personal impact of what we are discussing.

Like my noble friend Lady Massey, I want to talk about young people, for whom the issue is of such fundamental importance. I want to talk about under-age drinking. In contrast to the wealth of statistics that we have already heard, as I prepared for the debate, what struck me was not how much is known but how little. I have read the usual sources and I have been disappointed by the inconsequential nature of the statistics and the lack of explanation.

My first concern, therefore, is to understand more about the impact of alcohol abuse on young people under 16, to consider the scale of the problem and to ask my noble friend the Minister what he thinks the Government can do to ensure that that area of policy is better understood and better evidenced, so that if we have a policy for under-age drinking, it locks firmly and intelligently into everything else that is being done. Secondly, my other major concern is that if we are to have an intelligent policy to reduce alcohol abuse, it must deal with the family and the social context. We are all saying the same thing in this debate: we need a genuinely coherent and integrated policy.

My inspiration, as it were, for taking part in the debate stems from an evening that I recently spent with the teachers and parents of a South Wales school. It is well known and well documented that the heroin epidemic in South Wales has reached alarming proportions and is a fantastically serious issue because heroin is so cheap. From talking to parents and teachers, it is equally obvious that their main concern is with under-age drinking and access to alcohol. Every small shop in every Valley town seems to be licensed to sell alcohol. Young people—children—can usually buy it without being challenged.

What is happening in South Wales represents, acutely, the national picture. As other noble Lords have said, what is really worrying is that people under the age of 16 are drinking more and more hazardously. To complement some of the other statistics, I have my own raft of them. Young people under 16 are drinking twice as much as they were in 1990—their consumption has risen from 5.2 to 10.4 units a week. Nine per cent of 11 year-old boys and 5 per cent of girls describe themselves as regular drinkers. By the time that they are 15, that figure increases to 39 per cent of boys and 33 per cent of girls. As the noble Baroness, Lady Finlay, said, a quarter of those 15 year-olds reported binge drinking in the previous month.

Those figures put us right at the top of the league for teenage drinking across Europe. That is not a record of which we should be proud. We are alongside Ireland and Denmark but behind countries where alcohol has been a social fact of life for centuries—Mediterranean countries.

The problem is that, as one national expert put it, for young people, who come in all shapes and sizes and whose bodies may still be developing, risk free drinking does not exist". That is precisely the problem that the NHS faces. Severe intoxication is obviously more dangerous for children and adolescents than for adults. It can lead to hypoglycaemia, hypothermia and breathing difficulties—all of which can be fatal.

We know why young people drink and we know that their drinking habits change as they grow older. They change from drinking to be experimental to drinking for pleasure, social confidence and inclusion—all the reasons that we have already discussed. What is less clear is which sort of young people are at risk and what sort of interventions are likely to work—where and why they work and what we can do to spread good practice.

We need to know about the relationship with parental drinking, about which we do not know much. More than 900,000 children are living in homes where one or both parents misuse alcohol. Research has shown—and it is self-evident—that those children are more likely to present behavioural, emotional and psychological problems in school. One does not need much imagination to know what are the implications of the uncertainty of living with an alcoholic parent. In 1996, Childline reported that during the previous year it had received 3,000 calls from children reporting misuse of alcohol by parents. Half of them reported physical violence and the vast majority physical neglect. How do we begin to cost that for the NHS?

We know that the cost to the NHS of alcohol abuse is both direct and indirect. Directly, for example, it was estimated in the early 1980s, that 1,000 young people were admitted to hospital annually with alcohol poisoning. There is good reason to suppose that that figure would now be much higher, say that on the basis of the fragments of evidence that we have. For example, research from the Royal Liverpool Children's Hospital showed a tenfold increase in admissions due to alcohol between 1985 and 1996. All of those young people needed resuscitation or had been injured in accidents or assaults. No doubt that is not an isolated trend, but we do not know because we do not have national figures.

Turning to injuries, a recent European report stated that 13 per cent of 15 to 16 year-olds had been involved in an accident or had been injured. Again, we do not know how much that costs the NHS. The risk of unwanted pregnancy and sexually transmitted disease has been referred to, and is another obvious cost. An indirect cost is the contribution that alcohol makes to suicide, accidents and violence-especially for the 16 to 25 year-old group.

It is deeply frustrating that we seem to know so little about some of the most significant things. For example, it is extremely difficult to establish levels of dependency for teenagers under 16, although we know from research that one fifth of young men between 16 and 24 could be described as dependent.

My first question to my noble friend the Minister is therefore whether he will ensure that the national alcohol strategy includes a systematic research programme to assess the costs of under-age drinking to the NHS in terms of both hospitalisation and dependency. It would be useful, for example, to know whether there are regional variations; whether teenagers who drink heavily become adults with drinking problems; whether the children of parents who drink heavily are more likely—as is often assumed—to become drinkers themselves; what other countries are doing and what works. The example from Holland was interesting.

My second question to my noble friend is whether he will also ensure that there is a discrete policy for the reduction of drinking among young people, because it affects the community as a whole, from the child excluded from school—15 per cent of exclusions are due to alcohol—to the cycle of family violence which reproduces itself across the generations. We must ensure that the strategy will include the range of interventions required to match the scale of the problem.

I listened to the example of Holland, which attacked the problem of advertising. Our strategy needs a policy on the advertising of alcohol. We must make sure that shops and off-licences observe the law and challenge young people about their age. We need support for the range of policies to which my noble friend Lady Massey of Darwen referred. The list is comprehensive, but I suspect that, in practice, it is more partial.

We must recognise the boredom in young people's lives. In their responses to the Children and Young People's Unit consultation, young people, irrespective of age, said that they wanted more to do. They do not have enough things in their life to occupy, divert and enrich them. The strategy must include ideas about how to involve parents as role models and educators.

The programme is ambitious, but a national alcohol strategy should be ambitious, given the social and economic costs about which we heard tonight. I look forward to hearing what the Minister has to say.

7.40 pm
Viscount Falkland

My Lords, I apologise to the House and to the noble Baroness, Lady Masham of Ilton, for missing the early part of the debate. I was in a meeting and had to turn off my mobile phone, so I did not know that the debate was to start earlier. The noble Baroness and I have served together on the All-Party Group on Alcohol Misuse for many years—I shall not say how many—and we have learnt a great deal about the problem and the changes that have taken place over those years.

The best thing that I can do is to give the House details of a presentation that was made to the All-Party Group—I do not think that the noble Baroness was present on that occasion—by Dr John Kemm, a consultant in public health in the west Midlands. He was also a member of the Royal College of Physicians' working party that published a report two years ago, called Alcohol—Can the NHS afford it?. Dr Kemm gave a graphic—and imaginary—representation of a typical hospital. He took us round the wards and described the medical histories of patients in the medical and surgical wards and the children's ward.

For the medical ward, he gave us the typical case of Mr Smith, who drank about 40 units a week. Noble Lords will be familiar with the units that are part of the measurement of what is acceptable. He had acute pancreatitis, which is more common in heavy drinkers than in others and is difficult to treat. There was Mr Jones, who had been in hospital many times, suffering from hepatitis. Last time, he had vomited blood. His liver was in such a bad state that, if he had carried on drinking, he would not have been expected to survive much longer. Also in the ward was Mr Davies, who had lost his short-term memory and was no longer able to look after himself, due to Korsakoff's syndrome, a complication that sets in with heavy drinking and which can he prevented if it is caught in time. There was also Mr Taylor, who had had a dense right-sided stroke, which is common in people who drink. It is unusual in someone as young as Mr Taylor, but, the night before, he had had an alcoholic binge, which increases the risk of stroke substantially.

On the surgical ward, there was Mr Carr, who had just had a gall bladder operation. Although the original problem was not due to his drinking, his slow and difficult recovery involved being in hospital for an extra five days. There was a Mr Ponsonby, who had fallen off his roof after lunch and broken his femur. Forty-eight hours after his operation, he suddenly got agitated and disturbed due to a case of the DTs, meaning that the hospital had to get in a specialist nurse to treat him for 24 hours. The role of alcohol in his fall should have been spotted and his alcohol dependence managed better. Mrs James, another patient, had a carcinoma of the oesophagus, which is invariably associated with high alcohol intake. She had required serious surgery in which pieces of her bowel were taken out and used to mend her oesophagus. And so the round went on.

In the children's ward, there was Elsie, who had broken her wrist. On spotting two healing rib fractures, staff admitted her to a place of safety from her heavy-drinking parents. All the cases relate to things that noble Lords have already mentioned. Jamie, a young lad, had been to his parents' party and, when it was over, had finished up the drinks left over. He had been brought in with severe alcohol poisoning.

Dr Kemm also described a Friday night in the casualty department—there will no surprises for your Lordships in what he said about that—and the type of alcohol-related injuries with which staff had to deal. He also described the stress under which staff are put in such situations. Mr O'Neill had cut his head, and his X-ray showed obvious problems associated with a severe drinking habit. As being extremely drunk is like having a head injury, doctors are wary of discharging patients until they are sure about what is going on. Invariably, patients are kept in all night and have their blood pressure and their pupils checked every 15 minutes. That takes up a bed and valuable staff time.

It is difficult to give a precise number for alcohol-related admissions, but the Royal College's working party estimated that the cost to the health service was between 2 per cent and 12 per cent of the total amount spent on the NHS. Even at the lowest figure—2 per cent—that is a huge burden.

It was suggested and agreed at the meeting that the solution lay in spotting and managing acute alcohol-related cases better in hospital. It was also suggested that, to identify those at risk, all patients should be asked on admission about alcohol consumption. As noble Lords will realise, that is a tricky matter. Many people are unwilling to reveal that part of their life. It is all part of what is known as the denial of alcohol problems. If patients could be induced as a matter of course to reveal their level of consumption, that practice might reduce the stigma that attaches to the subject. Obviously, staff must be trained to ask the questions sensitively, thus ensuring that patients are not embarrassed and put off and that large numbers of them will answer the questions truthfully.

Your Lordships will have gathered that I was impressed by the presentation; otherwise, I should not have repeated it. It is the type of presentation that would lend itself well to education. In their health education, children must be told about alcohol, but in a way that stretches their imagination and makes them think about their own future and the dangers that alcohol might bring into their life. That would be useful health education at all levels, not just for children. I put that to the House and the Minister to consider.

7.48 p.m.

Earl Howe

My Lords, let me begin by taking us back to the statement quoted by the noble Baroness, Lady Masham of Ilton, from the recent conference held under the auspices of Alcohol Concern. It came from Dr Chris Luke of Cork University Hospital, and it was deeply shocking. Dr Luke referred to the new accident and emergency unit in the Royal Liverpool University Hospital, where in 1997 there were 100 nurses working. He said: Only a handful of the original staff are still there. Ninety per cent of the nurses in one of the most forward-thinking, high-tech A&E departments have left because of the sheer misery". That vignette of life in today's NHS exemplifies how well chosen are the terms of the Question tabled by the noble Baroness, with its emphasis on the well-being not just of patients but of the NHS itself. For when we look at the damage done to the people of this country by alcohol dependency, let us not ignore the men and women in the health service whose job it is to cope and to treat. The curse of alcohol abuse has many victims and morale among NHS staff, particularly nurses, is often one of them. Unless you have seen what life is like on a busy A&E unit on a Friday or Saturday night in one of our big cities, it is impossible to say that you know what a difficult job amounts to.

As has already been mentioned, the former Health Education Authority found that one in six people who attended A&E departments for treatment had alcohol-related injuries or problems of one kind or another. On Friday and Saturday evenings, that figure rose to no fewer that eight in 10. What an appalling impact that must have on the staff, on other patients waiting to be treated and on the ability of hospitals to cope with patients who need admission as in-patients.

It is no wonder that at the Alcohol Concern Conference the NHS frontline was described as a "war zone". For the raw statistics are that health service staff are two to three times more likely to be attacked at work, even than are the police. A zero-tolerance strategy sounds fine, but try telling a violent drunk three times stronger than you are that his behaviour simply will not be tolerated and see how far you get!

As the noble Baroness, Lady Finlay, reminded us, we are all familiar with alcohol consumption; it is an accepted part of daily life in a society with leisure time and spending power. We are told that used in moderation alcohol can be beneficial to our health and well-being. Taken to excess, it can kill. We cannot speak in that divided way about tobacco and hard drugs. There is no safe or beneficial dose of either of those products, which is why the messages from the medical profession about them are unequivocal and clear.

On the other hand, alcohol gives rise to decidedly mixed messages. For unsophisticated consumers, especially the young, such messages are difficult to deal with, yet the risks and consequences of alcohol misuse are no less dire. I very much agree with the final sentiment expressed by the noble Viscount, Lord Falkland, on that matter.

But why is there a particular cause to worry about this public health issue as opposed to others? The reason for concern is that things are getting worse. Thirty years ago, the death rate from liver sclerosis in England was seven times lower than it was across the EU. Since then, the death rate for other countries has fallen, but ours has risen almost to meet it. The noble Baroness, Lady Andrews, focused our attention on the young in what I thought was a wonderful speech. She cited the statistic that those 11 to 15 year-olds who admit to drinking—and more than half of all 15 year-olds admit to it—consumed twice as much in 2000 as they did in 1990. The number of drink-drive accidents has risen over the past two years by more than 15 per cent after a number of years in which it had fallen. The number of deaths directly attributed to alcohol misuse rose steeply in the late 1990s to more than 5,500 in 1999. In a debate such as this, one hesitates to use words such as "sobering", but in Britain today one person in 13 is dependent on alcohol; twice as many as are hooked on all forms of drugs, including prescription drugs. That is a truly staggering figure.

In the face of such a toll on society, we might expect that the risks of drinking alcohol to excess would be highlighted in vigorous public information campaigns. However, if we look for such campaigns, we look in vain. The amount of money spent in the NHS on drug prevention and treatment is £91 million a year; the equivalent figure for alcohol is £1 million a year. That is a paltry sum for a problem which is far bigger in scale.

Last October in another place, Hazel Blears was candid in acknowledging that the national alcohol strategy was slow in emerging, but in her defence she cited the fact that the Government's specific clinical priorities relating to cancer, coronary heart disease and mental health had first call on the department's time. One understands about time and resources, but here is an easy question. What commonly diagnosed condition is clinically associated with the following: cancers of the mouth, liver and oesophagus; cardiovascular disease and hypertension, leading to strokes and heart attacks; depression? The answer, of course, is alcohol addiction. Alcohol is a thread that runs right through all three of the Government's clinical priorities. It is a fact that 80 per cent of alcoholic patients referred for treatment have important medical problems as well.

I do not in the least belittle the measures taken by the Government in relation to alcohol addiction, but most of those, it has to be said, have emanated from departments other than the Department of Health: police powers of arrest and confiscation; powers to close premises; new offences; and guidance to teachers. The Department of Health is making all the right noises about conducting research into health promotion campaigns and the need to find out what works, but in doing so it gives the impression of being like one of James Bond's dry martinis—shaken but not stirred. I wish that Ministers could stir themselves rather more energetically on this issue than they have done to date.

The Government have notched up some successes in public health, but unfortunately their failures are more numerous and alcohol addiction is one area where failure is the result of too little action. At a basic level, I do think that the department should be doing much more to encourage safe consumption. Above all, it should be trying to dispel the nagging doubts, which I hope the Minister can do today, that the alcohol strategy is not all that important. As the Minister knows, I am not a great advocate of directions from the centre, but I very much see the merits of national service frameworks. The trouble is that when it comes to taking action on alcohol misuse, not enough is being done at a local level. The NHS and indeed local authorities find themselves working without any kind of framework of best practice and hesitate to allocate funding to specific services because they do not know which are the ones they ought to be funding. It simply is not a priority for them.

This is an issue which really does need a lead from the centre. Last year, a working party from the Royal College of Physicians published a very good report on the effect of alcohol in the NHS. That report was referred to by the noble Viscount, Lord Falkland. It drew attention to the need for greater levels of support and training for GPs. It also spoke of the need for a culture change in secondary care. By that, it meant that doctors need to move beyond treating the alcohol-related physical disease to tackling the underlying problem and assuming a wider responsibility for health promotion. It also stated that hospitals should have proper strategies to deal with screening and care. But all that requires research and training, including a larger component of the medical and nursing curriculum. We are still a long way from being able to frame protocols and procedures that are capable of being delivered.

I come back to where I began, which was with Dr Chris Luke. He has observed that alcohol typifies overload in the NHS. I believe that that is the thought that we should leave with the Government. The principal imperative for the alcohol strategy is to try to save some of the 33,000 lives lost every year from alcohol-related causes; to reduce ill-health; and to address the social and economic fall-out from alcohol misuse. But as the noble Baroness reminded us, it is also about the future health and well-being of the NHS.

8 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, I should like to join with other noble Lords in thanking the noble Baroness, Lady Masham of Ilton, for allowing us to debate what we would all agree is an extremely important matter. I want to assure noble Lords that the issues and problems that have been identified and raised in our debate will be helpful to the Government in taking forward the strategy to which many noble Lords have referred. I shall return to the question of the timing of the strategy. However, I wish to assure noble Lords that we take the strategy very seriously. It will provide an important framework for taking forward many of the issues and concerns raised by noble Lords.

I shall reiterate a point raised by the noble Earl, Lord Howe; namely, that alcohol is an enjoyable part of life for many people in this country. A recent survey estimated that 92 per cent of men and 86 per cent of women in Great Britain drink alcohol. It is our contention that most of those people will enjoying drinking alcohol in a moderate and sensible fashion, but some will misuse it. In his contribution, the right reverend Prelate the Bishop of Hereford described the potentially devastating consequences of misuse for the drinkers themselves, their families, communities and society as a whole.

On the scale of drinking, my noble friend Lady Massey of Darwen and the noble Baroness, Lady Findlay of Llandaff, focused on the consequences of binge drinking. It is estimated that 21 per cent of men drink more than eight units of alcohol on at least one occasion in a week, while 8 per cent of women drink more than six units. Binge drinking is most common among the 16 to 24 age group. Some 37 per cent of men and 23 per cent of women in this group report binge drinking.

I turn to heavy drinking. In 1998, 7 per cent of men and 2 per cent of women were drinking more than 50 and 35 units per week respectively. A psychiatric morbidity study carried out in 2000 classified 12 per cent of men and 3 per cent of women as dependent on alcohol, with 0.1 per cent of men being severely dependent. With regard to young people, my noble friend Lady Andrews referred the House to a number of available statistics. A study published on 15th March 2002 and now being considered by the department showed that 26 per cent of school-age pupils aged under 16 had had an alcoholic drink in the previous week. Among those pupils drinking alcohol, the average amount drunk had risen from 5.3 units per week in 1990 to 10.4 units in 2000, although it fell back to 9.8 units per week in 2001.

What are the consequences of this scale of heavy drinking? As all noble Lords have pointed out, those consequences are witnessed day after day in the National Health Service. Some 15 per cent of all those entering hospital as acute hospital admissions misuse alcohol. The noble Earl, Lord Howe, said that one in six people attending Aamp;E departments for treatment have alcohol-related injuries or problems, rising to eight out of 10 at peak times. Over 150,000 people admitted to hospital in England in 1998–99 had an alcohol-related disease. Almost 29,000 people were admitted with a primary diagnosis of mental and behavioural disorders due to alcohol. A further 10,900 admissions were for alcoholic liver disease and the toxic effects of alcohol. The Chief Medical Officer's annual report noted that in 1999 some 4,700 deaths occurred from liver disease, with two-thirds of them among those below the age of 65.

Alcohol misuse also carries longer-term health risks. Around 3 per cent of all cancers can be attributed to alcohol, while heavy drinking over a long period increases the risk of heart disease. Also there are issues surrounding mental health. Around 39 per cent of men and 8 per cent of women who attempt suicide are chronic problem drinkers. Alcohol consumption precedes attempted overdose in a staggering 70 per cent of men and 40 per cent of women.

If we equate those costs to the NHS, they are considerable. The right reverend Prelate the Bishop of Hereford asked whether we were absolutely sure about the costs, but he knows that we are not. Recent estimates indicate that the costs to the NHS may lie between £200 million and as much as £3 billion. A study carried out in 1991 put the estimate at between £188 million and £392 million, but that included only in-patient costs. The noble Viscount, Lord Falkland, pointed out the recent work undertaken by the Royal College of Physicians, published in February 2001. That work examined a number of studies of the costs of alcohol misuse and concluded that around 2 per cent to 12 per cent of the total cost of hospital services could be attributed to the care and treatment of alcohol problems. While we do not know the true figure, it is clear that it represents a very high cost to the health service.

It is also a high cost to NHS staff. The noble Earl, Lord Howe, and the noble Baroness, Lady Masham, emphasised in particular the stresses and strains endured by NHS staff. There can be no doubt that anyone who has looked at the pressure put. on staff working in Aamp;E departments would testify to the level of verbal and physical abuse suffered by so many members of staff at the hands of members of the public, in one way or another, under the influence of drink.

The noble Earl, Lord Howe, referred to our zero tolerance regime. I believe that it is beginning to have an impact on the health service. At the same time, we have invested resources to modernise Aamp;E departments. Many of those modernisation schemes will include security measures such as closed-circuit television. We are also seeking to protect staff through initiatives such as ambulances fitted with central locking doors, on-board closed-circuit television, personal alarms and swipe-card doors. We have also set targets for NHS trusts to provide ready access to comprehensive and confidential counselling services for all staff. Those services are designed to assist staff in dealing with the day-to-day stresses of working in the NHS.

Three or four weeks ago, I had the pleasure of opening a police station which has been established on the site of Leighton hospital in Crewe. This provided a very good example of joined-up working, because the police needed a new site for their station and the hospital was glad to provide it. I am told that in the months since the police station opened, no violent incidents have taken place in the Aam;E department.

While it is not possible for a police station to be established in every NHS trust Aamp;E department, that example demonstrates the benefit of close collaboration between the police and NHS hospitals. A number of other hospitals have opened small sub-units of police stations within hospital premises. They offer a police presence when it is required. There is no doubt that when the relationship is strong and positive, if NHS staff who are under particular pressure know that they can call on the police to come quickly, that provides a great comfort to them. The tragedy is that the staff of the NHS have to put up with these concerns day in and day out. It is right to acknowledge our support for what they do under what are sometimes very difficult circumstances.

A point which is as relevant to young people as it is to other adults is that those who misuse alcohol often become involved in other forms of risky behaviour, some of which were mentioned in our debate. I cite drug use, including tobacco, crime and disorder; my noble friend Lady Massey mentioned the issue of risky sex and teenage pregnancy; and of course the use of illegal drugs.

We must also recognise that the evidence of a link between alcohol misuse in the form of binge drinking and crime is very serious indeed. It has been estimated that 22 per cent of arrestees tested positive for alcohol and those with alcohol in their system are most likely to have been arrested for disorder offences. In addition, the recent British Crime Survey showed that 40 per cent of victims of violent crime thought that their assailant had been drinking.

This brings me to the issue of youth offending. We believe that much can be done in this area. We know that alcohol can make people aggressive and more likely to commit crimes. The Government's action plan in August 2000 to tackle alcohol-related crime, disorder and nuisance particularly focused on reducing the problems arising from under-age drinking, on meeting targets to reduce public drunkenness and on preventing alcohol-related violence.

There are many elements to that action plan, some of which involve giving new powers to the police to deal instantly with violent and disorderly behaviour; targeting hotspots associated with alcohol-related crime and disorder; more Pubwatch schemes where pubs and clubs share information on trouble-makers; and support for the role of bar staff and door supervisors in helping to reduce incidents of disorder on licensed premises.

The noble Baroness, Lady Masham, raised the issue of alcoholism within prisons. I am very optimistic that the strong collaboration currently taking place between the NHS and the Prison Service to improve healthcare in prisons is beginning to pay dividends. I am very supportive of an increased role for the NHS in the development of joint health improvement programmes, where alcohol is one of the issues that need to be tackled.

My noble friend Lady Massey asked for evidence of joined-up government action. I certainly accept that it has to be joined-up. When it comes to young people, as she suggested, one of the main tools of prevention is the substance misuse education programme of the Department for Education and Skills. All schools are required to teach drug, alcohol and tobacco education. The national curriculum science order, which is statutory, provides that at various key stages young people should learn about the role of drugs as medicines; that alcohol, tobacco and other drugs can have harmful effects; and they should learn how the misuse of solvents, tobacco and other drugs affects health.

A considerable amount of money has been made available through the Standards Fund to support the training of teachers and to deliver effective drug, alcohol and tobacco education programmes. In addition, a further £1 million has been made available for the Connexions adviser training programme. This provides advisers on the drug, alcohol and tobacco education which will be a very important part of the strategy to target disaffected young people.

Young people substance misuse plans, which were touched on by my noble friend Lady Massey, will ensure that work on addressing the issues of education, prevention and treatment of substance misuse—including alcohol—with young people follows a joined-up approach, including drug action teams, the health service, local social service departments and youth offending teams. Again, we come to the question of resources. I should say to the noble Earl, Lord Howe, that these young people substance misuse plans have been backed by £152 million of extra funding over the period 2001–04.

My noble friend Lady Massey rightly referred to the link between alcohol consumption and unsafe sexual activity. She will know of our implementation of the teenage pregnancy strategy which picks up this issue as one of the key points that we need to take forward.

Noble Lords have referred to the alcohol strategy the Government are addressing. I know that there is disappointment that the strategy will not be implemented until 2004. However, in this case it is right that we take time to get the strategy as accurate and effective as possible. The Government's aim is to consult on the strategy in summer 2002 and I hope that, as a result of that consultation, we shall be able to embrace a wide range of views of stakeholders and Members of your Lordships' House in deciding on the best way forward for such a strategy.

As noble Lords have suggested, there is no doubt that no single government department or organisation could hope to tackle alcohol misuse alone. We will need wide-ranging solutions and input from all government departments, from the NHS, the police, local authorities, voluntary organisations and the drinks industry itself.

We will ensure that the strategy will pick up the issue of how alcohol misuse impacts on the health service and the issues of promotion and prevention, which I very much take to heart. A number of noble Lords have said that we need to be much more proactive in that area and I shall ensure that the issue is seriously considered by the officials taking forward the strategy. I should say to my noble friend Lady Andrews that it will examine specifically the issue of alcohol use and misuse among young people.

As to the point raised by the noble Viscount, Lord Falkland, the strategy will also pick up the issue of how we detect alcohol problems in hospitals. Certainly we hope to work with the Royal College of Physicians in drawing up the strategy in order that patients' problems can be identified and they can receive advice and support.

I accept the point raised by my noble friend Lady Andrews about the research effort and the need for as much evidence base as possible. As part of the strategy we shall be looking to see how much we should be spending on research and development.

The right reverend Prelate the Bishop of Hereford referred to what he described as "inconsistencies" in the way treatments are provided. I agree. There are almost 500 services providing treatment advice and support for people with more serious alcohol problems and their families. We calculate that an estimated £95 million is spent on those alcohol treatment services, but there are variations in the quality and range of services being offered. Again this is a matter that we need to take forward in the strategy.

We shall also pick up the issue of funding for prevention and treatment initiatives. I should say to the noble Earl, Lord Howe, that one reason for the supposed disparity between £100 million on drug programmes and £1 million on alcohol programmes is that the drugs strategy in the main is funded from a number of small, identified central and local sources whereas alcohol prevention and treatment initiatives come solely through local sources, and it is sometimes difficult to identify that within the individual budgets of health and local authorities.

The noble Baroness, Lady Finlay, and the right reverend Prelate the Bishop of Hereford were right to stress the importance of primary care and the role of GPs and primary care staff in the impact that they can have on their patients. The role of primary care trusts is now as both public health authorities and commissioners of services, and the combination of the experience of GPs and their primary care staff, on the one hand, and their ability to commission services on the other, will enable a much more concerted, cohesive approach at local level in tackling alcohol problems in the future.

In the short time left to me, I can reassure noble Lords that we take the issue of alcohol misuse very seriously. We see the strategy that we will launch in 2004 as being very important indeed. I can assure the House that in taking forward the strategy and issuing the consultation paper later in the year we shall take account of the many interesting and important points raised by noble Lords in the debate today.

House adjourned at twenty minutes past eight o'clock.