§ Lord Avebury
rose to call attention to the burdens of alcohol abuse on local authorities, police, ambulance services and accident and emergency departments; and to move for Papers.
The noble Lord said: The long-awaited publication of the Government's Alcohol Harm Reduction Strategy for England and the interim analytical report that preceded it are to be welcomed, but their message is not. They reveal the enormous burdens on society created by the misuse of alcohol—costed at £20 billion per year—and it is getting worse. Yet drink is so much a part our culture, that every analysis of the problem has to begin with a ritual emphasis on the benefits of moderate consumption. And so the Prime Minister begins his forward to the document by observing that:Millions of us enjoy drinking alcohol with few, if any, ill effects.322 Unfortunately, 6.5 million people drink to an extent that they risk causing serious harm to themselves and other people, and 1.8 million are very heavy drinkers, almost certainly damaging their health and becoming prone to accidents.
Individuals should be able to make informed and responsible decisions about their own level of alcohol consumption—as the Prime Minister suggests—but it is for the Government to set the environment in which these choices are made, so that the total of all choices does not threaten our whole future, as it does now.
The Motion calls attention to the burdens of alcohol abuse on the public services. Behind the headline figure of 30,000 deaths per year—10 times the number of people that were killed in the 9/11 terrorist attack—lies a huge penumbra of disease and disability in the community. Local authorities have to deal not only with the immediate and most obvious manifestations of alcohol abuse such as vandalism and dirty streets, they have to pick up the pieces afterwards in terms of poor educational attainment, school exclusions—alcohol is directly involved in about 20 per cent of school exclusions, and indirectly in a further 20 per cent—domestic violence, the break-up of families, teenage pregnancies and child abuse. The NSPCC says that 70 per cent of the children taken into care have parents who are suspected of substance abuse, and 920,000 children live in a home where there is parental alcohol misuse.
Between 30 and 60 per cent of all child protection cases involved alcohol, the wide spread indicating that more research is needed in this, as in all, aspects of social and family effects.
Local authorities have to provide for the 50 per cent of rough sleepers who are alcohol dependent. In Westminster, the city council tells me that 75 per cent have a drink or drugs problem. The interim report mentions local authorities only twice, and makes no attempt to assess the impact of alcohol harm on them.
Some local authorities organise treatment, support and counselling programmes for people who are dependant on alcohol and wish to stop—at a cost of £17 million according to the Cabinet Office—but very few appear to co-ordinate their strategy, not only for the front line services, but also for children, education, the homeless and for the employees of the council who may have alcohol problems themselves. Sickness and absenteeism cost the economy £3 billion to £4 billion a year. Local authorities pick up their share of that tab.
Alcohol misuse accounts for 150,000 hospital admissions and one third of A&E attendances, at a cost to the health service of £1.7 billion a year. Ambulance personnel on the front line are often the victims of violent drunks but do not keep records of call-outs at which alcohol is a contributory factor, at an estimated cost of £0.5 billion a year. That is a serious gap in our knowledge. We need the information for the wider purpose of continuously measuring alcohol-related harm.
Professor Colin Drummond of St George's Hospital Medical School and others estimate that, in England and Wales, there are 1 million alcohol-related 323 attendances at A&E departments a year at weekends alone. They propose national A&E data collection on alcohol-related attendances, and it would be useful to have the department's view on that. It would require that A&E staff be trained to screen attenders and refer alcohol-related attenders to appropriate treatment. There are several ways of doing that. Professor Robin Touquet and his colleagues at St Mary's have developed the one-minute Paddington alcohol test, which enables them to identify patients at risk and refer them to a specially trained alcohol health worker. In 2001, only four A&E departments in the whole country had such a facility. It has been shown that, if alcohol misusers are identified at what Professor Touquet calls a "teachable moment", treatment is highly effective. Sixty per cent of patients who received brief interventions reduced their alcohol intake. The pay-off was that fewer of those patients returned to A&E for any reason.
There are teachable moments at which drinkers can be persuaded to change their behaviour in other environments: attendance at STD clinics; facio-maxillary clinics; fracture clinics; gastroenterology outpatient departments; and GP surgeries. There is nothing in the strategy about the GP contract, although, on average, the GP sees one heavy drinker every day. Twice as many people are dependent on alcohol as are dependent on all other drugs put together. Consumption is rising, as it has done almost continuously for the past 50 years. If even a small percentage of those people could be referred to an alcohol health worker at a teachable moment in the GP's surgery, the returns would be huge. Routine screening of new patients and brief intervention delivered opportunistically in primary healthcare is effective in reducing alcohol misuse and saving healthcare resources. Would the Government consider including that in the quality and outcomes framework of the new GMS contract?
In last week's debate on the strategy in another place, the honourable Member for Dudley North contrasted the £95 million spent on alcohol treatment services with the £1 billion spent on drugs services. He also mentioned the £95 million spent by the drinks industry on rebranding Smirnoff. That is bad enough, but my honourable friend the Member for Orkney and Shetland elicited the fact that, in the past seven years, the Department of Health had spent nothing on highlighting the dangers of alcohol misuse. It should fund posters and leaflets about the risks, which could be used in hospitals and GPs' surgeries, as well as in health education classes in schools.
We have heard how weekend binge-drinkers are out of control. The problem is getting worse, as the president of ACPO said on the "Today'. programme yesterday morning. Before that, Deputy Commissioner Sir Ian Blair said that he was concerned about the rise in alcohol-fuelled disorder, fights and disturbances in public places. Similar comments are made by police officers up and down the country, as we 324 saw in the BBC's "Drunk and Dangerous" series. A senior civil servant in the Home Office says that it is more or less impossible for the police to enforce the law in city centres. During one eight-week period in 2002, the duty nurse at Charing Cross police station saw 1,193 detainees and recorded that 37 per cent had identified alcohol as an issue for them. Nearly two thirds of sentenced men prisoners and 39 per cent of sentenced women prisoners admit to hazardous drinking. The Prison Service was to introduce an alcohol strategy for prisoners this spring. Has it yet done so? What are the details?
We shall have an opportunity to discuss the barmy idea that bingers will sober up, if they are given a few more hours in late-night vertical drink factories, when the Licensing Act guidance is approved by the House. Apart from the mayhem on the streets every Friday and Saturday night, alcohol is a factor in half the crimes that are committed and in an even higher proportion of violent crimes: 58 per cent of rapes; 60 to 70 per cent of homicides; 75 per cent of stabbings; 70 per cent of beatings; and 50 per cent of fights and domestic assaults. In 2000, 44 per cent of domestic violence victims said that their attacker was under the influence of alcohol, compared with 33 per cent in 1998. That is one of the evil effects that are increasing. Of those who die in fires, according to the chief of the London Fire Brigade, 23 per cent are over the blood alcohol limit for driving. In England and Wales, violent crimes reported to the police were up by 2 per cent last year; in London, the increase was 4 per cent.
Drink driving and drink-related road accidents and deaths are on the increase, but the number of drivers tested has gone down. The Government have rejected the idea of reducing the blood alcohol limit to 50 mg or allowing the police to test people randomly near pubs and clubs, as the BMA has proposed.
All the problems that we experience in England are found to a greater or lesser degree elsewhere in Europe. Yet, the only action at European level proposed in the strategy—and only if voluntary measures fail —is the compulsory labelling of bottles. There is no mention of the possibility that Europe might harmonise taxes on alcohol with a view to reducing consumption throughout the EU and equalising competition between member states. There is not a word about the WHO's European alcohol action plan and how the strategy connects with it.
Labelling would certainly help drinkers to know whether they are drinking safely. Three out of five drinkers claimed to know what the recommended benchmarks were, but, of those, two fifths had no idea of what they were, and only a third got the answer right. The label should tell drinkers not only how many units they can safely drink in a day but what that means for the stuff in that particular bottle. It should also give a health warning on the dangers of exceeding the safe amount, as suggested by the BMA.
325 Finally, I come to the most calamitous and irrational omission from the strategy: any policy for reducing the level of alcohol consumption, to which harm is directly related. The interim analytical report said:Price and availability are important levers on overall consumption: there is clear evidence of links between price and availability and overall consumption, and hence harm".That is echoed in the report by the Academy of Medical Sciences, Calling Time, which recommends that action should be taken to reduce consumption to 1970 levels by increasing taxes. Research sponsored by the European Commission shows that there is a link between the amount of alcohol consumed and the incidence of harm in Europe as a whole. A WHO report, Alcohol: No Ordinary Commodity, found that,the net effects of taxation and price increases … are to reduce alcohol use and related problems".The strategy, perversely, rules out the use of the price mechanism. Instead, it proposes co-operation with the industry in the prevention and minimisation of the consequences of alcohol misuse on a voluntary basis. It is bizarre to trust the people who introduced alcopops and encouraged a huge increase in drinking by 11 to 15 year-olds.
The more the industry is involved in palliative schemes for detoxification, after-care and support, the more difficult it will be for any future government to disentangle themselves from such arrangements and introduce policies that bite on consumption. That cosy relationship will prevent the objective consideration of any measures that would damage the profits of the industry. It is like inviting arms merchants to stop wars or fast food chains to combat obesity.
The interim report shows that alcohol was 49 per cent more affordable in 2000 than it was in 1979. That is the reason for the torrents of alcohol that are engulfing a whole generation. Disposable incomes have increased by over a third during that period, while the real price of all kinds of alcoholic drink— beer, wines and spirits—has gone down. One need not be Adam Smith to understand why more and more people drink far too much. The Government's rejection of the laws of economics, coupled with their unfortunate reliance on the drinks industry, mean that the strategy has little hope of making a real impact on England's most dangerous habit. I beg to move for Papers.
§ Lord Mitchell
My Lords, I thank the noble Lord, Lord Avebury, for introducing this debate. Alcohol abuse has become an epidemic and the noble Lord is to be applauded for drawing our attention to this blight and the burden it lays on our local authorities, hospitals and accident and emergency services. In economic cost, to say nothing of the human cost, the price tag associated with alcoholism is enormous.
I shall confine my comments today to a specific issue: foetal alcohol syndrome. It is probably true that many people know that drinking while pregnant can cause problems to the unborn baby, but the degree of 326 knowledge today is probably at a similar level to that in the 1950s about tobacco and cancer. The simple issue is this: a pregnant woman who drinks runs the risk of alcohol crossing her placenta and entering the body of her foetus. At early stages in its development, the foetus will have only a rudimentary liver, which clearly will not be able to filter alcohol out of the body. That is the stage when the baby is most vulnerable, but even as the pregnancy develops and the organs become better formed, the exposure is still there.
The problem is that alcohol in the body of the foetus can rob the brain of oxygen, destroy brain cells that can never be regenerated and retard the growth of other organs. The brain suffers from incomplete development, which will permanently affect the body of the baby from birth. Of course, many women drink when they are pregnant. Many drink when not knowing that they are pregnant. Many drink to celebrate that they are pregnant. And many drink because they know no better or because they think that the risk is minimal.
I shall describe what FAS means to a growing child. The problem is that the affected child usually looks normal and, at first glance, acts normally. One can talk to a child with FAS and wonder what all the fuss is about, but they are mentally retarded. Sadly, the ill informed reaction is to admonish such children for being stupid. The incidence of bullying at school is high. Dumb kids get a bad time; dumber kids are humiliated. Such children exhibit difficulties translating hearing into doing, thinking into saying, reading into speaking and feelings into words. They have difficulties perceiving similarities and differences. They cannot generalise and make associations, or compare and contrast, and they have difficulties with patterns, sequences and judgments. They have problems with emotions. Many cannot tell the time. They get lost if left alone. And when they leave school, they cannot hold down even the simplest of jobs. Typically, such children appear normal until they reach early puberty, then they tend to be abandoned by their playmates. They adopt new and younger friends, only to be dropped again when they too reach puberty. Eventually, such children become friendless.
The scale of the issue is massive. Each week, 28 babies are born with FAS. That is more than the combined number of babies born with muscular dystrophy, spina bifida, HIV infection and Down's Syndrome. It is one statistic that seems set to rise. I leave it to your Lordships to calculate the cost to society of FAS, but every one of those who is significantly afflicted becomes a major cost to our health service and to our special needs schools. The tragedy is that much of it could be avoided.
Your Lordships will hear in this debate and read in many learned papers about the effects of the alcohol pandemic. Nowhere is binge drinking more prevalent than in the 16 to 25 year-old female sector of society, and nowhere is it more widespread than in our own country. "Ladette" girls on the lash, getting legless on a Friday night, are prime participants in casual sex and prime candidates for inevitable pregnancy. I know that it is tough enough to persuade those young women to 327 go easy. They would probably retort that they know the risks and "What the hell? Friday night is Friday night". We have daughters and granddaughters and we know how hard it is to urge restraint. However, what those young women do not know is the real risk that they are running as the foetus in their body is being wrecked by their indulgence. It is here that government have a responsibility to be much more proactive in making such knowledge much more widely available.
Sometimes, we in this country stick our heads in the sand about those types of medical issues. The medical profession is not always at the vanguard of recognising new ailments such as FAS, preferring to say perhaps that it is a figment of the imagination. Sadly, so too are government. In the recent Cabinet Office paper, Alcohol Harm Reduction Strategy for England, to which the noble Lord, Lord Avebury, referred, FAS is barely acknowledged. The paper states only,that some groups, such as pregnant women and those engaging in potentially dangerous activities (such as operating heavy machinery), should drink less or nothing at all".That is all right then. Problem sorted.
The United States takes a much more proactive approach to FAS. The medical profession and the caring services have a much greater awareness of the issue. The US Government have taken much more anticipatory action.
Were I to stand here this evening with two cans of Budweiser beer—one can bought in New York and the other bought in London—there would be a noticeable difference. The American can would have printed on it the following:GOVERNMENT WARNING: According to the Surgeon General. women should not drink alcoholic beverages during pregnancy because of the risk of birth defects".The British can would have no such message. What does that tell us? It means either that we do not know or that we do not care. Either way, it is not very promising. We do not have a Surgeon General in this country, but we do have a Minister from the Department of Health, who will wind up our debate. Will he tell your Lordships' House why American women are entitled to be alerted to that issue whereas our own women are left in almost total ignorance?
Indeed, I read in the Daily Mail, which I admit is not my normal source of information, that government guidance is that mothers-to-be can safely drink up to four units a week. Even assuming that a young person knows what a unit is, which is highly questionable, that advice is wrong and dangerous. The message should be loud and clear: "If you are thinking of getting pregnant, do not drink. If you are pregnant, do not drink". It is a clear message, so why are the Government not giving it?
We live in a culture in which the drinks companies are allowed to target their marketing to young and impressionable women. It is cool to knock back Tequila slammers, Bacardi Breezers and Smirnoff Ice. I talk to people in the industry. They respond with warm platitudes, but they do little. And how about this gem? I can hardly believe that it is true, but I read that 328 Tesco is recruiting pregnant women as wine tasters. Apparently, pregnant women have an enhanced sense of taste and smell and can detect subtle differences. How macabre is that?
I conclude with a plea to the alcohol industry. You are playing a very dangerous game and you will do well to re-read the history of the battle that was waged against the tobacco industry in both the United States and here. In the 1950s, the tobacco companies knew full well of the connection between tobacco and lung cancer, yet they kept the data under wraps. Today, the alcohol companies are in a similar position. They know the correlation between drinking in pregnant women and subsequent birth defects, yet they are keeping quiet. The tobacco companies were sued for many billions of pounds and they nearly went out of business. The alcohol companies could be on a parallel track. My advice to them is to address this problem and to recognise its dangers. They should work closely with government and the voluntary organisations so that this looming tragedy can be avoided.
§ 6.9 p.m.
§ Lord Brooke of Sutton Mandeville
My Lords, it is a privilege to follow the noble Lord, Lord Mitchell. My own speech will not remotely have the specialist quality of his. I thank him for having raised a subject of which I had some inkling, although I had no conception of it in terms of the degree of detail which he used. Those remarks are genuine. I join the noble Lord, Lord Mitchell, also in congratulating the noble Lord, Lord Avebury, on securing and initiating this debate and on the characteristically well informed and constructive way in which he spoke. As I remarked at the end of the previous debate, both debates today have been secured by Balliol men. As one who has the same college loyalty, I quote again, as I did in the earlier debate, the observation of Phillip Guedalla, a man similarly blessed or afflicted:Life is just one damned Balliol man after another".I dare say that all of us in your Lordships' House who have prepared for this debate have been as depressed by the sombre statistics that we have studied as we have been impressed by the comparative unanimity of the statistics, which saves one from the unproductive effort of comparing and rationalising the various hymn sheets. Ministers, too, such as Hazel Blears and Melanie Johnson, have quoted statistics that we can recognise.
As to the debate's substance as against statistics, the debate was stigmatised for me yesterday within the Palace, but outside the Chamber, as being implicitly the self-indulgence of puritans. Hogarth was quoted to me in the same context, the quoter perhaps forgetting that Hogarth's famous cartoons were to illustrate the virtues of beer and the evils of gin. Of course, it was in any case in Hogarth's lifetime that Mirabeau was the first man in the history of western thought to utter the word "civilisation". Indeed, in the past century proportionate British consumption of alcohol has fallen, although in the past half century, due to the growing enthusiasm for wine, it reversed its decline and rose again.
329 The particularly worrying statistics relate to the behaviour of under 16 year-olds. The proportion drinking has remained fairly constant, but the consumption of those who drink has doubled in a decade, and a third of those under 15 admit to having experienced being drunk by the time they were 13. Only one in 10 French or Italian children says the same. We share with Denmark and Ireland having the heaviest teenager drinkers in Europe, and there is an interesting illustration of our behaviour on the Continent currently available on the London Underground. Our preferred continental destination among stag night cities has moved from Amsterdam to Prague and Tallinn. The illustrations in the lastminute.com advertisements beside the escalators for trips to Prague and Tallinn show that in neither case is the architectural charm of the cities the big draw. The good citizens of Budapest—Anglophiles since the 19th century—had better be warned that they are next in line.
Against that background, I hope that the Government will pay attention to Turning Point's recommendation that young people as well as voluntary sector and community representatives should be involved in planning policy, environmental design, public transport and initiatives on safe places in which to congregate. That would take planning and licensing laws beyond being simply the responsibility of the police and the local authorities. Westminster has always had good community and police liaison, and a good project was developed in the West End during the previous Parliament under the chairmanship of my former Westminster parliamentary colleague, Sir John Wheeler, which could serve as a paradigm.
From my similar previous inner-city constituency responsibility, when I had been the MP for the City of London for a month, a surgical team at Bart's invited me to shadow it for 24 hours to see how its day was spent. I remember being warned late in the evening that I would be roused from my bed in the hospital if emergency surgery had to be carried out on casualties that Friday night from within or without Islington pubs. Of course, Thursdays, Fridays and Saturdays in inner cities provide A&E departments with their heaviest nights.
In a BBC News online broadcast on 18 October 2003, Dr Paul Ransom, the A&E consultant for Brighton and Sussex NHS Trust, said:On Thursday, Friday, Saturday nights we could get by with a quarter of the staff on the evening shifts if it wasn't for alcohol".Seventy per cent of relevant respondents to an opinion poll thought that the number of patients they were treating, whose illness or injuries were the result of alcohol misuse, had increased during the past five years.
The total cost of alcohol-related crime, assaults and disorder in England and Wales is estimated to be up to £7.3 billion. To that is added up to £4.7 billion as a consequence of the human and emotional impact suffered by victims of crime, including, of course, the cost of victim support services. If those combined 330 figures are accurate, they constitute 60 per cent of the £20 billion that Turning Point believes alcohol costs the country each year. That figure presumably includes many of the one in six of NHS staff who the Commission for Health Improvement found had been subject to violence at work. The British crime survey of 2001–02 stated that 47 per cent of all those assailed that year believed that their assaults had been alcohol-influenced.
As to behaviour that may not necessarily lead to violence, as the noble Lord, Lord Avebury, said, 6.4 million people have levels of drink consumption over the recommended guidelines. To be fair—or, on the other hand, unfair—to them, almost 50 per cent of the nation do not even know what the guidelines are. Perhaps I may ask the Minister a specific question. Turning Point's Waiting for Change report states that the Department of Health spends 18 times more on funding research into drug treatment, compared with research into alcohol harm reduction. It would be interesting to hear the department's rationale for quite so large a discrepancy.
However, to revert to the Government's strategy, I am interested in why the DCMS does not join with the Home Office and the Department of Health in the shared responsibility across government to make the strategy happen. I acknowledge that the DCMS did not submit the Licensing Bill to pre-legislative scrutiny—that was not the case with its Communications Bill and the draft Gambling Bill. The consequences showed up in your Lordships' House, which received that Bill first. Of the 88 defeats that the Government received in your Lordships' House in the previous Session, one in eight was on the Licensing Bill—the second largest number of any of the 18 measures that suffered defeat at one time or another.
As the Bill went through after a four-year gestation period, it became apparent that many of the premises—I do not mean licensed premises—were faulty. For example, the Government argued that spreading closing times would reduce disorder. By contrast, police in Westminster testified that most crime within the borough occurred at 3 a.m. The Government praised Manchester as a model for its code of practice. By contrast, the City of Manchester said that excessive drinking in the city centre was, inter alia, putting off students from pursuing Manchester as a university destination. The Commons Minister in charge of the Bill then visited Manchester and found that there was a 125 per cent saturation of licensed premises in the city centre, leading to cut-throat, competitive happy hours to attract custom. It says a good deal for putative Mancunian students that the prospect of discounted alcohol might put them off going.
Most of all, however, the Government argued throughout the Bill that alcohol-induced anti-social behaviour outside licensed premises fell outside the scope of the Bill and would be resolved by other means. It says volumes for that attitude that yesterday ACPO's spokesman, referred to by the noble Lord, Lord Avebury, should have spoken as he did on the 331 radio about the relative incapacity of the police to control such behaviour, and that such attention that they can give is at the price of other policing.
I remark in passing that the strategy is silent on how the police and local authorities will take action against retailers and licensed premises that do not operate in a responsible manner. I also personally regret that the Bill wiped clean the slate of all the undertakings as to their conduct, which local communities had painstakingly secured from landlords in magistrates' courts down the decades.
In conclusion, I fear that I have not found the source of an alleged comment by the Home Office in mid-March this year, though it may have been a quotation of the noble Lord, Lord Avebury, that the new drinking laws would create a crime explosion in cities and town centres; whereas the following week, which I infer was the week in which the strategy was published, the Secretary of State for the DCMS, the right honourable Tessa Jowell, said that the new laws would prevent crime. That is at odds with the Government's exclusion of consideration of antisocial behaviour during the passage of the Licensing Bill, and it seems to me that the link between the licensing laws and the strategy stands in need of strengthening rather than the opposite.
§ 6.20 p.m.
§ Lord Bradshaw
My Lords, I start by declaring my interests as a member of the Thames Valley Police Authority and as a councillor on Oxfordshire County Council. I am also a member of two crime and disorder partnerships. I join other noble Lords in thanking my noble friend Lord Avebury for introducing this subject for debate.
Dealing with the anti-social behaviour that results from drunkenness is one of the greatest burdens on police resources. Urinating in the streets, throwing missiles— often bottles and glasses—the use of obscene language and causing minor public disorder or damage may seem relatively insignificant, but if left unchallenged these acts lead to a fear of crime, an acceleration in public disorder and a decline in the mixed city economy that we all aim for. The high-visibility police presence required to deter such behaviour is very resource intensive.
The arrest of drunken offenders incurs significant personal risk to police officers. Furthermore, such offenders are vulnerable while in custody. Drunkenness is a common feature of death in custody, which in turn leads to huge inquiries that eat into police time. Drunken prisoners take longer to process, require many more visits from prison doctors—who are always in short supply—need more cell checks and remain in custody longer while they sober up. There are also obvious impacts on cell hygiene, which gives rise to extra costs. Officers are diverted from other law-enforcement duties to deal with alcohol abuse, which obviously has other adverse effects on crime.
The problem we confront is serious and all the available evidence suggests that it is getting worse. Noble Lords have heard enough about that evidence 332 from other speakers in the debate. The new licensing law, for which we still await the guidance notes. has been described as a "leap in the dark" in seeking to tackle the situation. I submit that this has been pushed by the drinks and entertainment industries. They are obsessed with profits, engage in irresponsible sales promotions and ignore the social consequences of alcohol abuse. In my view, the Government are too concerned about being considered "anti business" to take the firm action needed here. They rely heavily on voluntary codes of good practice and a voluntary fund aimed at national level projects to promote social responsibility.
While no doubt it is difficult to judge the effects of the new Licensing Act before it comes into force, research suggests that there will be an increase rather than a decrease in anti-social behaviour. Studies undertaken in recent years in Ireland, Scotland, Holland, Germany and New Zealand where permitted hours have been deregulated all show that this has led to increased disorder by extending binge drinking late into the night which, in turn, increases and extends the need for all sorts of other services, including the police. That puts an extra strain on their resources. Moreover, as a councillor, I can bear witness to the costs incurred by local councils in clearing up the mess resulting from a night of binge drinking.
The British Crime Survey shows that many non-domestic alcohol-related assaults take place in the context of the night-time economy, half of them around clubs and pubs, and 70 per cent at weekends. Most other incidents occur in surrounding public places and on public transport. Half of the incidents involve injury, and in one-fifth of them the aggressor is armed with a glass or a bottle. Under 40 per cent of incidents come to the notice of the police because they are dealt with by that dubious army of quasi-legal individuals called "bouncers", who operate somewhere on the far fringes of the law. Some 50 to 80 per cent of violent crime is committed by an intoxicated person and, as we have heard, much domestic violence is alcohol-related.
I am very glad to see that a health Minister is to reply to the debate because he can take a slightly more dispassionate view of the situation than perhaps was the case while the Licensing Bill was being considered. The licensing law regime should be very tough with the immediate and, if necessary, permanent closure of premises and banning of staff if violence or open drug taking has occurred. I am not interested in closing premises for 24 hours; I really do mean that such premises should be permanently barred.
There should be an immediate start for the treatment and education programmes referred to by my noble friend Lord Avebury and the noble Lord, Lord Mitchell. These should be funded by a levy on the drinks and entertainment industries and should cover both the local and the national level, otherwise initiatives like arrest referral schemes and drug and alcohol action teams will not work. At present they are pitifully funded. I have just read the minutes of a meeting of an Oxfordshire drug and alcohol action team. The word "alcohol" was not mentioned in those 333 minutes because the team is struggling just to deal with the drug problem. That is why, as I have said, I am particularly glad to see that the noble Lord, Lord Warner, is to reply to the debate.
We must ask whether the advertising and promotion of drinks should be outlawed, as is the case for tobacco. I know that drinking is a social pleasure, but it is no excuse for violence, drunken driving or wife beating. Lastly, the offences of serving people who are under age or are already under the influence should not be treated as trivial misdemeanours, but taken seriously and be the cause of the loss of the licence. I say that because there is no doubt that drinking is being taken up at an ever younger age. Those charged with enforcing the law, local authority trading standards departments, are pitifully underfunded, and the number of checks being carried out is very low.
I hope that I have been constructive, but the problem we face is extremely serious and dangerous.
§ 6.27 p.m.
§ The Lord Bishop of Manchester
My Lords, I, too, congratulate the noble Lord, Lord Avebury, on introducing this debate and concur with his wish for an informed strategic rather than piecemeal approach to dealing with alcohol abuse. The noble Lord, Lord Brooke, mentioned the long history of the problem. I shall not embarrass noble Lords by bursting into song, but mawkish old ballads such as "Father, dear father", with their melodramatic stories of social disaster because of drink, remain uncomfortably pertinent to this debate, and the need to reduce alcohol consumption.
I am grateful to the noble Lord, Lord Brooke, for mentioning Manchester. It has the largest number of undergraduates of any city in this country and, while I acknowledge his points about the fears of potential applicants, I am glad to report that applications to Manchester's universities remain very strong indeed.
The noble Lord, Lord Avebury, referred to the number of A&E admissions. The latest figures in Manchester show that two-thirds of all people presenting themselves at the North Manchester Hospital A&E department on Thursday, Friday or Saturday nights are there because of an alcohol-related injury. Some 80 per cent of those attending each night at the Royal Infirmary are there for alcohol-related reasons. Moreover, I am told by our ambulance service that over half of their call-outs in the evenings and at weekends are to incidents where alcohol is a factor. I have also been told of increased violence being meted out to crews and paramedics.
We have just held a summit meeting in Manchester of the police, politicians, academics and the people who work with those whose lives have been damaged by alcohol to assess the level of burdens placed on our local services in the face of the problems indicated. A survey has shown that one in four men in the northwest admit to binge drinking at least once a week. That our local burdens arising from alcohol abuse are not worse is thanks in part to the Greater Manchester 334 police City Centre Safe scheme, which has been rightly praised in the Government's Alcohol Harm Reduction Strategy. We are also grateful for the co-ordinated approach to policing and protecting people who seek a good night out. That has been initiated by our police and it has been helpful to hear the points made by the noble Lord, Lord Bradshaw, on policing.
The Manchester experience shows that A&E departments can be relieved of burdens related to alcohol when efforts are made by local authorities and emergency services to co-ordinate transport home, to remove sources of conflict and vulnerability, to promote education in healthy drinking and to encourage licensees to behave more responsibly. As a result of those co-ordinated measures in Manchester, we have seen a fall of 12 per cent in reported violent incidents related to alcohol.
However, the reason why such measures had to be taken in the first place was the rapid growth in the city centre of the number of pubs and clubs which have greatly increased Manchester's alcohol-related problems. I cannot see how the Government can praise City Centre Safe on the one hand, and a moment later argue that the growth and development of licensed premises will have no effect on public order, not to mention the destructive effect on health, which has rightly and alarmingly been described by the noble Lord, Lord Mitchell.
In the last year for which we have regional figures, mental and behavioural disorders due to alcohol accounted for nearly 9,000 hospital admissions in the north-west. As your Lordships will know that affects more than just the person being treated. Rather alarmingly, case audits in Greater Manchester reveal that 30 per cent of all child protection cases on the at-risk register are alcohol related. In other words, as noble Lords have eloquently demonstrated, this is a multi-faceted problem that has a complex network of tragic effects.
Evidence from Greater Manchester shows that much can be achieved when agencies think strategically and are enabled to work together. The Government's Alcohol Harm Reduction Strategy recognises that. But behind those words we need more resources and much clearer warnings from the Government about the all too often disastrous consequences of alcohol. Nationally the voluntary or charity sector provides about 70 per cent of services available to help those suffering from alcohol abuse or misuse.
Through the years those excellent initiatives have grown piecemeal and they are often unevenly located. In Manchester city we have, for example, the Guinness Trust, Turning Point, which has already been mentioned in a national context, community alcohol teams, the NHS alcohol arrest referral scheme, Alcohol and Drug Services, of which I am patron, which has its abstinence based Twelve Step day care service with after care support, the Booth Centre at the cathedral and so on. There are also educational programmes helping both secondary school pupils and those of any age misusing drugs at teachable moments, as the noble Lord, Lord Avebury, described.
335 All that is impressive, but the trouble is that nearby in a neighbouring district, under a different local authority, there is far less. There are no local in-patient detox beds, no services for alcohol screening and assessment, no day-care provision and so on. The truth is that people in that local authority area do not receive the same level of help. That is a savage paradox. It means that such people end up as a burden on hospitals and other services, not least because their mental or physical conditions have deteriorated because help was not available in the first place.
The message is clear. We need to spend money to save money. That is how we treat other drug addictions. Over £1 billion of public money is invested in other drug services each year. Yet the agency, Alcohol Concern, estimates that only £95 million is spent on alcohol services, primarily from the budgets of primary care trusts and social services. I am sure that the Minister will correct me if I am wrong, but I gather that only £7 million is spent directly by central government.
None of the burdens addressed tonight will be eased without the support of the licensing industry. To counter binge drinking, Greater Manchester Police have initiated the Best Bar None scheme where licensees are inspected to ensure that they have proper standards of customer care and our alcohol strategy commissioning group is building links between those who treat people with drink problems and the alcohol industry. I hear the reservations made by the noble Lord, Lord Avebury, about that kind of seemingly cosy arrangement, but we have seen it have a positive effect.
Our public services across the country bear a great burden of care for people who misuse alcohol and those whose lives they touch. By working together and with agencies in the voluntary sector, they are able to achieve much, but they need a coherent strategy. The Alcohol Harm Reduction Strategy recognises the desirability of that. However, strategic thinking requires strategic budgeting. So the verdict is so far so good, but let us go further—much further—and try to remove the evils of over-drinking that have blighted the lives of far too many for far too long.
§ 6.36 p.m.
§ Lord Rea
My Lords, the noble Lord, Lord Avebury, has done us all, and particularly the Government, a very good turn by initiating this debate and for outlining the problem so clearly. The recent publication of the Government, to which many noble Lords have referred, the Alcohol Harm Reduction Strategy, shows the Government's concern.
As well as outlining the extent of the problem, the document makes a series of proposals for action—the right reverend Prelate described some of them—which, if carried out, may well ameliorate the situation, but nowhere in the strategy did I find mention of a serious attempt to curb the ever-increasing supply, availability and consumption of alcohol. Consumption in the UK has risen from an equivalent of 5.5 litres of pure alcohol her head per 336 annum in 1960 to 11 litres in 2002, a doubling of the figures. Over the same period, while the price of alcoholic drinks, including tax, has of course risen, it has fallen by some 60 per cent in relation to average earnings. At no time in the past century, or perhaps ever, has alcohol been so cheap in this country relative to average salaries or pay.
To attempt to control such a popular addictive habit, when its source material is so easily available, is a Canute-like exercise. It is the equivalent of treating patients with typhoid or cholera while paying no attention to the contaminated water supply. As well as a falling relative cost, consumption is encouraged by subtle advertising, suggesting to young people that drinking certain new products is cool. A Smirnoff Ice Black, mentioned by my noble friend Lord Mitchell, sounds very wicked and rather exciting; to drink it surely is a sign of maturity and success. The advertising suggests that one will be a success particularly in sex, whereas experience points in the other direction.
Studies by Saffer and Dave, and others, cited by the Calling Time report from the Academy of Medical Sciences, mentioned by the noble Lord, says that,alcohol advertising affects attitudes and behaviour, especially in the young … Among young people, more exposure co alcohol advertising: increases positive beliefs about alcohol and drinking; reduces perception of risk; shapes perception and encourages pro-drinking attitudes; shapes perceptions about acceptable levels of alcohol intake (upwards); [and] increases consumption".There is an almost perfect correlation between expenditure on alcohol advertising and weekly alcohol consumption by 11 to 15 year-olds. Contrary to the Strategy Unit document, there is evidence that banning advertising can be effective. There is also evidence that hard-hitting counter-advertising works for both alcohol and smoking; but where promotion of alcoholic drinks is widespread the impact of the counter-advertising is swamped. I am aware that there are already restrictions on advertising but, by keeping your eyes open, it is not difficult to see that these are not very effective and are widely breached.
It is interesting to draw a parallel with our other two major public health problems—tobacco smoking and obesity—where industry is promoting the consumption of products harmful to health. In both cases, as with alcohol, industry is able to mobilise far greater resources promoting its products than the Government are in discouraging their consumption. Noble Lords will all remember the powerful rearguard action of the tobacco industry long after the link with lung cancer and heart disease was firmly established. As has already been pointed out, the ban on advertising tobacco products was achieved only after a long struggle and after it was shown that voluntary restrictions did not work. Control of smoking in workplaces has still no legal backing, although the issue is being kept alive in your Lordships' House by the Bills of my noble friend Lord Faulkner and the noble Baroness, Lady Finlay.
In regard to the food industry's promotion of "obesogenic"—I like that word—foods to children, the issue is still at the stage of allowing the industry time to put in place a self-regulatory code of practice, 337 with the implication that if this is not effective regulation will be imposed. This is the policy proposed by the strategy paper, where it states:If industry actions are not beginning to make an impact in reducing harms"—by early in the next Parliament—Government will assess the case for additional steps, including possibly legislation".I remain sceptical that the voluntary route will be any more effective than it was with the tobacco industry but I appreciate that, in the words of Tessa Jowell regarding food advertising, the Government,doesn't want to pick a fight with the industry".This is, of course, a theme that has underpinned much of government policy since 1997—let alone the previous government where it was only to be expected. But many of us—not only on these Benches and in the health professions—feel that the Government would have huge popular support if they took a much tougher line with industry when an important public health issue is at stake, as it is here.
To return to the relative reduction in the cost of alcohol over the past 40 years, would not the most obvious step be to start rectifying this by increasing excise duty? Some may argue that with duty on alcohol so low in many countries in the European Union, legal personal importation—with or without additional smuggling—would undermine this. They have an important point.
However, the extremely generous traveller's allowance for carrying alcohol across borders could be reviewed. At present, taking the standard recommended UK limits of 21 units weekly for a male and 14 for a female, permitted importation on a single journey—perhaps with a white van—would amount to two years' supply for a man and three for a woman. Altering this allowance might have to be agreed via the EU, which would delay matters endlessly, but there is a clause, I think in the Treaty of Maastricht, which allows unilateral action by a member state where an important public health issue is involved.
There is little doubt that increases in cost are the single most effective way of reducing consumption. My noble friend Lord Warner may correct me, but I could not find a single reference in the Strategy Unit document to the effect of price or excise duty on consumption. Why is this not being considered when it was explicitly used by the Chancellor of the Exchequer in the campaign to reduce smoking?
Finally, there is one other issue which is relevant to today's discussion—it has been discussed in much more detail by my noble friend Lord Mitchell—and that is the effect on the foetus of maternal drinking. The foetal alcohol syndrome is now a recognised clinical entity but accurate statistics of its incidence are not available, partly because it is difficult to diagnose. The Department of Health states that there were 95 "finished consultant episodes"—which are not equivalent to cases—in 2000, 90 in 2001 and 128 in 2002, but it can give no further information such as that given to us by my noble friend Lord Mitchell.
338 It is not certain whether the incidence in the UK is higher or lower than in other countries. The World Health Organisation gives the rate as 0.33 to 9 per 1,000 births in various countries. The figures given by my noble friend Lord Mitchell are twice the highest of those figures. I wonder whether my noble friend can account for this discrepancy.
Finally, I agree very much with my noble friend that because alcohol is most damaging to the foetus in the early stages of pregnancy—often before the woman is even aware that she is pregnant—this should be made a very explicit and powerful point in any anti-drinking health education.
§ 6.47 p.m.
§ Lord Mancroft
My Lords, the whole House is grateful to the noble Lord, Lord Avebury, for giving us the opportunity to debate this important subject today. It is important because alcohol misuse is a very serious health problem with significant social costs because there is an increasing level of alcohol-related crime and public disorder and it is an enormous and increasing burden on the public purse.
In wording the Motion we are debating today, the noble Lord drew attention to the burdens faced by local authorities, emergency services and A&E departments. I suggest that it does not much matter where the burden actually falls: either way it is too great and the taxpayer is footing the bill. Many noble Lords have spoken about the extent of the problem; I should like to talk about possible solutions and focus on those in the Government's strategy paper.
My two opening comments are general. First, it is not a strategy paper; it is entirely tactical. Perhaps one of the reasons the Government make such a meal of things is that they have not learnt the difference between strategy and tactics. The paper is a collection of individual ideas. I think the right reverend Prelate described it as "piecemeal". I do not think he meant that critically, but he is right. Some of the ideas are good, some not so good, but the paper contains no overall strategy except to try to reduce the harm caused by alcohol. It does not really need a strategy paper to conclude that that is a laudable aim.
Secondly, I wonder why it took two-and-a-half or perhaps even three years to produce. I know several people working in this field who could have written the paper in a week or two. Frankly, it is fairly basic stuff. That does not make it bad, but it is fairly basic.
My next comments are indeed criticisms. The paper refers to two categories of problem drinkers—binge drinkers and chronic drinkers. At one stage the paper also refers to the "chronic alcohol syndrome".
At this point I should declare an interest as chairman, for almost 10 years now, of the Drug and Alcohol Foundation, which is one of the leading providers of day care for drug addicts and alcoholics in the City of Westminster; and for 15 years I have been chairman of the Addiction Recovery Foundation, which is now the main provider of information to professionals working in this field.
339 Last week we hosted at Church House the inaugural UK/European Symposium on Addictive Disorders. Some of the leading providers of care for addicts and alcoholics in the world came to our conference and. although I asked every single one that I reasonably could, no one knew what a chronic drinker is and no one had heard of "chronic alcohol syndrome". It is called "alcoholism"; it is an illness. It is chronic, but it is also treatable.
Your Lordships may think that I am being pedantic but accurate definition of the issues is essential if any strategy is to work. Alcoholism is an identifiable, treatable illness. Alcohol misuse or abuse, whichever you want to call it, on the other hand, is not an illness and is therefore not responsive to treatment. All alcoholics misuse alcohol but not all alcohol misusers are alcoholics: to waste expensive and scarce healthcare resources on someone who cannot benefit is clearly absurd. The strategy's failure accurately to identify and differentiate between these two groups makes one of the four "key aims" of the strategy a great deal more difficult to deliver, therefore. That "key aim" is described as the,better identification and treatment of alcohol misuse".It is entirely correct that early identification and referral is vital for any successful treatment programme. The strategy's Chapter 5, headed "Identification and treatment", is very difficult to quarrel with. The real problem is that much of the treatment within the health service is of fairly indifferent quality; and that the NHS and local authority purchasers of care have appeared reluctant over the years to buy from the voluntary sector, where there is often a better quality of care at a lower price. My understanding is that the National Treatment Agency is to be given the responsibility for alcohol treatment. Although it has not yet happened, it is a very significant step forward. I congratulate the Government on that decision, which those of us in the drug and alcohol treatment world have been pressing for for many years—indeed, since long before the NTA was born or thought of.
However, I hope that the Minister is aware of the National Treatment Agency's concern that this added responsibility will not be accompanied by an appropriate increase in resources. To increase the NTA's workload without increasing its budget—as the noble Lord, Lord Bradshaw, suggested—would threaten the progress it has made in drug treatment, while severely handicapping its ability to improve the treatment of alcoholism.
Of course I know that no government paper is ever going to be perfect, but sometimes I am left to wonder. The summary to Chapter 5 in the strategy, states:Government will improve the identification and referral of those with alcohol problems by: running pilot programmes to establish whether earlier identification and treatment of those with alcohol problems can improve health, lead to longer-term savings, and be embedded into mainstream health care provision".340 How can earlier identification and referral not improve things? I really hope that the Government are not going to waste time trying to prove what has already been proven on countless occasions. It is remarks like that that really do cause one to despair.
The second substantive point I wish to make concerns education and communication, which is covered in Chapter 4 of the strategy. These comments apply as much to drugs as they do to alcohol. I started my remarks about treatment with a criticism, and I shall do the same now, if only to get the negatives out of the way.
For some years the Government have insisted on their campaign to encourage "sensible drinking". That has to rate—I have to tell your Lordships—as one of the most irritating and pointless campaigns ever embarked upon. Alcoholics cannot drink sensibly, and binge drinkers, somewhat obviously, have already made the decision not to. The campaign is backed by "guidelines", which suggest the appropriate maximum units that men and women can safely consume daily or weekly. The problem is that no one knows, understands, or even cares what these units are. They are entirely artificial and were invented 15 years ago by the Portman Group, which is an industry group.
At my conference last week, I asked every professional counsellor I could find if he or she knew how many units they could safely drink, and whether he or she found the existence of this advice useful in his or her work. Without exception I was told that the whole exercise is a pointless waste of time and effort. So I ask the Minister to convey to his department the message that the alcohol treatment field would like to see an end to "sensible drinking" and advice about "units".
There is an assumption throughout that giving information—educating people, by which I mean children and young people—about the dangers, will deter them from risky behaviour, and thus reduce harm. At the bottom of page 27 the strategy says,provide alcohol education in schools that can change attitudes and behaviour".In case your Lordships have not noticed, I have just removed my treatment hat, and placed on my head my hat as chairman of Mentor UK, which is part of the International Mentor Foundation, the world's leading organisation in the field of substance misuse prevention. Mentor's extensive experience throughout the world means that I can say without fear of contradiction that there is no evidence whatever that providing drug and/or alcohol education has the slightest positive effect on behaviour. Indeed, there is a growing body of evidence to indicate that it may even lead to an increase in drug and alcohol use.
Prevention and education are two completely different things. We do not know how to prevent young people from misusing drugs and alcohol, but there is increasing evidence that there may be some initiatives we can take to help them to alter their behaviour. As yet the Government have failed to understand that, and, without a commitment from the Government anything we do is going to be too little. 341 My organisation is working with three government departments, and we are starting to get some interesting results.
Your Lordships may have seen the coverage in the Times on Monday, and today some interesting letters about a research project we are running in conjunction with the Department of Health and with the support of Defra into drug and alcohol use among young people in rural areas. If the Government are really serious about trying to prevent the problems that the noble Lord, Lord Avebury, has brought to our attention, this is the way to go about it. I hope that the Minister, when he comes to respond, will make a commitment to developing evidence-based prevention programmes, and have a careful look at the results of the existing education programmes, because I think he will find that they are fairly disappointing.
Assuming that treatment can and will be improved—a big assumption—and that we will cease to waste money on pointless education programmes, and focus on evidence-based prevention, we can make real progress. But it seems to me that in many ways the most difficult area is this subject is that of "binge drinkers". They are a uniquely British phenomenon. There is some evidence that there is some binge drinking in Australia and Denmark, and it is starting in France, but fundamentally it is a British problem. It is a relatively new problem and no one is clear therefore what the solution might be. Those among the binge drinkers who are alcoholic will, in theory, of course get picked up within the improved treatment process that the Government proposes. It is the others—the binge misusers—that present the real problem.
I suspect that part of the solution to the problem of binge drinking and public drunkenness—if I can call it that—lies, as has been suggested, with the alcohol industry itself. The advent of stronger lagers and those revolting, sweet and extremely strong fruit drinks makes the business of getting very drunk extremely easy. The relatively recent concentration of licensed premises in town and city centres only serves to encourage that. But there are solutions. The alcohol industry must accept its share of the responsibility to resolve these issues. That means paying more attention to being good citizens than to increasing profits, because if it does not in the long term I believe the industry's profits will suffer. It needs to realise that the implied threat behind the strategy paper is that if it does not use its considerable financial and structural muscle as an industry to help resolve the issue of public drunkenness and disorder, the Government will quite rightly take steps to do so; and I suspect that the industry will not like those steps.
That leaves me to conclude that the answer to the implied question of the noble lord, Lord Avebury, is that in the foreseeable future this is going to be a considerable drain on the public purse through a number of different agencies. Despite my criticisms I think this strategy paper is a first small step in the right 342 direction. But I do hope that the process of implementation will be a little quicker than the drafting of the original paper.
§ 6.57 p.m.
§ Baroness Masham of Ilton
My Lords, I thank the noble Lord, Lord Avebury, for instigating this debate on a subject which needs exposing; and data need collecting on alcohol abuse so that positive improvements can be made.
The noble Lord, Lord Avebury, and I serve on the All-Party Parliamentary Group on Alcohol Abuse, which is served by Alcohol Concern. This group helps to keep Members of Parliament and Peers up-to-date with changing trends and developments concerning alcohol abuse. The members of the group no doubt have many different reasons for attending. I, for one, have seen several people lose their lives far too early due to alcohol abuse or the combination of drugs and alcohol abuse, or drugs, alcohol and anti-depressants, which can become a lethal cocktail of abuse to the systems of vulnerable people.
The subjects the noble Lord has put down for discussion are admirable, but the hidden problems of alcohol abuse in the home and the desperate plight behind closed doors of the children of alcoholics must not be forgotten, including that of babies who may suffer violent attacks from parents who cannot control their anger due to alcohol. Many children have to try and keep homes running while their parents or mother is incapable due to alcohol.
The unpredictability of an alcoholic mother is a huge problem for school children who are unable to bring a friend from school home in case their mother is drunk and they feel embarrassed and let down. So often in these circumstances children have to cover up and pretend all is well, when they feel the desperate need of help and support.
Not long ago there were some television programmes showing the incredibly difficult job the police have in controlling drunk people after heavy drinking in some city centre areas. When heavy drinkers turn violent, they become a menace to society. With the extension of drinking hours and the problem of alcoholic behaviour in Britain, the message coming out of Parliament is a confused one for everyone.
Some time ago I visited prisoners being kept in Wandsworth police cells, as the prisons were full. One prisoner was being processed by a GP. The prisoner so obviously had a serious alcoholic problem, I said to the GP, "What is going to happen to him?". The answer was, "If only I had a drying-out alcoholic unit to send him to, that is what I would do". We have a huge public health problem on our hands due to alcohol abuse. The long-awaited Alcohol Harm Reduction Strategy for England has at last been published, but unlike the drug strategy—where funds were available—there is already concern that, without resources, progress in harm reduction for alcohol will wither on the vine.
It would be totally wrong if the Government took much-needed money from the health service to fund the alcohol strategy. You only have to look at the 343 desperate need for more intensive paediatric cots for premature babies who have to be shunted round the country, or the vital need for the control of the dreaded MRSA and other hospital infections. The public and press are beginning to know about many of these needs.
Surely the vast drinks industry should help foot the bill of providing rehabilitation facilities for these people who realise alcohol is ruining their lives and that they need help to come off and stay off. I hope the Minister will agree that alcohol abuse and treatment of people with an alcoholic problem needs the combination of primary care trusts and local authorities working together along with voluntary groups. This is where there should be a framework for evaluation, joined-up government and local needs assessment. Alcohol problems cover health, education, social services, probation, police, the Home Office, housing and employment. The people who have had a problem and who attend Alcoholics Anonymous groups seems to find this a useful way of supporting each other when overcoming their addiction.
The concerted effort of many organisations, both government and voluntary, seems to be paying off over smoking, but there is still a long way to go. It seems there should be a concerted effort to tell the public of the dangers of over-indulgence in alcohol. In the long term, the aim should be to change people's behaviour and habits before it is too late. As with smoking, the pictures of damaged lungs can be effective. I think damaged livers from excess drinking of alcohol as well as information might change a few habits.
So many young people who drink way beyond the safe limit just do not think it will happen to them. Last Sunday, knowing of this debate, I called in at the accident and emergency department of my local hospital in North Yorkshire. I was pleased to meet some of the staff who told me three of their nurses were attending training on alcohol abuse and were on a course. What they found most useful was learning how to handle people who had become abusive and difficult. I was told when there is trouble in the A&E department, the police were marvellous and arrived on the scene in minutes.
This is an example of a hospital in a small town which has problems, but these can be controlled as numbers are not too great. The story is quite different in a large, inner-city Yorkshire hospital, where sometimes gangs have had fights and have been known to continue the fight in the A&E department after having delivered a stabbed member of the team.
It is important that ambulance service personnel all have adequate training in dealing with people who become abusive through alcohol. Vomit and urine are easy to cope with; it is the violence which needs careful handling to avoid injury to staff.
I visited an interesting project in Sheffield, run by the charity Turning Point. The project is run from the centre called SHED. Young students from a school with lots of problems are trained to be peer counselors 344 and try to change the attitude of children with alcohol problems within the school. I feel there are some young people doing remarkably good things to try and help other young people understand the dangers of alcohol abuse.
I also visited a school in Huddersfield where school members had a remarkable acting group which showed younger children the dangers of drinking though role-play. It is good that this sort of realistic education is being promoted.
Last week I was talking to a lady who has a flat where people, who are subsidised to live in the building, have alcohol problems. She told me what a nuisance they were and asked what she should do. She said she too had plenty of problems, but she was working her guts out in the local hospital. When she came home she could not get any sleep due to the loud music and disturbance from the alcohol users. Surely the local authority should control their social problem people.
The problems of binge drinkers on the streets are frightening normal people—old people and disabled people are frightened to go out. Time has run out, so I will stop. However, there is a huge amount to do, and I hope the Government will help those people in the community who are trying so hard in this regard.
§ 7.6 p.m.
§ Lord Chan
My Lords, I also thank the noble Lord, Lord Avebury, for giving us this opportunity to discuss this growing public health problem of alcohol abuse and its disruptive effects in community life. As a non-executive director of a primary care trust in Wirral, this debate is particularly relevant.
Wirral has the highest percentage of people who drink alcohol every day in Merseyside, and there is only one acute hospital on the Wirral. All our NHS trusts operate on a budget that has a combined debt—in this year just closed—of almost £10 million, and 40 per cent of that debt belongs to the hospital.
Primary care trusts are now being asked to participate in the treatment of drug addicts including those who have been sentenced to drug testing and treatment orders. Should we not include alcohol abusers in these programmes as well? That, of course, would require trained staff.
As has been mentioned by other noble Lords, the Prime Minister's Strategy Unit published a report on alcohol harm reduction, estimating that the annual cost of alcohol-related crime and public disorder has increased to £7.3 billion, and that is about 10 per cent of the current NHS budget. Therefore, it is certainly time for us to look at how we can reduce and address the problems of alcohol abuse.
The impact of alcohol abuse is found to be most disruptive in the accident and emergency departments of hospitals—and in our local hospital it is no different—at peak times, usually between midnight and five o'clock in the morning on Fridays, Saturdays and Sundays. At those times nearly seven in 10 cases are due to alcohol. On an annual basis, in England some 23,000 hospital admissions are alcohol-related.
345 People who are drunk and have injured themselves through fights and falls cause fear and alarm in A&E departments by being noisy and threatening. These patients are also responsible for verbal abuse and violent behaviour towards hospital staff. Most of all, they are examples of unnecessary injury among young men and women. Hospital employees are also put under stress when having to cope with antisocial behaviour due to alcohol. Some 35 per cent of all patients who attend A&E departments are there due to alcohol, and they cost the NHS £500 million every year, according to Alcohol Concern, and that will increase.
For a problem that contributes to high expenditure in the NHS, alcohol abuse has not been the subject of a public campaign. No dedicated budget exists for public education and awareness campaigns about the dangers of excessive alcohol consumption. A MORI poll last year found that only 7 per cent of men and 22 per cent of women knew what the Government's recommended level of alcohol consumption was for them.
According to the British Crime Survey, half the victims of violent crime, which causes disruption in community life, report that the perpetrator was under the influence of alcohol at the time. Violent crime included domestic violence—an issue that is very important, particularly in view of the domestic violence legislation going through Parliament—and sexual assault. More than half of alcohol-related violence occurs in and around pubs, discos and night clubs, mostly at the weekend. Despite increasing public concern, little has been done until the publication of the report, and it does not go far enough, as noble Lords have stated.
Alcohol misuse causes harm to health, public order, productivity with the loss of 17 million working days, and families, with about a million children affected by their parents' alcohol problem, according to the report. What is required is a campaign to educate the public about the dangers of alcohol abuse. The publication is a start and, in spite of its deficiencies, is to be welcomed. However, what we look for and need are sustained programmes to improve the situation at local level.
The advertising of alcohol on television and in other media should be regulated along the lines of tobacco. I am particularly concerned about alcohol abuse affecting young people from all social, cultural and ethnic backgrounds, including those groups not traditionally associated with alcohol misuse. Children in those groups born and bred here have taken to the regular use of alcohol. Even overseas students—I have information from students from China—have taken up alcohol misuse. Some have been arrested for drink driving, according to the police. At least one car-load of Chinese students has been killed on the roads with, when tested, the driver having high levels of alcohol in his blood.
I support the concerns of the noble Lords, Lord Mitchell and Lord Rea, about foetal alcohol syndrome, although the diagnosis of affected babies is 346 not easy to make. However, we desperately need to increase the awareness of the dangers of alcohol consumption during pregnancy and among young people through all media.
§ 7.14 p.m.
§ Lord Brooke of Alverthorpe
My Lords, I, too, congratulate the noble Lord, Lord Avebury, on being successful in the ballot. I thank him for his excellent and most comprehensive introduction to the debate, and thank other noble Lords who have contributed to it. In particular, I congratulate the noble Lord, Lord Mancroft, on the organisation of the inaugural UK-European symposium on addictive disorders. I know, not only from my experience but from what others have told me, that it was extraordinarily successful, with more than 400 people participating in the three-day event the week before last. I also thank Deidre Boyd, the principal organiser, for all the work that she and her colleagues did.
I am urged to move on quickly as we are running out of time, so I shall not go over some of the ground that I had intended except to say that, when the issue came up at Question Time a couple of months ago, the noble Baroness, Lady Scotland, was at the Dispatch Box. I said that I felt that, since the Government came to power, we had seen a worsening of the climate of alcohol abuse in the country generally. I also said that I was somewhat disappointed with the nature of the report produced, and expressed very strongly a belief—one that I still hold—that the voluntary approach with the drinks industry would not produce the results needed to reverse the difficulties that we are in. Having listened to my fellow Peers this evening, I do not think that anyone spoke with any great confidence about the voluntary approach producing those results.
I will jump some of the points that I wished to make in statistical terms, and underline two or three points made by other speakers. I shall put them in the form of questions to my noble friend. Given that I am saving him time, I hope that he will endeavour to answer some of them.
Can we expect to see funding allocated to the strategy, whether there be a tactical approach or a strategic document, and at least to the important recommendations made? Will we see a similar allocation of public funds from the Government to the money that they have allocated to the drugs strategy? I again commend the Government for their work and money allocated on drugs. We now need them urgently to address alcohol, too. When will an announcement be made?
Can we expect similar expenditure to that in the anti-drugs strategy on advertising and education? There may be question marks about the effectiveness otherwise, but it is at least important that the Government be asked to address the issue, and we could see whether it would be successful in practice.
I am concerned, too, about some advertising that we currently see on television, which is extraordinarily laddish and loutish in many respects. Noble Lords 347 with long memories will recall that we had a whole bout of that in the 1970s and 1980s, with the drunken bear strolling around on our television screens. That was shortly followed by the soccer tragedy at the Heysel football stadium in Belgium. In the light of that and the complaints made, ITV then withdrew those adverts. I rather sense that we are going through a bout that is not dissimilar. If there is the kind of episode that we witnessed previously, I fear that people will then wish that they had never run such adverts at all. I would like to hear how the Government feel about what is run before us in some of those TV adverts.
I shall turn to the precise nature of the debate. When can we expect better security for staff employed in A&E units? We get constant complaints, understandably so, from those attacked on ever-increasing occasions. Why cannot we ask the licensees within a hospital's catchment area to make a contribution towards the cost of supporting and paying for the personnel needed to assist and support staff when they are faced with such assaults? Would the Minister be prepared to take that back to his department and consider it?
When will the drinks industry be required to display on drinks labels, in an understandable form, the strength of the drinks within the bottles? I am not getting into the units issue, but people need to be given clear guidance on what they are drinking and what the consequences are likely to be for them. That is an area where we are sadly negligent by comparison with what happens in some other countries.
As your Lordships will have gathered, 1 am highly sceptical about the willingness of the drinks industry to accept some social responsibility for its actions. I know that many tenant managers are under extreme pressure to hit targets to deliver results in their pubs. I hear that their area managers do not much care how those results are delivered.
Hence the abundance of "happy hours" on a wide scale everywhere with cheap drinks. In many places, there is under-age drinking in pubs and clubs. If the Minister so wishes, I can take him to places as near as SW4 where this happens regularly and where no action is taken by the police authorities. There may be, as the noble Lord, Lord Brooke of Sutton Mandeville, explained, good reasons why the police are unable to do that, but on a wide scale substantial amounts of under-age drinking are taking place.
I believe that the Government need to review their approach on pricing policy on alcohol. As noble Lords have demonstrated, the country is much more affluent than it was 20 or 30 years ago, yet in relative terms the cost of alcohol has fallen. It therefore follows that there is more money around to be spent on it and that needs o be addressed by the Government. They must at some point be bold. We need to see some target increases in the cost of alcohol, particularly the drinks which are customised and designed for hooking the younger, under-age drinkers. That is the responsibility of the Treasury, not the Minister, but I trust that he will take it back to the Treasury.
348 In conclusion, I urge the Minister to produce draft legislation on the major issues in the strategy document and establish some form of pre-legislative scrutiny. Parliamentarians can then begin work on it, together with those in the industry who want to see changes of the nature noble Lords have been crying for today. That would force an entirely different response from the industry to the continual delay and pussyfooting which we will encounter with the so-called voluntary approach.
Headlines and paper threats such as those we saw in today's newspapers coming from the Home Secretary will not produce the changes. I believe that unless we start looking at the possibility of introducing legislation and then force the industry to produce a more positive response, matters will only get worse. If that is to be the case, delay will be troublesome for the whole country. It is urgent that we get moving quickly on this and do not have to wait as we have for the production of the strategy document.
§ 7.22 p.m.
§ Baroness Finlay of Llandaff
My Lords, I want to talk about Friday and Saturday nights and Sunday morning. First, I pay tribute to the noble Lord, Lord Avebury, for initiating this important debate. His excellent opening remarks set the scene, supplemented by so many excellent speeches. I thought that the speech of the noble Lord, Lord Mitchell, was particularly important in focusing on a problem insufficiently highlighted in the public domain.
The Minister is used to us all calling for more resources, but I would like him to consider two suggestions which are resource-neutral. The first is the one-minute Paddington alcohol test, which intervenes at a point where hazardous drinkers often encounter healthcare and where they can be moved to nonhazardous behaviours. The second is the establishment of a British Standards Kite Mark for glasses and bottles used in pubs and the move from glass to plastic bottles for drinks. I do not believe those moves would cost money and they would save resources.
Alcohol is a real problem. The pleasant charming girl becomes a weeping wreck in the corner, prone to self-harm when she has had too much to drink. The quiet personable young man becomes aggressive and ends up charged with assault after a fight and has facial injuries which leave him scarred for life.
On Friday and Saturday nights, 80 per cent of A&E attendances are alcohol-related and Professor Shepherd, a colleague of mine in Cardiff, found that they relate to licensing hours. Over 60 per cent of facial injuries are alcohol related. Young men are the most likely victims of assault.
In the Prime Minister's Strategy Unit research conducted through St George's Hospital, the pattern of injuries was remarkably consistent across the UK, particularly face, head, arm or hand injuries. The weapons used were usually fists, knives, hoots or bottles. Only 10 per cent were caused by coshes, glasses or guns.
349 Eighty-five per cent of assault victims have facial injuries. The face is the target and the approximate ratio is four boys to one girl. It used to be a ratio of six to one, but girls seem to be getting into the fights, too. People are brought into casualty by ambulance and about half of them are alcohol-related attendances. Of those brought by the police, almost all are alcohol related.
But we must not forget that some are brought in dead. They are brought in after road traffic accidents, after falling under trains or underground trains, or having been the victims of other accidents. The worst effects are associated with binge drinking, which is on the increase. Alcopops are a real problem because they give children the message that it is okay for kids to drink something with alcohol in it. They taste disgustingly sweet, but their underlying message is so damaging.
My daughter is lucky enough to work in A&E at St Mary's Hospital Paddington. She works with Professor Touquet, who she finds quite inspirational. She has learnt from him that one minute makes a difference. Since 1986, he has been working on the problem of alcohol abuse and the load it puts on acute services. He has discovered the "teachable moment"—the time when the person with an alcohol problem presents in casualty, when he is vulnerable because he is injured or has fallen over and feels ill. That is the point when he will move from pre-contemplation—"I don't have a problem"—to contemplation—"Perhaps I do have a problem"—and even into action—"I have got to do something about this problem". My daughter describes being able to move people in one minute from pre-contemplation to contemplation.
These people are much the worse for wear when they present, but the other interesting finding is that if they are given an appointment with an alcohol worker within 24 hours, 62 per cent of them will attend. But if there is a delay of 48 hours, 62 per cent of them do not attend—they default. It is about catching that "teachable moment" and intervening there and then.
The strategy action point says that this type of measure should be piloted. No, I would say to the Minister, "Just roll it out. Make it one of the targets. Use it for star status or whatever other status you want". One minute where these people encounter health services could make the difference of a lifetime to them. It has been shown that 25 per cent are moved from hazardous drinking to non-hazardous drinking. They need to encounter the question at the time they present with one of the top 10 conditions.
Unfortunately, nurses and doctors themselves have a sad history of alcohol abuse. Eighty-seven of the 210 doctors who the GMC had under medical supervision in 2003 have alcohol implicated in their need for professional rehabilitation to ensure that they practise to the standards required of doctors. But it seems sound that intervention and then letting people help themselves, such as Alcoholics Anonymous has done, are the key to stopping abuse.
350 The next issue I want to address is the injuries which follow. The compensation cost to taxpayers from compensation paid out for injuries on licensed premises alone is about £3 million per annum. This is the tip of the iceberg because it does not include compensation from those known to the criminal justice system, nor time off work, nor the health service costs, nor the cost in road-traffic accidents related to alcohol.
So Professor Shepherd's work, researching toughened glasses, is incredibly important. He has shown that toughened glasses have an impact resistance six times greater than non-toughened ones. They disintegrate into sugar-lump-type fragments, so even when you are hit in the face with one of them, the injury is not as bad as would be caused by shards of shattered glass. Even the thin glasses—the type in which Guinness is served—are more impact-resistant than ordinary tankards if toughened glass is used to make them. Bar workers are at particular risk of glass injury, especially to their hands.
There are a few actions that I seriously believe need to be taken. Some imported toughened glass is not toughened very well and it can prove to be more dangerous. Therefore, the solution is to develop a British standard to protect drinkers and bar staff and then to get the industry to follow the lead such as that taken by Stella Artois and other organisations, which are now using plastic rather than glass bottles. These are plastic bottles with three layers. The inside and outside are plastic and there is a film of nylon in between, which stops oxygen getting through and making the drink deteriorate. Therefore, the liquid tastes just as good as it would out of a can, if one likes that kind of drink.
There is another problem. Young adults migrate from outlying feeder towns into our main cities at peak times for the purpose of drinking. But the problem is that the police do not migrate with them, and the police know the youngsters who are at risk. Therefore, if A&E and the police were linked into crime reduction partnerships, the police could access accurate anonymised data on the amount of alcohol that is behind crime. If they came down with us from the Valleys into Cardiff or into other cities with these youngsters, they might spot the troublemakers. Therefore, the solution is to use crime reduction partnerships, and the next step may be that the clubs which encourage the binge drinkers can be named and shamed and the problem that is out on the streets reduced. I hope that the Minister will seriously consider the two points that I mentioned: the BSI standard for glass and the one-minute PAT test.
§ 7.31 p.m.
§ Lord Addington
My Lords, my noble friend Lord Avebury deserves a vote of thanks from the entire House for making us take note of the problems of alcohol misuse. I do not know whether my noble friend would agree that there are no problems with proper alcohol use.
351 When I started to consider this subject, I tried to think about just how deeply alcohol use goes into our society. I came to the conclusion that it is totally impregnated within our society. We have used it for thousands of years. The first story that I can think of that has a reference to alcohol is the original story of Noah. who apparently was a Sumerian who kept himself alive when washed out to sea in the Arabian Gulf by feeding himself and his family on the beer that he was intending to sell up-river.
The whole of modern society has used alcohol. If we go back far enough, we come to the time when beer was considered to be safer than water and alcohol was used to fight infections. It is deeply embedded within our society. The only western society that tried to ban alcohol—the United States—ended up causing major social problems by criminalising large sections of its society, which capitalised on organised crime.
Having said that, there is still, and always has been, the issue of what happens if people drink too much at the wrong time and what happens if the problem is not addressed. As my noble friend Lord Bradshaw said, the only thing that is different now is the intensity of the drinking. That is something that we must square up to. We have known about this matter for years. The problem of people drinking too much has always existed. The young have always been the ones to binge drink. We did not call it that when I was a student. When I was a young rugby player with medical students in the team, I saw binge drinking but we called it something else. However, it existed.
What tended to happen in the past, but which I do not think is happening now, was that there was more frequently a steadying hand on the shoulder. It has now become fashionable not to have a drink in order to relax and enjoy oneself but, more commonly, to get "out of it" and leave responsibility behind.
I read an article in the Times on Friday which talked about the design and development of drinks by the drinks industry. The writer of the article came to the conclusion that I myself have come to: following the fashion for taking ecstasy, clubbing, being completely removed from reality and getting totally "out of it", the very young have moved on to alcohol. We have seen an intensification of that trend. The use of alcohol represses one's inhibitions. It allows people to relax and talk more freely.
To use another historical example, the Spartans in ancient Greece were remarkable because they did not have to pour alcohol into their soldiers to persuade them to kill up close. Alcohol allows people to lose control and to do things that they would not otherwise do. Another instance that I want to give is not too far removed geographically from my previous example. In Bosnia, both sides of the "irregulars" committed atrocities while filling themselves with home-made vodka to help them to get on with the job. Alcohol is something that we can misuse and have frequently misused.
The Government's current policy effectively states, "Oh, there is a problem". It then calls for voluntary cooperation from the drinks industry. The noble Lord, 352 Lord Brooke, who spoke just ahead of me, pointed out the kind of advertising and laddish behaviour that we are now seeing. Let us hope that that is a fashion and not an ongoing trend. Ultimately, it will come back and bite very hard because it goes away from the idea of social relaxation to the idea that it is all right to behave in a totally unacceptable manner.
I turn to the document that has been referred to. I believe that the best summary of it was given by the noble Lord, Lord Mancroft. I shall summarise his summary by saying that it is a start. It is a slightly incoherent, panicky and nervous start, but it is a start. The Government must convince the drinks industry not only that it has a responsibility but that taking action will be directly in its own interests.
Drinks which help a person to remove himself totally from his surroundings—for example, alcopops, which, I agree with the noble Lord, Lord Mancroft, are absolutely disgusting—are very attractive to the young. Indeed, my 18 month-old daughter thinks that they are great when we go past them in a supermarket. They look lovely and come in pretty colours. and the hand goes out towards them. I have heard other small children say to their parents, "Can we have one of these?" because they do not realise that they are something that adults have. I have also read articles reporting that such drinks have had their heyday and that other designer drinks are coming in. Even if that group of drinks will no longer be such a factor, we must persuade the drinks industry to address the fact that it has a responsibility and also a long-term interest.
Ultimately, the Government have sticks as well as carrots available to them. The thing about a stick is that you must be prepared to pick it up and at least wave it around before anyone believes that you are going to do anything with it. Current government policy does not state that the Government will ultimately use sticks if they have to do so. Personally, I believe that we should be using sticks. We should address the fact that the drinks industry, with its constant development of new types of beer, spirits and so on and the marketing of spirits, has a great responsibility for the way that such drinks are used.
If the Government are not prepared to cajole the industry, they must be prepared to do something else. Surely drinks that are targeted towards the young or whose marketing catches the young should he taxed more heavily. I say that purely off my own bat; I have no party authority to say it. But my personal opinion is that that would be the logical conclusion to draw. We must start to address the problem head on.
It may be that the intensity of such drinking at present is a fashion and that it will go out of fashion. It will take time to disappear—all fashions do—but it can also come back. For a long time, the Government as a whole—I include the whole Whitehall and Westminster community—have been very tentative about their policy towards alcohol. They have moved too slowly and often without attacking the problem head on because alcohol is such an important part of our society and something in which we all partake. We 353 must step out of our nice little warm environment in which we say, "Why can't everyone be like me and not drink too much in public?" and, instead, say, "There is a problem here. We must address it and ensure that we have some kind of coherent strategy"
The noble Baroness, Lady Finlay, referred to shatterproof glasses, which I believe is a point which could he followed up by the Government. I remember that the All Party Beer Group—I put my hand up again—gave out shatterproof glasses three or four years ago saying that that was the way forward. I would suggest that Government guidance stating that they had to be used would not be inappropriate.
§ 7.40 p.m.
§ Lord McColl of Dulwich
My Lords, I, too, thank the noble Lord, Lord Avebury, for initiating the debate and for his brilliant speech. I rather like the advice in the New Testament to take a little wine for your stomach's sake, but my wife reminds me that it does say, "a little" wine.
That advice is being ignored by many thousands of people today who indulge in binge drinking. They seem to be completely oblivious to the great dangers and also the huge burden that alcohol puts on our emergency services. Drinks, even cocktails, are no longer alcoholic enough for the majority of the general public. That has led to them mixing their drinks to achieve a higher alcoholic content. For instance, a turbo shandy, which is now commonly drunk, comprises double vodka, a bottle of Smirnoff Ice and half a bottle of beer. That is being regularly consumed in universities.
Spirits are now very much stronger, with the creation of new concoctions, such as Absinthe, which is 70 per cent alcohol; Sambuca, 40 per cent; and Aftershock, 40 per cent. It is worth noting that one 500 millilitre bottle of Absinthe, which is roughly a pint, is equivalent to 28 standard drinks. Binge drinking seems to have swept the United Kingdom. British bars and clubs have aggravated the situation by promoting "buying in bulk". For example, several wine bars offer the drinks promotion, "Buy two glasses and get the rest of the bottle free".
The environment in which people now drink has changed dramatically. Modern premises are not like the old public houses that one used to go to with friends for a quiet drink. The rapid consumption of drinks tends to be encouraged within these new establishments with promotions such as shots of spirits served in open test tubes, which cannot stand upright on a table—neither can those who drink them—so the encouragement is to drink them straight down in one gulp. That type of shot is served by members of the bar staff who regularly circulate and approach the customers who are still seated, rather than waiting for them to approach the bar.
As those drinking games become increasingly popular, so they become more and more extreme. That is exemplified by a website called www.BarMeister.com, an online guide to drinking, 354 which lists 499 different drinking games. One of those is called "Centurion: 100 shots of beer in 100 minutes". Each person starts with a full shot glass and the timer is set at one minute. When the timer runs out, everyone takes their shot and the timer is reset. That is repeated 100 times. That equates to eight standard drinks in a little over one hour. Most people tend to be sick when they reach 60 shots but the game is continued. The next one is called "Nine Before Nine". The individual has to drink nine pints of beer before nine o'clock in the morning. In order to do that they start at 6 a.m. and drink a pint every 20 minutes.
Many drinking gimmicks have been devised by the younger population in order to make a night of binge drinking more successful. For instance, drinking fines are commonly used for lateness among friends. One university hockey club website states that if a member of the club is arriving late at a venue in the evening, a fine will be imposed. If you are one to 20 minutes late, a beverage has to be purchased and drunk continuously without pausing for breath until it is finished. If you are 10 to 30 minutes late the same procedure is followed yet with a double amount of the beverage to be consumed, and if you are more than half an hour late, three pints of beer must be consumed within 15 minutes.
Drinking games and drinking gimmicks become more extreme the more people get used to them resulting in very dangerous practices becoming just the norm. I refer, for instance, to "The Dentist's Chair". A volunteer is strapped into a dentist's chair and spirit is poured down his throat by someone called "the Dentist" until he can take no more and closes his mouth. The time is then recorded and displayed on a board.
Those university rituals play a large part in the life of students. At many universities, freshers' week is a week of binge drinking. That behaviour gets into the mindset of the fresher that binge drinking is an acceptable part of university life. Powerful peer pressure forces them into binge drinking. Ten per cent of students drink to dangerous levels. The average safe dose for an 11-stone man is 21 units in a week, but he can often consume all of that in a single evening.
Binge drinking is not only common among those who are legally entitled to drink but is being adopted by minors. As many noble Lords have already said, more than one in three 15 year-olds report being drunk at the age of 13 or earlier, which is very different from the situation in France and Italy. A report published in August by doctors working in an accident and emergency department found that children as young as six have needed hospital treatment after going on drinking binges.
Drinking large numbers of units over a relatively short period is likely to be far worse for the general health than consuming the same level of alcohol over a week. After all, alcohol is a poison. Its action is to depress the function of the brain, as the noble Lord, Lord Addington, emphasised. The apparent stimulation is due to suppression of inhibition and 355 repeated instances of binge drinking have been linked to strokes, kidney damage, memory loss and an increased risk of breast cancer in women.
Alcohol-related problems are responsible for 22,000 deaths each year and 150,000 people being admitted to hospital. Around 40 per cent of accident and emergency admissions are alcohol related and between midnight and 5 a.m. that figure rises to 70 per cent. The severe implications of alcohol to health are indisputable. Prolonged heavy drinking damages one's liver. In the short term that may be reversible but the damage can become permanent and life-threatening. Cirrhosis is the main cause of death in very heavy drinkers.
The main part of the brain to be affected is the frontal lobe which controls our social behaviour and suppresses our more primitive instincts. Judgment is also seriously impaired, which makes driving dangerous, even with small quantities of alcohol. Prolonged heavy drinking over many years can lead to significant brain damage and loss of intellectual ability. Heavy drinkers who substitute alcohol for healthy food are prone to nutritional deficiencies. Alcohol is also very high in calories. Four pints of beer can contain over 1,000 calories. As a result, weight gain becomes quite a common problem.
The burden which alcohol creates for our police force is vast. That has already been dealt with by many noble Lords. The burden on the fire service is also considerable, as has been mentioned several times. We could save an enormous amount every year if this problem were really tackled. It is not being tackled properly at all. Drinking to excess seems to have become socially acceptable among most age groups and genders. We must do something about it. The Family Spending Report of February 2004 states that British households spend on average £5.90 a week on spirits, wine, beer and alcopops for home consumption; and only £5.40 on fresh fruit and vegetables.
I am sure that the noble Lord, Lord Avebury, is right. We must seize the teachable moments to try to stop this appalling scourge. One good idea is to label all drinks with the number of units they contain.
§ 7.50 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)
My Lords, I congratulate the noble Lord, Lord Avebury, on securing this debate and on his telling analysis. We accept that alcohol misuse is a significant problem that needs to be addressed by our society. This has been reflected in the important contributions in today's debate. I am grateful to the noble Lord for giving me a copy of the excellent lecture on the social problems of alcohol that he gave in 1981. This illustrates that the problem has been around for some time and is not peculiar to this Government's term of office, and it shows, as this debate has shown, that the manifestations of the problem do change.
The Government have been taking action to try to combat the harms caused by alcohol misuse by improving education, by improving health care, and 356 by tackling crime and disorder. I do not suggest that we have all the answers, but we have shown a way forward in our work on trying to set out a coherent and comprehensive alcohol harm reduction strategy for England. I noticed that this document has not totally endeared itself to all parts of your Lordships' House. This is the only Government to have produced such a comprehensive strategy that honestly acknowledges the gaps in our knowledge. I am deeply impressed by the action research of the noble Lord, Lord McColl, in this area. I shall certainly not compete with him on the knowledge that he has shown of the drinking habits of students, which is impressive.
§ Lord Warner
My Lords, it is not the purpose of this Government to demean students. We are actually trying to improve their access to university.
One of the strategy document's key strengths is its cross-cutting nature. It recognises also that the Government alone cannot solve the problems caused by alcohol misuse. That is why the strategy tries to involve and bring together a wide range of government departments, a range of people in the NHS, police, local authorities, voluntary organisations and the drinks industry in a partnership to try to tackle misuse. The Government agree with all noble Lords who have said that we need integrated responses from all the agencies, both at the national and the local level.
The Department of Health and the Home Office will be jointly responsible for implementing the strategy, but the Department for Culture, Media and Sport and other departments will be very much involved. Let me make that clear to noble Lords who have expressed concerns in that regard. A number of noble Lords have questioned why we do not, to put it crudely, price the problem out of existence. There is evidence that population measures such as high prices, taxes, restricted availability and restrictions or bans on advertising do not always deliver the required results. Countries such as Britain, with historically high alcohol taxes and restricted hours of availability, have seen a rise in alcohol consumption, while in other countries such as France and Italy, consumption has decreased independently of any government measures. There is plenty of evidence for this, which was used by the Strategy Unit. I will not run over all the sources, but there are seven or eight that I can communicate to noble Lords if they wish.
Action on education is an important issue. We know that people need relevant and easily accessible information about alcohol to help them make decisions about their drinking. I agree with the noble Lord, Lord Mancroft, that we need better evidence on what works in education on this topic. I know from my time as chairman of the Youth Justice Board that young people are starting to drink earlier. There is good research evidence on that, and I agree with noble Lords who have raised that issue. That is why giving information about alcohol must start early. That is why the Government have ensured that alcohol 357 education is built into the national curriculum for science from the age of seven. Alcohol education also forms part of personal health and social education. The DfES has invested £3 million in the 2001–04 period to improve teacher training on drugs, alcohol and tobacco education. New, improved guidance on drug education was issued to schools in March of this year.
A number of noble Lords have raised issues around communications. The Department of Health has set aside a central budget of about £0.5 million each year for alcohol health promotion work. I accept that that is probably not enough. We produce a range of leaflets and other materials that advise the public of the dangers of alcohol misuse. We produce specific leaflets for parents and young people, and we produce leaflets in key minority ethnic community languages. Every day, NHS health promotion units, as well as doctors and nurses, provide advice on sensible alcohol consumption to their patients. We will certainly look at whether the new quality and outcomes framework for the GP contract can be used in this area when it is reviewed. Furthermore, when the opportunities present themselves, A & E and arrest referral schemes try to get messages across on heavy drinking.
Most people respond, and they drink sensibly and responsibly, and do not cause harm to themselves or to others. I suggest to the noble Lord, Lord Mancroft, that there is a need to continue with some kind of sensible drinking message for many people. It is not appropriate for everyone, as the noble Lord has said. Our research shows that those people who do not drink sensibly simply do not wish to do so. Many of those whose drinking is heavy at times still think that they are operating within normal boundaries. We do have a serious problem here. Communicating with these drinkers is a real challenge for this Government, and would be for any government. That is why we are reassessing the sensible drinking message to try to find a format that people can relate to in their everyday lives and drinking experiences. It is important to get this right. There would be no point in replacing the current message with one that does not work any better.
We aim to complete a reassessment of this area and have revised messages ready by the end of June 2005. Whether we express any new messages on units depends on the research that we are currently carrying out. This work will determine our expenditure on promoting our messages. My noble friend Lord Brooke asked about that. We have already made a start, and that is why we want to commission more work in this area to try to understand how people absorb and act on communication methods and messages. We are also developing communication work targeted specifically on binge drinkers and chronic drinkers. This will be the time to consider increasing expenditure on promoting those messages.
We recognise the concern that has been expressed about alcohol advertising, especially about advertisements that may appeal to children and young people. We currently have a framework of statutory and non-statutory rules on advertising, which states 358 that advertisements should not appeal to children and should not give a false impression of alcohol. Advertisements should not imply that drinking alcohol improves a person's mental or physical abilities, or that it can be associated with social or sexual success. The strategy recommended a review of these rules to ensure that they were working as intended.
Ofcom has been asked to oversee this review. We understand that Ofcom proposes to consult a range of stakeholders in this area and complete the review by the end of 2004. This review will focus in particular on ensuring that advertisements do not target under-eighteens, that they do not encourage irresponsible behaviour, and that Ofcom's publicity stresses the regulator's role in relation to broadcast advertising and complaints.
A number of noble Lords have stressed the importance of action to tackle the long-term effects of alcohol misuse, which can have a devastating effect on health. The link between alcohol and liver cirrhosis is well known. The Chief Medical Officer has made it clear and noted in his reports that the death rate from liver cirrhosis is rising significantly, particularly among people aged under 65. Over the past 10 years the number of men aged under 65 dying from liver disease and cirrhosis rose from just over 1,000 to nearly 2,500. The number of deaths among women has roughly doubled in the same period.
Chronic long-term drinking can also be associated with an increased risk of heart disease, stroke and certain cancers. There have been a number of local initiatives in this area where the NHS has tried to work with patients to try to improve their understanding of the damage that they are doing to themselves. There has been a particularly effective one at the Royal Liverpool Hospital.
The short-term health effects of alcohol misuse are clearly visible, as a number of noble Lords have said, in our A&E departments. My noble friend Lord Brooke of Alverthorpe asked about safety measures in A&E departments. The Department of Health counter fraud and security services, working with the NHS, try to improve security in a number of areas, particularly in A&E departments. But I will take back the question about whether licensees should be contributing to this particular activity.
Binge drinking can be linked with accidents and injuries, as a number of noble Lords said. I pay tribute to the work done by Colin Drummond in his report on A&E attendances, which found that on average 40 per cent of all A&E attendances are alcohol related. This rises to 70 per cent of attendances between midnight and 5 a.m. over the weekend. We are extremely grateful to Professor Drummond for his report and the insight that it provides.
I would also like to pay tribute to the work done by Professor Jonathan Shepherd in Cardiff A&E, which I first encountered when I was in the Home Office. He has done a huge amount of work to show the importance of A&E departments in helping to produce local strategies that can improve our response. The 359 work that he has done with the police and other local agencies—and the impact that that has had on national policy—is very significant.
We plan to pilot a range of models of screenings and interventions to establish whether the encouraging results from initiatives such as Jonathan Shepherd's can be achieved across NHS treatment structures. I am sure that he and others will be pleased to learn that at least one of the pilot sites will be an A&E department. The pilots will also help to establish whether these interventions can save the NHS the cost of more complex and costly healthcare for these patients at a later date.
The Government's strategy documents note that very little information has been collected on alcohol treatment and that it has been given very little priority at the national and local level. That is typical of the honesty with which the Government have approached this area. Therefore, the first step is to plug these information gaps.
The Department of Health will conduct a national audit of demand for, and provision of, alcohol treatment. That will be completed by the end of January 2005. The results of this audit will be used to develop a programme of improvements to treatments. I accept that there has probably been less research on alcohol dependence than on drugs, which has been a high priority for the Government. However, I draw the attention of noble Lords to the fact that alcohol treatment itself tends to be funded by PCTs at the local level. That is why figures in this area at the national level are modest, as several noble Lords have said.
A number of noble Lords have drawn attention to the effects of excessive drinking during pregnancy, which may affect the brain of the developing foetus. The Government have recommended that women who are pregnant or are trying to get pregnant should not drink more than one to two units of alcohol per week. We have good reason to believe that the majority of women are aware of and follow this advice. The infant feeding survey of 2000 indicated that 71 per cent of pregnant women who drank during pregnancy drank less than one unit per week on average. Only 3 per cent drank more than seven units per week and only 1 per cent of women drank more than 14 units per week.
I am not sure where my noble friend Lord Mitchell obtained his figures on the number of FAS cases. Our hospital episodes statistics show that 128 children were diagnosed with Foetal Alcohol Syndrome during 2002–03. That is admittedly more than the previous year, but clearly substantially lower than the figure that he cited.
The Government plan to publish a White Paper on public health later this year. We are currently conducting a consultation exercise asking for views on priorities for action. That will end on 28 May. I cannot speculate on the details of what might be in the White Paper, but I would urge anyone who has an interest in public health to contribute to that consultation. Certainly the Government will consider very carefully the points made in the debate today.
360 A number of noble Lords raised issues concerning labelling. Unit labelling is currently governed by EU law, which does not allow for compulsory unit labelling. The Department of Health will examine whether that can be changed at the EU level. In the meantime we will be encouraging drinks manufacturers to put unit labels on bottles. There is no evidence from the USA that health warnings work. That is why the strategy calls for more information about sensible drinking to be placed on bottles.
I should like to turn to some of the issues that have been raised relating to alcohol-related crime, disorder and anti-social behaviour. Alcohol-related crime and disorder and under-age drinking are major concerns to many of our communities, especially in town and city centres. The Home Office has been trying to combat these concerns. This was discussed by the Home Secretary and the ACPO conference yesterday, a point to which a number of noble Lords have alluded.
There are many excellent examples of localities which have developed good approaches to tackling alcohol-related crime. The Home Office published a development and practice report alongside the alcohol strategy, called Alcohol audits strategies and initiatives:lessons from crime and Disorder Reduction Partnerships. That sets out examples of approaches to dealing with alcohol-related problems locally.
One such example is the Leicester Nightrider scheme, which was set up to deal with the problems caused by the slow dispersal of crowds leaving clubs and late-night bars. A number of noble Lords have referred to Manchester. The Manchester City Safe scheme was set up to co-ordinate approaches to alcohol-fuelled violent crime. It targets people with safer drinking messages, using posters, for example, and enforces penalties for anti-social behaviour to achieve the maximum deterrent effect. It works closely with the industry and brings together a range of statutory authorities to ensure effective management of the night-time infrastructure. As a result of the scheme, late-night disorder was reduced by 8.5 per cent in the first year and 12.3 per cent in the second year. There are good practical examples of how the police and the other agencies are having an effect.
All licensed premises in Burnley are, having paid a joining fee, members of Burnley Against Night-time Disorder. Those arrested in Burnley for violent crime, disorder or supplying drugs are photographed by the police and put under an interim ban that prevents them entering licensed premises in the town centre until the next BAND meeting reaches a decision on whether to uphold the ban. The decision is reached after a vote by licensees, and the banned person's details are circulated in town centre licensed premises.
Police commanders have the flexibility to deploy officers according to demand. In addition, most forces have operational support units. I say gently to your Lordships that police funding has been increased substantially by this Government, and the number of police officers is at a record high. There are resources available to tackle the issue in many of our police force areas. Police in inner-city areas have already made 361 effective use of fixed penalty notices for disorder. Such notices have had a good effect on attempts to deal with people who are drunk and disorderly. Lancashire police recently launched a penalty notice for disorder scheme in Blackpool and have made effective use of the street issue of notices.
During the summer of 2004, we will crack down through a new enforcement campaign on under-age drinking and alcohol-related violent crime. Police forces will conduct announced and unannounced action against retailers who sell alcohol to under-18s and to those who are already drunk. We want to make it clear that operating outside the law will not be tolerated. Naming and shaming is another new idea that is being considered and is well worth further consideration as part of local initiatives to tackle crime.
Several noble Lords asked about plastic glasses. People such as Professor Shepherd, whom I have already mentioned, have done a lot of work in that area. There is an issue about establishing whether there could be a kitemark. As I understand it, there is no kitemark at present. There is also an issue about the capacity to produce more plastic bottles. Those issues are being considered with the industry, and I will write to the noble Baroness with more detail.
I do not have time to deal with all the questions that were raised, but I will write to noble Lords on the issues that I have not had time to answer them on. Once again, I thank the noble Lord, Lord Avebury, for introducing the debate. I have tried to give examples of how the Government are trying to tackle the issue. Now, I propose to save my throat and go and have a sensible drink.
§ 8.11 p.m.
§ Lord Avebury
My Lords, I warmly thank all those who took part in the debate. It has made a significant contribution towards discussion of the Government's alcohol strategy. I hope that it is not the only contribution that we shall make in your Lordships' House on the subject. It is a moving target.
The Government must encourage a wider debate on the strategy outside the House. It is important that the views expressed this evening, many of which echo those of professionals in the health service—many distinguished members of the health service have taken part—deserve a thorough airing in a climate in which the Government listen to suggestions for improving the strategy, where it can be modified at the edges. I think that we have established that some of your Lordships are not satisfied with the fundamental basis of the strategy, which is that we have eschewed the price mechanism and embarked on a policy of collaboration with the drinks industry. Many of your Lordships expressed scepticism about that.
As for the other ideas that came up, we were encouraged to hear what the Minister said about cracking down on retailers who sell drink to children under 18. I wonder only why it has taken so long to get round to doing that, when everybody knows what is 362 happening. I also suggest to the Minister that it would be difficult for police officers to enter premises such as the large vertical drinking factories in the West End to establish whether anybody on the premises was under the age of 18.
We have heard an enormous amount about the funding of alcohol treatment schemes and I was disappointed to hear the Minister say that they will not be promoted until the national audit of such ideas is completed in January 2005. Why identify the strategy and then embark on a series of further studies? I rather sympathise with the remark of the noble Lord, Lord Mancroft, that we have enough of pilots and that we need to get on with it.
I conclude by mentioning the identification and referral of patients who come to accident and emergency departments or to general practitioners. Everyone has acknowledged that there is a treatable moment. The noble Baroness, Lady Finlay of Llandaff, for example, spoke about the Paddington scheme, which allows patients to be referred immediately, or in a short period of time, to an alcohol treatment worker. To set up further pilots when that work has been going on, to my knowledge, for around 15 years would be a waste of time. That would be a disappointing result to all the work that has been put in to the strategy.
However, we are grateful to the Minister for his comprehensive reply. I am only sorry that we do not have further time to go into the issue in more detail, but we shall come back to it soon. I beg leave to withdraw the Motion.
§ Motion for Papers, by leave, withdrawn.