PARLIAMENTARY DEBATE
Alcohol Harm - 17 March 2020 (Commons/Westminster Hall)

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Paisley.

I thank the Backbench Business Committee for allocating time for this debate. The request for it was made some six months ago, in the hope of it being granted in the run-up to Christmas or when many join in Dry January, but pressure on parliamentary time meant that it has only just been granted. I appreciate that now we are in a very different time as regards health concerns. None the less, alcohol harm is an ongoing and long-term concern not just for those who drink to excess but for their families and wider society, and it will still be with us even after—as we hope—the coronavirus crisis is past.

I thank the Minister for Care for stepping in to respond to the debate at a time of great pressure for her and the Department of Health and Social Care. I pay tribute to the great leadership being provided by the Prime Minister, the Secretary of State for Health and Social Care, the other Health Ministers and all those involved in leading on the exceptional and unprecedented crisis in our nation—thank you.

I appreciate that the current unprecedented situation means that fewer colleagues are present for the debate. Many put down their names and intended to speak. I thank those who are in attendance. One colleague asked me to mention that she regrets being unable to be here: the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is chair of the recently instituted all-party parliamentary group for the excellent 12 steps programme, which has made a difference in so many people’s lives.

There are, and have been for a long time—as long as I have been in Parliament, which is now some 10 years—several all-party groups concerned with alcohol harm: one under that name, one on foetal alcohol spectrum disorder, another on the children of alcoholics, and the drugs, alcohol and justice all-party group, and I am delighted to see its secretariat in attendance today. Alcohol harm, therefore, is not a minority concern here in Parliament, as some may think.

Before I go on to talk about the concerns that many of us have about the impact of alcohol harm, this debate is in no way intended to denigrate the fact that drinking responsibly and enjoying a drink is something that I and many others do. That is not what we are here to do today; we are here about drinking to excess, harming oneself and others.

I will come on to the speech that I had prepared, although that was before we found ourselves in these exceptional circumstances this morning, when the country faces the prospect of many self-isolating for long periods. Even so, while Ministers in the Department of Health focus on the crisis, over the coming weeks when giving health advice, they might still send out a few helpful messages to those stuck at home who may be tempted to drink more than is good for them.

Many tips, many of them straightforward, have been given over the years by organisations such as Drinkaware, whose work I commend, but perhaps not sufficiently widely promoted. This might be an opportunity to do that—for example, taking a non-alcoholic drink before an alcoholic one, having a glass of water by the side of the alcoholic drink, or trying alcohol-free drinks. Last year, here in Parliament, our all-party group hosted an alcohol-free drinks event attended by 60 colleagues. We had an enjoyable time—alcohol-free gin, champagne, lager—[Interruption.] I am very aware that the hon. Member for Strangford (Jim Shannon) attended that event and it was indeed enjoyable. We should try alcohol-free drinks and, as Drinkaware suggests, aim for two or three alcohol-free days a week to rest the liver.

To turn to the substance of the debate, 10 million people are drinking at levels that increase the risk of health harm.

I congratulate the hon. Lady on this timely debate. Does she agree that, in these exceptional circumstances, one of our concerns over the coming weeks and months should be the massive reduction in social interaction? There will inevitably be a spike in the number of people drinking alcohol at home. Both Government and communities have to be aware of that to try and ensure people do so responsibly and not to significant excess, which may well happen in the coming weeks.

The hon. Gentleman has expressed far more eloquently than I have exactly the issue that many will face. It is particularly interesting that the 55 to 64 age group is one of the most at risk, with its excess drinking described by charities working in the field as a “national health disaster”. There is an opportunity here to gently—I am aware there is a lot of other stress—help people understand the implications of drinking to those levels.

In the Green Paper published in July 2019, the Government said

“the harm caused by problem drinking is rising.

Over 10 million people are drinking at levels above the official guidelines and putting themselves at extra risk.”

Tragically, exactly the same thing was stated by Public Health England in the third line of its 2016 evidence-based review, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies”:

“there are currently over 10 million people drinking at levels which increase their risk of health harm”.

It goes on to talk about

“1 million hospital admissions relating to alcohol each year”.

Interestingly enough, half of those occur in the lowest three socioeconomic areas.

“More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

Sadly, several years on, we still do not have what is very much needed: a distinct and discrete alcohol strategy—it could be better called an alcohol harm strategy—to address the issue. I recommend the Health Minister to look at the alcohol charter, if she has not seen it, which was produced by some of our all-party parliamentary groups following the 2016 report and makes some suggestions as to what that strategy could contain. They include tackling the increased availability of excessively cheap alcohol, empowering the public to make fully informed decisions about their drinking and providing adequate support for dependent and non-dependent drinkers.

If I had a main call today, it would be to ask that the Government produce an up-to-date alcohol strategy. The last one was produced in 2012 and it is out of date, not only because of statistics—I am afraid I will bore colleagues with some more shortly—but also with reference to our approach to minimum unit pricing, which I will refer to later.

Our relationship with alcohol is complex, and so are its harms. Alcohol is embedded in our culture. Whether we are celebrating, had a tough day or need to reward ourselves, alcohol very often seems to play a role. It has become normalised. It is increasingly difficult to find a birthday card that does not wish an un-beer-lievable or gin-tastic birthday to someone, or makes another reference to alcohol. Although our culture celebrates alcohol—enjoyment in the right proportions is not a bad thing—we are too silent about its harms. All too often, we stigmatise people who are dealing with the consequences of harmful alcohol consumption, or leave them to cope with those consequences alone.

Most of us know a person or family affected by harmful drinking. The statistics are, if I may say, sobering: across the UK, more than 80 people a day die from alcohol-related causes. That figure is far higher in areas of poverty where people struggle to cope. Alcohol is now the leading risk factor for death, ill-health and disability among 15 to 49-year-olds in England, and is associated with around 40% of violent crime. In my local authority of Cheshire East, there were 185 alcohol-related deaths and 8,460 alcohol-related hospital admissions in 2017. The number that sticks out the most, however, is the number of people who do not get help: 88% of dependent drinkers in Cheshire East are not in treatment and do not get the support that they need.

My hon. Friend said that the effects of drinking alcohol were obvious, but does she accept that for men trying to have a family, for example, the effects can lead to permanent difficulties such as infertility, which is not always obvious?

My hon. Friend makes an excellent point. Having engaged on this subject for many years in this place, I thought that there was nothing that I did not know, but I did not know that, so I thank him for drawing people’s attention to it. Similarly, it is of great concern that many people are unaware of the impact of foetal alcohol syndrome, which arises from drinking during pregnancy—we cannot emphasise enough the importance of not doing so.

Public Health England estimates that only one in five dependent drinkers in England gets the right support. That is sad because treatment, when obtained, can be very effective and good value for money. For every £1 spent, there is a societal benefit of £3. It does not stop there, though. Alcohol not only impacts individuals, but wider society and public services, costing NHS England £3.5 billion every year. There is no better time than now to remind ourselves that we should encourage help and the prevention of harm where we can, so that our NHS staff, whom I thank in this time of crisis, can treat those in health difficulties.

Anyone who has been in an A&E on a Friday or Saturday night will not be surprised to hear that alcohol-related incidents account for 25% of A&E work in England. Sir Ian Gilmore, who chairs the Alcohol Health Alliance—I thank them and commend their work informing the public and supporting parliamentarians—said

“While A&E departments used to feel the impact on Saturday nights, it’s now every night of the week”,

and that

“The lack of a strategy is really harming the nation”.

English police spend more than half of their time dealing with alcohol-related casework.

Alcohol’s impact on families is stark: in England, about 200,000 children live with an alcohol-dependent parent. I will speak a little about that, but I will first commend the Government because when my hon. Friend the Member for Winchester (Steve Brine) was Health Minister, he was very conscious of the issue and granted more than £6 million to help the children of alcoholics, following a campaign run by colleagues in the House. He rightly said:

“Alcohol abuse can tear lives apart, not only for the people trapped in the grip of an addiction but for their children, who are often robbed of the support, comfort and structure they need from their parents.

I am committed to finding new ways to help families in the midst of these heart-breaking situations.”

I would be interested to hear from the Minister about progress on the pilot schemes in several local authorities, which I expect are now quite well developed, to help children of alcoholic parents or carers, following his initiative.

I have always found Health Ministers to be very concerned about the issue, but one of the systemic problems appears to be that the Home Office leads on alcohol strategy. That has to change. There is a lot of concern among Health Ministers and the Department of Health and Social Care about the issue, but we need them to lead on it.

Children of alcoholic parents or carers experience real difficulties. They are twice as likely to experience difficulties at school, three times more likely to consider suicide, four times more likely to develop alcohol problems of their own, and five times more likely to develop eating disorders. I am pleased by the progress that I have mentioned, but we still have a long way to go on tackling harms.

The Government are rightly excited about the positive impacts of alcohol care teams in hospitals, and I encourage them to go further and ensure that a team is embedded in every hospital when time can be given to that. However, we know from listening to dependent drinkers that help in hospital needs to be complemented by help in communities, if they are truly to be helped.

The loneliness agenda and social prescribing are important initiatives that need to include suitable provision for dependent drinkers. Having attended an Alcoholics Anonymous meeting as a guest, I was really impressed with the care and support that members of that AA group gave one another. It was clearly proving very effective, but we need to do more.

I thank Adrian Crossley, the head of addiction and crime at the Centre for Social Justice, who is doing a lot of work on alcohol treatment. He basically says that we have to assign funding to each local authority in accordance with locally recognised need. I know that this is an unpopular term, but we must ring-fence it so that it really can make a difference.

We must also develop the Government’s promised addiction strategy to ensure that there are wrap-around services to help to stabilise and then promote lasting recovery—particularly the family support that is needed for the 200,000 children in England who are living with an alcohol dependent parents. Those are important initiatives. There is no wrong door to accessing the most appropriate services, but we need to join them up—whether they are local family services, voluntary groups or mental health support.

If I may, Mr Paisley, I will take a little longer than normal to make my speech, because there are not too many colleagues present. I was disappointed in the Chancellor’s view on alcohol duty in the recent Budget. I thank him for providing £2.5 million towards the development of family hubs in local areas. Such hubs are one-stop-shops where people will be able to go—several are up and running in the country now—for joined-up services from local health providers, local authorities and voluntary groups.

People can go to such hubs with any issue that relates to their family life. One of those issues should, and hopefully will, be addiction. Sadly, many families do not come forward for help. They are ashamed of the stigma, are soaked in a culture that celebrates the products that often blight their lives, and carry a burden that is often unrecognised and unsupported. We need more accessible, practical support for families.

We need to remember, too, that the harms from alcohol do not fall evenly across the UK. The burden falls most heavily on poorer communities. The north of England, for example, has significantly higher rates of alcohol-related deaths than London or the south-east. I am delighted that this one nation Conservative Government are committed to reducing inequalities and levelling up across the country, but, as I have mentioned in this House before, we will not be able to do that simply by repairing physical infrastructure such as roads and bridges. We need to create stronger, healthier communities and families, and one of the ways we can do that is by tackling alcohol harm.

The figures I have mentioned demonstrate that alcohol presents a grave public health challenge. Without question, we need a paradigm shift. Tackling alcohol-related harm needs to become a fundamental policy priority. Regulation certainly plays a part in shifting behaviour on a personal level, as we have seen over the past few years with tobacco; I commend parliamentarians who took a lead on that. As we have seen there, the Government can create an environment that enables us to make informed choices and lead healthier, happier lives.

I will now focus on price. Why? Because the 2016 report from Public Health England concluded:

“Policies that reduce the affordability of alcohol are the most effective”

policies in health treatment. Yet, over the past few years since then, and even before then, quite the opposite has occurred. Alcohol duty rates have been cut or frozen in Budget after Budget and as a result, in real terms, beer duty is some 18% lower than in 2012, duty on spirits and cider is 10% lower and duty on wines 2% lower. We all know that the price of something has an impact on whether we will buy it, and alcohol is no exception; as I say, Public Health England said price was the No. 1 factor in determining how much alcohol is bought.

Alcohol has become dramatically more affordable in the past 30 years. The affordability of beer in the off-trade has more than tripled in real terms since 1987 and off-trade wine and spirits are 163% more affordable. One of the most targeted approaches to addressing the price of the cheapest alcohol is minimum unit pricing. I urge the Minister to look at it again.

Minimum unit pricing, as the name suggests, sets a price below which alcohol cannot be sold. In Scotland, which introduced minimum unit pricing two years ago, it is currently 50p. That means that a pint of beer containing two units of alcohol—for the record, as many here will know, the chief medical officer’s suggestion for sensible and moderate drinking is 14 units a week—cannot be sold for less than a pound.

Minimum unit pricing would have hardly any effect on pubs and restaurants, where the vast majority of alcohol is sold at more than 50p per unit. Instead, it is highly targeted at the cheapest products that cause the most harm, such as white cider and super-strength cheap lager. If the Minister cares to look, I introduced the Alcohol (Minimum Pricing) (England) Bill in 2018, so there is one oven ready if the Government would like to take it up.

One reason the Government did not take it up was that they said they wanted more evidence that MUP would work. I remember the Chancellor saying that we would await the outcome in Scotland. As I say, two years since Scotland implemented MUP, the evidence is very encouraging. Consumption fell by 3.6% in Scotland in the year after MUP was implemented. During the same period, it rose by 3.2% in England and Wales. The important thing is that the fall in consumption appears to have occurred particularly among those consuming the most alcohol, who are most at risk, and it seems to have been in the high-strength, dangerous drinks of the sort that I mentioned that consumption has fallen.

Wales has decided to follow Scotland’s lead and is implementing MUP this month. Following the evidence, these are the statistics. Again, I apologise to colleagues for more statistics. In England, a 50p MUP is predicted to save 525 lives and prevent over 22,000 hospital admissions and 36,000 crimes annually when at full effect. The evidence is clear, we need to act without delay and implement MUP in England. It was interesting that the 2012 alcohol strategy referred to this very positively. I refer the Minister to the foreword by the then Prime Minister:

“We are not rejecting MUP, merely delaying it until we have conclusive evidence it will be effective”.

Will the Ministers look again at MUP and the evidence following Scotland?

The duty escalator which was in place between 2008 and 2012 increased alcohol duty by 2% every year. The result was that alcohol-related deaths fell while it was in place. They have started to rise again since it has been abolished. Last week, the Chancellor announced in this year’s Budget alcohol duty will be frozen across the board. In real terms, this means a cut. It will lower the price of alcohol. All decisions present trade-offs.

While I appreciate the desire to support our local industry of pubs and brewers, I want to reflect on the impact of this decision on health. Research from the University of Sheffield—I am sure the Minister’s staff will look at the report, because it is commendable—has shown that changes in alcohol duty since 2012 have led to nearly 2,000 additional deaths and 61,000 hospital admissions in England. There was an enormous human cost, but also a strain on public services by adding an estimated £317 million to NHS England’s bill. It is estimated the duty changes could have cost England’s businesses as much as £58 million in lost working days since 2012.

Increasing alcohol duty also raises urgently needed revenue. Considering the impact of the current cuts alongside all changes to duty policies since 2012, in this year, 2019-20, the Government are losing out on nearly £1.3 billion in forgone revenue. That is enough money to pay the salaries of more than 40,000 nurses. By 2024-25, the cumulative costs of these cuts will be £13 billion.

While the Budget focused on supporting pubs, I do not believe that cutting duty will be that helpful for them. Ending the alcohol duty escalator after 2012 and the subsequent duty cuts and freezes have not made a measurable difference to the rate of pub closures. This reflects the experiences of those working in the pub trade. Nearly 90% of publicans in the north-east said that duty cuts have not had a positive effect on their business. Less than 5% felt that alcohol taxes were the main cause of pub closures, while a majority thought that cheap alcohol from supermarkets and off-licences was to blame.

Before I end, I want to address alcohol labelling. If we want to create an environment in which people are supported to make informed choices to live healthier, happier lives, we need to make sure they have all the information they need. At the moment, people do not get it. We have more information on a pint of milk than when buying alcohol. It is no surprise that only one in five people know that the chief medical officers commend us not to drink more than 14 units a week, but the public wants to know this information. Research from the Alcohol Health Alliance found that more than 70% of people support warnings that exceeding the drinking guidelines can harm one’s health. I put down an EDM on this last June. It is interesting that it garnered support from 20 colleagues. It stated that two and a half years after the chief medical officer’s guidelines of 14 units per week for low-risk drinking were published:

“a survey of 320 products found that two-thirds of alcohol labels still displayed the old guidelines; … that the pregnancy logo and number of units are not legally required to be shown on labels”.

We believe they should be and there is a lack of information generally on alcohol labels compared with other food and drink labels. Will the Government look again at labelling and make the information on alcohol products mandatory? The public want to know more. It is not just that alcohol increases health risks and that therefore information on alcohol content is wanted, but that they are actually interested in the calorific content. I was involved in a joint event with the all-party parliamentary group on obesity some years ago. It was remarkable. Evidence was given that when people drink with a meal and are perhaps not as thoughtful about what they are eating, the overall increase in calorific consumption can be 400 in that meal alone. It is time to look again at alcohol harm. Alcohol containers should, like any other food and drink container, have to display ingredients, nutrients and calories. They should display the CMO’s guidelines and warnings that exceeding this amount could damage one’s health. We can no longer ignore the harm caused to our society, communities, constituents, families and friends by alcohol.

I thank the hon. Member for Congleton (Fiona Bruce) for introducing this debate, and you for allowing it, Mr Paisley. There is a perennial and universal issue across the UK and Ireland. No nation or region is exempt. Policies may differ, but the challenges remain the same. I declare that I sit on the commission on alcohol harm. Presumably my past experience as Scottish Justice Secretary in invoking legislation on alcohol, including kicking off minimum unit pricing—as opposed to past indiscretions of which I am less proud—have allowed me some focus. We must consider how alcohol harm comes about.

The papers available to me as a result of sitting on the commission on alcohol harm have been revelatory to me, even as somebody who served for seven and a half years as Justice Secretary and has been aware of the harm across huge swathes of our society, as correctly pointed out by the hon. Member for Congleton. The testimony from children in particular—those who have grown up in families with alcohol-dependent parents and where other siblings have been affected by other issues—is quite distressing, to say the least. For that reason, we require a reaction.

I have a personal interest too. Bus passes are issued to people at a lower age in Scotland than elsewhere in the UK. I went to two funerals lately of friends with whom I grew up, neither of whom lived long enough to get their bus pass. Both of them succumbed to alcohol. Nobody sets out to succumb to alcohol and die as a result of it. In the case of those two close friends, it happened because they had underlying issues. They were lost souls and had problems, and indeed had suffered themselves. It was a tragedy, and they deserve our sympathy every bit as much as anybody else who dies from any other aspect. The issues remain universal, and how we tackle them. It is about affordability, availability, and advertising.

I am certain, through my experience of seven and a half years, that more education alone will not work. That was stated by someone in the alcohol industry when I first went into office. Someone said, “What we need is to educate people better.” That is utter nonsense. We have been doing that throughout my lifetime. Do we need to educate better? For sure we do, but the idea that we will be able to tackle the problem in our society simply through better education or greater awareness is not capable of being sustained. Action needs to be taken. As the hon. Member for Congleton correctly said, that does not mean that one needs to be a prohibitionist. I most certainly am not, and I enjoy a drink along with my friends and indeed my family. Alcohol is an important part of our economy, and an important lubricant within wider social aspects. As hon. Members said in interventions, it will be affecting how our people deal with matters. It cannot simply be a matter of prohibition.

Affordability is key. Minimum unit pricing is important, and David Cameron supported it when I introduced it in Scotland. England and Wales should take it on board, and Wales, to its credit, is looking at that. Equally, it has to be borne in mind that minimum unit pricing was never meant to be a stand-alone policy; it was meant to tie in with other tax regimes, and that means other fiscal and tax charges. We need the proverbial belt and braces. Scotland cannot deliver all it wants through MUP without being able to control the excise duty, so there has to be action on that. While I support steps to protect the Scotch whisky industry from actions and levies imposed in the United States of America, I am disappointed that we have not seen a continuation of the increase to tackle it hard here.

However, this is about not just affordability but availability. I am always reminded of John Carnochan, the head of our violence reduction unit, who talked about alcohol problems in our peripheral housing schemes. He made the point that if he wanted a haircut, he went to the barber, and if he wanted new shoes, he went to a shoe shop, so why, if he wanted alcohol, could he go to virtually any shop? Within 500 metres of where I live, in both London and Edinburgh, people can go out of their front door to anything upward of 40 outlets that sell alcohol on or off-trade. The likelihood is that as a result of coronavirus, there may be a cull of the on-trade outlets, but the off-trade outlets will remain, and that is where the significant problem has grown. In my lifetime, off-sales have gone up massively and the on-sale trade has declined massively. That is an issue, because alcohol consumption is a learned pattern. People need others there who encourage them to moderate their drinking and make it a social pastime, as opposed to them perhaps sitting at home consuming to excess. That is why even in Scotland, action has to be taken to restrict availability. There are far too many off-sale outlets. We need to encourage licensing boards not to issue licences and, where there is over-provision, to ensure that that does not happen.

Equally, there is the question of advertising. For alcohol, it is becoming almost subliminal. The evidence coming through from young people giving testimony to the harms commissioner is clear: they view alcohol almost as another product, but it is not. We enjoy it and benefit from it, and our economy even requires it, but it is not another product—it is a licensed drug. Therefore, how we make it available and allow it to be advertised is fundamental. We are taking action as a society to ensure that we restrict smoking so that it is no longer the cool thing to do. We need to do likewise with alcohol, because the advertising at sporting events has most certainly had a detrimental impact.

I welcome the steps that the Minister has taken. I look forward to further action from her and the UK Government, but it is also fair to say that those in the devolved Administrations also have to take action, because we are on a journey. We cannot stay as we are. The harm is too great and further action is needed. To sum up, this cannot simply be about education; we need to tackle affordability, availability and advertising.

It is a pleasure to serve under your chairmanship, Mr Paisley, and to follow my two colleagues, my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Member for East Lothian (Kenny MacAskill), who have done us a great service by looking at the underlying causes of alcohol consumption and its role in society. Those very important factors need to be taken into account.

I totally agree with the hon. Member for East Lothian that education on its own will not solve the problem. A much bigger attack on the whole way we drink, and the reasons why, is required. My hon. Friend the Member for Congleton raised a number of those, particularly pointing out people’s need for alcohol when they are lonely, and we should look at that in more detail. Public Health England states that between the ages of 15 and 49, alcohol is the leading risk factor for ill health. It also pointed out that working years of life lost would be saved as a result if this situation were to end.

I raise two issues in particular—one about drink-driving and another relating to pregnancy. I absolutely support the coronavirus strategy. In 2014, there were 240 fatalities as a result of alcohol. That has to be set against the number of fatalities at the moment from the coronavirus. Getting some perspective on this is essential to tackling the disease. I would certainly like to see a lower limit for drink-driving. There has been some success in curbing drink-driving, but I do not think it has been enough. It still accounts for a large amount of hospital admissions and difficulties in that area.

There is an important point relating to pregnancy. There is a tremendous amount of advice for a woman who is looking to become pregnant or is pregnant, but pregnancy does not arise from just one person, it arises from a couple, and there needs to be equal concentration on the result of drinking alcohol for the man as well as the woman.

We know that drinking during pregnancy can lead to lifelong physical, behavioural and cognitive disabilities for the child. My hon. Friend the Member for Congleton mentioned foetal alcohol syndrome as a sign that a woman has drunk too much during pregnancy. Of course, binge drinking is the great no-no. A long list of difficulties occur as a result, but I will not go into them all here; a number of speakers have already gone into that.

However, the important question is when to advise a woman to stop drinking altogether, since that is the advice of the medical establishment in this area. There is a very good indication that she should stop when she intends to get pregnant, rather than when she is pregnant. There can be a fairly long period between someone intending to get pregnant and knowing that they are pregnant, which reinforces the value of that.

I mentioned that the role of the man needs to be taken into account, and I repeat that the ability of a man to stay off alcohol when wanting to create a family is essential. I pointed out that a long-term risk is that alcohol increases the risk of infertility. There are issues here that we need to take into account. We need to provide much wider advice to reinforce that. The short-term risks of alcohol fall on men, but the long-term risks of alcohol fall on women. Understanding that is a helpful way of approaching this for the future.

I have two Members left to call. Before I call the next, I ask them to bear it in mind that I would like to call the first Opposition spokesperson at 10.30 am. That gives each speaker about seven minutes each, if that is sufficient, but I will not set a formal time limit.

It is a real pleasure to serve under your chairmanship, Mr Paisley, and to debate this matter with the hon. Member for Congleton (Fiona Bruce). I am always inspired by her compassion and her devotion to doing all she can to make her constituency and the nation a better place to live. That always encourages me and encourages all of us.

I am also pleased to stand with the hon. Lady on many things; I do not think there is anything that she and I disagree on—not that I am aware of anyway. We are kindred spirits across political parties. We may have different opinions on the politics, but not on the constitutional issues and certainly not on what we want for society.

I am a great believer in all things in moderation. Since becoming a type 2 diabetic I have realised that the key to my continued health lies in my ability to eat in moderation. It took me many years to realise that. The issue with alcohol is that many people struggle for moderation, just as I used to struggle with sweet food—two bottles of Coca-Cola with a Chinese takeaway from Davy Lee’s in Newtownards, five nights a week. In addition to that, there was the stress issue. I was probably Davy Lee’s best customer. Now I have a meal from there once in three months, at most, and it is “no Coke here”. I have no sweet drinks whatsoever.

The issue of alcohol-related harm is not ring-fenced for people with alcoholism, or any specific age group. It is a UK-wide problem across classes, genders and race, and we need a better way to address it. We look to the Minister for a helpful response. I concur with the comments of those who have spoken—and probably those who will speak after me—in that we need to address the issue not only in England but in Scotland, Wales and Northern Ireland, from where I have got my statistics and information.

Across the United Kingdom, 80 people a day die because of alcohol, and that statistic has to change. In Northern Ireland there were more than 11,000 hospital admissions due to alcohol in 2016-17. Across the UK 33 people a day are diagnosed with an alcohol-related cancer. There is a high cost to those numbers, and it is not only medical and physical; it is emotional and affects families. Healthcare costs associated with alcohol in Northern Ireland are estimated at £122 million, and alcohol is strongly linked to health inequalities there. We can see that it is, in our offices and advice centres. The rate of alcohol-specific deaths is more than three times higher in Northern Ireland’s most deprived areas than in its least deprived areas. I see that in my office every day, as I am sure you do, Mr Paisley. I see families who are broken by alcohol, by verbal and physical exchanges, by the effect on children, by abuse, marriage break-up, despair and sadness.

Shockingly, alcohol is involved in 40% of violent crime in Northern Ireland. I understand that the relationship between alcohol and domestic violence is complex, but research finds that between 25% and 50% of perpetrators of domestic abuse have been drinking at the time of the assault. The figure is as high as 73% in some studies. I concur with what my hon. Friend the Member for East Londonderry (Mr Campbell) said in reference to the coronavirus and the steps that the Government have taken. I welcome what the Government have done and urge everyone everywhere to focus on the directions and rules laid down by the Prime Minister and the Government. As my hon. Friend said, if there is no sport or social interaction during the coronavirus outbreak, people will be at home—perhaps for 24 hours a day, if they are struck down with the virus. There is potential for all sorts of problems and, let us be honest, people will probably go to the off-licence—or someone will go for them—and buy drink in. They will consume alcohol at home. I am not a prophet, nor the son of a prophet, but I can see great potential for issues to arise from that.

It is for that reason that I support the calls by the Alcohol Health Alliance UK for minimum pricing. In its words:

“The cheaper alcohol is, the more people drink, and the more harm is caused. One of the reasons why alcohol harm has been rising is because alcohol has become much more affordable over the last few decades. It is possible to buy a bottle of…cider, containing the same amount of alcohol as 19 shots of vodka, for as little as £3.70.”

That is someone’s high for under a fiver. The alliance states:

“The most effective policy to tackle such cheap high-strength drinks is minimum unit pricing (MUP). By setting a floor price linked to the amount of alcohol in a product, MUP targets the cheapest drinks which are linked to the most harm, while having minimal impact on moderate drinkers or on pub and restaurant prices.

MUP was introduced in Scotland in 2018 and in Wales in March 2020. The early evidence from Scotland is very encouraging”.

I often look to Scotland for the direction it is taking on health issues. Particularly in this case it has shown what the rest of us can do. The alliance says that

“off-trade alcohol sales fell by 3.6% in the year following MUP; in England and Wales, they rose by 3.2% over the same time. The minister of health in the Republic of Ireland has recently written to the Northern Irish executive regarding implementing MUP on both sides of the border”.

I fully support that, and I urge the Northern Assembly to take that action and to do it as soon as possible.

It is essential that Northern Ireland, the part of the United Kingdom with the second highest rate of alcohol-specific deaths, is not left behind. I want to see minimum unit pricing in Northern Ireland. For the protection of health in my country, I stand by these calls, Mr Paisley, as I know you will, too, and I urge the Minister to consider how we can help to minimise alcohol harm without adversely affecting our hospitality sector, which is vital. If people drink in moderation, that is okay, but we are talking about those people who do not do it in moderation. That is why this debate is so important.

I look forward to hearing the Minister’s response and I thank the hon. Member for Congleton again for bringing this matter forward. Her desire to help to make homes and communities stronger and happier by reducing the harm caused by alcohol is something that is close to my heart, close to my chest and close to the person that I am.

It is a pleasure to speak in this debate. I wanted to take part in it because alcohol harm has been a live issue in Gateshead and the rest of the north-east for a long while. Across Gateshead, which covers my community, the admission rate for alcohol-related conditions in 2010-11 was 817 per 100,000, compared with 643 for England as a whole. However, when we look at 2018-19, the latest year for which we have figures, we see that the rate had increased by 28% compared with an all-England increase of 3%. Admission rates for alcohol-related conditions now stand at 1,045 per 100,000 for Gateshead, compared with 664 per 100,000 across England.

I will talk specifically about minimum unit pricing, as other colleagues have done. Sheffield University research shows that if there was a minimum unit price of 50p per unit, there could be 8,000 fewer deaths, 14,000 fewer hospital admissions and 21,000 fewer crimes related to alcohol consumption every year. The impact of minimum unit pricing would be greatest in the most deprived areas, even though—this point is really important—people in those communities do not necessarily consume larger amounts of alcohol. Nevertheless, nine out of 10 alcohol-related deaths in those areas could be prevented.

I will also say a little about the impact of pubs, because most Members will have been lobbied very strongly by constituents, as I have been, as part of the Long Live the Local campaign, especially in the run-up to the Budget. I agree with the idea behind Long Live the Local. In fact, I will declare an interest, as a community shareholder in the community pub in the village where I live, Ye Olde Cross; we won an award recently for saving our pub. However, having made that plug, pubs seriously have an important role to play in the community.

Evidence already mentioned by the hon. Member for Congleton (Fiona Bruce) shows that minimum unit pricing would have little impact on pubs, as the minimum unit price is aimed at the strongest and the cheapest alcohol. Across the UK as a whole and more specifically across the north-east of England, where my constituency is, 48% of pub managers support minimum unit pricing, because they are competing with cheap, shop-bought alcohol that is consumed at home or while people are out and about.

I want to be clear that to resolve this issue, we should not simply point the finger at individuals; this is a public health issue and it must be tackled as such. For many people, it is linked to poverty, poor social conditions and lack of opportunity, so we need to take a holistic approach to resolving it, and minimum unit pricing is one element of that approach.

I am sure that the Minister knows what I am about to say—we need to restore public health funding. We also need to ensure that public health directors know what their funding is, so that they can provide the appropriate services, as a matter of urgency.

As other Members have said, minimum unit pricing must be part of a wider strategy. I urge the Minister to consider minimum unit pricing as an important part of that strategy along with marketing, which makes alcohol more attractive.

I thank colleagues at Balance North East for their research and for working with me on this issue. I also want to say that this is not about completely stopping people drinking; that is a personal choice. It is about ensuring that the odds are not stacked against people who may find it difficult not to drink to excess.

I am pleased to be participating in this debate. I begin by paying tribute to the hon. Member for Congleton (Fiona Bruce) for giving us a very thoughtful and comprehensive opening to the debate. I begin also by saying that people have mentioned the effect of being isolated at home because of the coronavirus and that it is worth bearing in mind, as we go through this crisis, that drinking alcohol lowers the body’s immunity.

We have heard a lot today about the damage of alcohol over-consumption. The cost to our families, our communities and ourselves is almost incalculable. It cannot be counted in pounds and pence, although very often we are forced to do that, for practical reasons. Alcohol abuse leads people to lose their homes, families and jobs. There is a cost in hospital admissions, perhaps on numerous occasions, and people may even end up encountering the criminal justice system. Victims of alcohol abuse become economically inactive. They often become absent parents. The damage to mental health and physical and emotional wellbeing is profound.

I remember standing in this Chamber a couple of years ago to speak on alcohol abuse. A number of us involved in that debate were willing to admit that we came from homes with an alcoholic parent. My father was by all accounts an alcoholic, although I never knew him, as he died when I was 15 months old—he was very much helped on his way by alcohol. The damage to my family was not insignificant. My husband’s father was also an alcoholic and died because of the demon drink. These stories are not unusual; in fact, they are far too common. Almost every person we meet has a family member or knows someone who is an alcoholic. That is very sad, but it is a fact of life. However, that does not mean that we cannot turn things around. It does not mean there are not measures that we can take and, in Scotland’s case, have already taken to combat this problem. There is no silver bullet, but much can be done to mitigate the harmful grip that alcohol has on our communities. In the round, a number of measures can be taken.

In Scotland, 686 hospital admissions and 22 deaths every week are due to alcohol. In 2018, the figure for alcohol-specific deaths was 1,136. In 2018-19, there were 35,685 alcohol-related hospital admissions in general acute hospitals. Worryingly, hospital admissions are still more than four times higher than the level seen in the 1980s. Clearly, in Scotland, we could not simply shrug our shoulders and tolerate that. We tried to turn the situation around. I am pleased that the SNP Government chose to use the powers at their disposal to tackle the level of alcohol harm suffered by our communities, at great cost to those communities, on every single measure.

The hon. Member for Congleton pointed out the need for England to have a revised or updated alcohol strategy, and she is correct to say so, as the current one is out of date. Indeed, the Scottish Government updated their own alcohol strategy in 2018.

I could stand here today and talk about the fact that the Scottish Government have invested almost £800 million to tackle alcohol harm and drug use since 2008 and will allocate a further £95 million next year to reduce the harms caused by alcohol and drugs. I could mention—indeed, I have already alluded to—the Scottish Government’s alcohol framework setting out 20 actions that build on existing measures to change Scotland’s relationship with alcohol. I could even mention the legislation introduced by the Scottish Government to ban irresponsible alcohol promotions, such as the multi-buy discounts in supermarkets.

Will the hon. Lady give way?

I am worried about time, so I will press on, if that is okay.

That legislation was associated with a 2.6% reduction in consumption in the 12-month period following its introduction from October 2011. The hon. Member for Henley (John Howell) might be interested to know that in 2014 Scotland reduced the legal alcohol limit for drivers from 80 mg to 50 mg in every 100 ml of blood. That reduction has not been made in the rest of the UK, which, apart from Scotland, currently has the joint highest levels in Europe that are permitted for driving. I could mention a whole range of measures—

The hon. Lady has another six minutes. She does not need to feel that she is rushed.

Okay. I will give way briefly.

I compliment the hon. Lady and particularly the Scottish Parliament on what they are doing. The hon. Lady has outlined a blueprint for the whole of the United Kingdom of Great Britain and Northern Ireland. We should all take note of it and let it be our blueprint for Northern Ireland, Wales and England.

I thank the hon. Gentleman for his comments. As I will go on to say, there is no room for complacency in any part of the United Kingdom. There are things that work that every part of the United Kingdom should implement, and the UK should continue to review them to see how the measures can be improved.

All the measures that have been taken, on their own merits and collectively, represent real action and commitment to dealing with the scourge of alcohol on our communities. Many of them were set out by my hon. Friend the Member for East Lothian (Kenny MacAskill), who has significant insight into the issue from his role as Cabinet Secretary for Justice in the Scottish Government. There has been broad agreement today that minimum unit pricing for alcohol is the single most significant action that can be taken to tackle alcohol harm, as we have seen in Scotland, but it is not a silver bullet. Nothing is, and nothing ever will be. As my hon. Friend the Member for East Lothian reminded us, it is part of a package of measures and must be seen in that context. I urge the Minister to emulate that measure in England in order to benefit the communities that many Members in this Chamber represent.

When it comes to the strongest drinks on the market, in England we can buy cider for 18p, lager for 23p, vodka for 36p and wine for 38p—I am talking about units, not bottles. Minimum unit pricing was introduced in 2018 in Scotland. Shamefully, the policy was delayed for several years as the alcohol industry dragged it through every court it could find to stop it or delay its implementation for as long as possible. Studies indicated that there would be around 121 fewer deaths a year as a result, and there would be a fall in hospital admissions of just over 2,000 a year by the end of year 20 of the policy.

It gives me no pleasure to say that the initiative sadly met more blocks during its passage through the Scottish Parliament, as Opposition parties opposed it purely on the basis that nothing the SNP Government introduced could ever be supported. Although that is the usual response to any SNP policy in the Scottish Parliament, eventually the Tories abandoned their absurd opposition. Labour, however, simply could not bring itself to do so because it was an SNP initiative. The Labour party argued and argued against it and grew more ridiculous with every word. In the end, unable to support it even in the face of overwhelming evidence that it would be a key weapon in the battle against alcohol harm, Labour contented itself with abstaining on the issue. I know that many Labour MPs from other parts of the UK looked on at their Labour colleagues with bewilderment at what was going on—not for the first time, and probably not for the last. Willingness to put narrow party politics before public health is one of several reasons why the Labour party in Scotland is completely adrift. Some issues go far beyond party political lines.

The evaluation of the first year of alcohol minimum pricing has been very promising. As the first country in the world to introduce such a measure, we saw off-trade sales per adult in Scotland fall by 3.6% in the first year after implementation. In the same period in England, there was a rise of 3.2%. There was an 18.6% fall in off-trade cider sales per adult in Scotland in the year following minimum pricing, and an 8.2% rise in sales in England and Wales. There is still more to do, and there can be absolutely no complacency.

A 50p per unit price provides a proportionate response to tackle higher-risk alcohol use. We know there is a proven link between consumption and harm, and that minimum unit pricing is the most effective and efficient way to tackle the cheap, high-strength alcohol that causes so much harm. Going back to the comments made by my hon. Friend the Member for East Lothian, the World Health Organisation said that tobacco education was not, and could not be, as effective as regulation and Government action. We need to remember that when we seek to tackle alcohol harm.

People in Scotland still buy 9% more alcohol per head than those in England and Wales, but that gap is closing because of growing sales of alcohol in England and Wales last year. A 50p minimum unit price is no longer sufficient, because after it was brought in in 2012, the implementation of the policy was delayed by court action for years after the 50p level was set. It is time to explore raising that unit price to 60p, because it has to be set at a level where it is effective; it is not there for some kind of virtue signalling. A 60p minimum unit price seems reasonable to me.

I urge the Minister to carefully examine the action that has been taken in Scotland to tackle alcohol harm. It is a basic economic fact that if the price goes up, consumption goes down, and if the price goes down, consumption goes up; it is not rocket science. There are no silver bullets for tackling this issue, but there is some good practice in Scotland. Scotland, as well as England, has to build on what we already know and what we are already doing. I urge the Minister to emulate this practice for the good of the families and the communities who live with this scourge every day, and who need action.

It is a pleasure to serve under your chairmanship, Mr Paisley, and I congratulate the hon. Member for Congleton (Fiona Bruce) on having secured this debate. It is always a pleasure to hear from a fellow Cheshire MP, and she introduced the subject extremely well. She was right to say that this is an extraordinary time, but when we hopefully get through the current crisis, the issue of alcohol harm will still need to be tackled. She was also right to say that as we face this crisis, there is an increased risk that long periods of self-isolation will lead to excessive drinking. I know there is tremendous pressure on the Department at the moment, but I hope that important point will be considered. The hon. Lady has also described the importance of integrating the loneliness and social prescribing agenda into alcohol support strategies.

We also heard from the hon. Member for East Lothian (Kenny MacAskill), who brought his own experience to bear on this matter. He was clear that affordability, availability and advertising are the key ways in which to tackle this issue, and that education on its own is not enough; he was also right to identify off-sales as a trend that needs looking at. The hon. Member for Henley (John Howell) made some interesting points about drink-drive limits and also raised the issue of drinking before conception—before the period of pregnancy—which we do not talk enough about at the moment. As always, we heard from the hon. Member for Strangford (Jim Shannon), who discussed in detail the history of his eating habits, raising an important point about moderation and controlling temptation that can be applied equally to this area. He also clearly highlighted the social difficulties caused by excessive alcohol consumption.

We also heard from my hon. Friend the Member for Blaydon (Liz Twist), who spoke mainly about minimum unit pricing. She talked about the benefits that the University of Sheffield’s study demonstrated such pricing could create, and made the interesting point that 48% of publicans support minimum unit pricing, which we do not always appreciate. She was also right that a holistic approach needs to be taken to alcohol harm, which is a point that most Members touched on to some extent.

Every year, thousands of people die because of alcohol consumption and many more people are harmed. This is an issue that goes beyond the individual and affects the whole of society, including their family and their whole community. The statistics we have heard this morning are shocking, and I make no apologies for repeating some of them, because they are worth repeating. Alcohol is the leading risk factor for death for 15 to 49-year-olds in England, and eight people die every day due to alcohol. Alcohol-related hospital admissions are at a record high, having risen by 44% over the past decade. In 2018, there were 1.1 million admissions to hospital related to alcohol use. Every day, 33 people are diagnosed with one of seven types of alcohol-related cancer, and liver disease is a major and increasing cause of death. It causes about 2% of all deaths in the UK every year, having increased by a shocking 400% since 1970.

Those numbers come at a high cost. Alcohol costs NHS England £3.5 billion annually, and 25% of A&E workers’ time is spent dealing with alcohol-related incidents. It is also reckoned to cost the economy £1.2 billion to £1.4 billion annually. In total, over 10 million in the UK consume more than the recommended levels of alcohol.

As we heard, 2 million people have an alcohol-dependent parent; at least 200,000 children live with at least one alcohol-dependent adult. According to the Children’s Society, parental alcohol abuse damages the lives of 700,000 teenagers across the UK. More than 4,000 children a year contact Childline with concerns about their parents’ alcohol use—it is the most common reason for children to call about their parents. We know from previous debates about the adverse childhood experiences of growing up with a parent with alcohol or substance misuse, which can have lasting, and sometimes devastating, impacts on children. We hear about them having to fend for themselves, when they have no option but to take on as best they can the adult responsibilities foisted upon them.

Children themselves may get into a similar spiral. One in three diagnosed mental health conditions in adults is known to directly relate to adverse childhood experiences. The World Health Organisation outlines a cycle of violence, because alcohol and substance misuse impacts on children’s lives, with a devastating impact on their adulthood.

My hon. Friend the Member for Leicester South (Jonathan Ashworth) has campaigned passionately on these issues; he is clear that alcohol addiction is a public health issue and is strongly linked to health inequalities in England. The rate of alcohol-specific deaths is more than double in the most deprived areas compared with the least. Tackling alcohol harm is a key route to increase the health of our nation, to reduce health inequalities and to reduce pressure on our public services. That means investment in those services, focus on prevention and challenging the wider circumstances and social determinants of ill health, including addiction. We struggle with that at the moment, because alcohol services continue to be cut because of public health spending reductions of around £700 million, including addiction services cut by £162 million. That has an impact; we heard from my hon. Friend the Member for Blaydon that local authorities still do not know their public health allocation for next year, despite it coming into force in two weeks’ time.

We must fund alcohol treatment services fully; the hon. Member for Congleton highlighted that 88% of those who need services in Cheshire East are not getting that support. Unless we take this issue seriously, that figure will not improve.

I want to say a few words about workforce. Whenever we talk about health issues, there are always workforce implications. The number of training posts in addiction psychiatry has decreased by 60% since 2006. In 2017, the Royal College of Psychiatrists census found that the NHS had 20% fewer consultant addiction psychiatrist posts than four years previously. Obviously, that has an impact on frontline staff, and there is less one-to-one client contact, which is vital. We must improve co-ordination and partnership working with mental health services. Too many people who experience addiction problems also experience mental health conditions such as depression, anxiety or schizophrenia. Yet just one in four people with a diagnosed mental health problem in substance treatment also receives mental health treatment. We have talked many times about the need for mental health to get parity of esteem.

The Government’s alcohol strategy in 2012 devoted just two paragraphs to recognising the link between co-morbidities of alcohol problems and mental health. That simply is not good enough. Dual diagnosis must be the expectation, not the exception. Just as we need to do more to improve recovery and addiction services, we need to be bolder on prevention and population health interventions. We have a proud record on bringing down smoking rates, because we have taken decisive action. We need to do the same with alcohol abuse; it must be at the heart of the prevention agenda.

There are three areas that should be included—transparency on alcohol labelling, pricing, and prevention and marketing. Unfortunately, there is not time to go through all those in much detail, but I know that the Government committed to a new prevention Green Paper and updated alcohol strategy. While I appreciate that the Department has huge pressures on it at the moment, it would be helpful if the Minister gave us an indication of when we might expect to see that, if she is able to, because that will be the key to making progress on those issues in the future.

I thank the Minister for giving way and for stepping in to respond to the debate. She said that most people drink responsibly, but Drinkaware’s statistics, which are very worrying, show that 49% of men are classified as increasing or higher risk drinkers compared with 31% of women. That is a very high percentage.

I listened carefully when the Minister said that the Government currently have no plans to implement minimum unit pricing. In the light of that, and given the funding and investment she talks about that will deal with the consequences of alcohol addiction, does she agree that tackling the consequences is less effective than tackling the problem at source? Cider and some of the highest content alcohol is on sale in shops in England for less than a bottle of water or a pint of milk. Does she agree that making alcohol a little bit more expensive could have an impact?

I urge the Minister to contact each of the regional devolved Administrations, in Scotland, Northern Ireland and Wales. It would be a good idea for interaction with those three regional Administrations, to gauge a universal policy for the whole of the United Kingdom of Great Britain and Northern Ireland and to take all the evidence from other parts of the United Kingdom, which could gel a strategy that we could all agree on. That would be a substantial way forward.

I thank the Minister for Care for stepping in to respond to this debate. I also want to thank my hon. Friend the Member for Henley (John Howell), the hon. Members for East Lothian (Kenny MacAskill), for Strangford (Jim Shannon), for Blaydon (Liz Twist), for North Ayrshire and Arran (Patricia Gibson) and for Ellesmere Port and Neston (Justin Madders) for their contributions.

It is very rare that we hear in this place such a united voice from Members of Parliament from all political parties, but we did so today, because we recognise that alcohol harm is a major threat to our country’s wellbeing. It is a blight, particularly on the lives of the most vulnerable—the youngest and those in many of our most deprived areas. Wider society, too, is paying an incalculable toll. What came across again and again in the debate was that, although all the initiatives that we have heard from the Minister are good and we are grateful for them, much more needs to be done. Alcohol harm must be elevated in the national prevention agenda. A distinct and separate alcohol harm strategy is essential.

Question put and agreed to.

Resolved,

That this House has considered tackling alcohol harm.