Alcohol Harm Commission: Report 2020

Question for Short Debate

Asked by

To ask Her Majesty’s Government what assessment they have made of the report by the Commission on Alcohol Harm 2020 ‘It’s everywhere’—alcohol’s public face and private harm, published on 14 September 2020.

My Lords, I had the privilege of leading a group of 16 experts to investigate one of the most pressing issues of the day: the harm caused by alcohol. I extend my sincere thanks to each of those 16, who gave their time and expertise so generously in their dedication to reducing alcohol harm. The findings of the Commission on Alcohol Harm were stark. One cannot overstate the sheer scale of the harm caused by alcohol every day to individuals, those around them and society. Alcohol is linked to 80 deaths every day across the UK and, most worryingly, it kills people when they are young. Alcohol is responsible for more years of working life lost than the 10 most frequent cancers combined.

However, the commission found that alcohol harm extends beyond health. We heard a great deal about the impact on families: 200,000 children are estimated to live with an alcohol-dependent parent, making them five times more likely to develop eating disorders and three times as likely to consider suicide. Some children are harmed even before they are born. Exposure to alcohol in the womb can cause foetal alcohol spectrum disorder, a lifelong developmental condition found in up to 17% of UK children.

The links between alcohol, violent crime and anti-social behaviour are strong. Alcohol fuels almost 40% of violent crimes and half of domestic violence. Drunk-driving causes almost 9,000 casualties and 260 deaths a year. Police Sergeant Mick Urwin told us that

“delivering a death message to a parent, brother, sister, son or daughter to inform them that someone has been killed by a drink driver is not something I ever got used to”.

The burden falls on all society, particularly public services. There are 1.26 million alcohol-related hospital admissions annually and alcohol costs the NHS £3.5 billion. The cost of alcohol-related crime is even higher, at £11.4 billion per annum. That is why sentencing to alcohol abstinence and monitoring is so important, with its high compliance rate allowing people to face and tackle their harmful drinking, and it has been shown to decrease repeat offending.

The extent of these harms is truly shocking but is no surprise, as alcohol is ubiquitous. That is why we titled the commission’s report It’s Everywhere—a quote from a witness. We heard how alcohol is all around us: at social gatherings, on TV, in supermarkets, card shops and the workplace, and at all times of day or night. People told us they could not escape from alcohol; “relentless” was a word we heard repeatedly. Although national consumption has fallen from 2004’s historical high, especially as more young people abstain, the increases in measures of harm and deaths persist.

Alcohol’s harm is often hidden in plain sight, leaving people to deal with it alone, unsupported. The stigma of harmful drinking makes people conceal their problem. Children instinctively understand that they are expected to keep quiet about their parents’ drinking. To quote another witness:

My Lords, I am most grateful to my noble friend Lady Finlay for her powerful introduction. I declare an interest as one of the members of her commission, which she so admirably steered to producing such a wonderful report.

In the limited time that we have, I want to focus on calories. I have been banging on about calories since the Labour Government were in power and about the need for calories to be shown on labels for alcohol. Why is the drinks industry exempt from telling people what they are consuming and what it might do to them?

I am pleased that we are starting to make some progress. There is a firm recommendation in this report and I hope that the Minister will be positive. One of the old excuses for why we could not do anything was that we were in the European Union and legislation and regulations there prevented us from acting unilaterally. We have now come out of Europe and we now have the freedom to do as we choose. I look to see whether the Minister will take sides on this issue, now that he has the freedom to do so, if required.

I had a useful conversation this morning with Sir Keith Mills, who has been appointed by the Prime Minister to review the way in which incentives might be used to encourage people to reduce their weight and exercise more. He is looking at new technologies; there are some developments taking place that are of some significance. I see that the Minister is nodding in agreement, so perhaps when he comes to respond he might say a little more about that. A change would allow an app, on our mobile or on our wrist, to tell us, for all items that have calories marked on them, just what we are purchasing. We would know what is in our shopping basket while still in the supermarket. That would be a big change. We should not permit the drinks industry to be exempt from that change.

I hope that the Minister will assure us that the consultation will be concluded soon and the Government will come out with a strong indication that, for the first time ever, we will have formal labelling on alcoholic drinks.

My Lords, I declare an interest as co-chair of the All-Party Group on Liver Health, for which this is a very relevant debate. I thank the noble Baroness, Lady Finlay, for all her work in this field.

What do we need to make inroads on this problem? Obviously, first, we need better access to treatment. Secondly, Scotland’s minimum unit pricing saw a net reduction in off-trade sales by 4% to 5% in its first year. That is worth while, but it is not enough in itself.

Recent research by Cardiff University—I declare an interest as chancellor of that university—has demonstrated the link between food purchases and alcohol purchases. Buying the food for our meal literally prompts us to pick up the bottle of wine or beer from the next aisle of the supermarket. This research suggests that food and alcohol sales need to be separated and not part of the same trip to the till. Many other countries do this. I recall that in Australia the same supermarket sold both sets of items, but you went to a totally separate section and paid a separate bill for the alcohol. Finland, Sweden, Canada and some parts of the US apply similar rules. The Government should explore this.

We need further controls on the advertising of alcohol. Finally, we need more information on labels and when we buy alcohol in the pub. If we buy a lemonade or crisps or a bar of chocolate, we know the calories and contents. When we drink a glass of wine, we deserve to have access to the same information on calories and the number of units.

My Lords, as another of the commissioners, albeit a rather absentee one, I am grateful to the noble Baroness for instigating this debate and to all those who participated in the report either as witnesses or by taking evidence. Its findings were powerful and worrying.

The noble Baroness, Lady Finlay, and I worked together in 2011 to persuade the Government to legislate for compulsory sobriety tagging for alcohol-related crimes. The alcohol abstinence and monitoring requirement, which checks offenders’ intake every 30 minutes, was piloted successfully and is now rolled out across the country. There is a clear connection between problematic alcohol consumption and crime, particularly heavy drinking or binge-drinking and violent crime. The most recent findings, from the Crime Survey for England and Wales in 2018, estimate that the proportion of violent incidents where the victim believed the offender to be under the influence of alcohol was 39%. The estimated total social and economic cost of alcohol-related harm in 2018 was £21.5 billion.

Reducing alcohol-related crime will mean fewer victims, save taxpayers’ money and have a positive impact in communities and on individuals. The legislation to introduce this solution to alcohol-related crimes took more than 10 years from conception, when Boris Johnson as Mayor of London first asked for it, to final implementation. It is a common-sense, effective, value-for-money solution. Why did it take so long?

In the time I have left, I, like others, commend the Government for their commitment to calorie labelling of alcoholic drinks as part of the obesity strategy. Polling shows that the UK public are overwhelmingly supportive of health and nutritional information on alcohol labels. It is clearly absurd that alcohol-free beer, for example, shows nutritional information but ordinary beer does not. This has to change. It is another common-sense, effective policy and I urge the Government to stick to their plans.

My Lords, I chaired a committee for the Home Office in 1987 on young people, alcohol and crime. Many of the recommendations in this report, ‘It’s Everywhere’ - Alcohol’s Public Face and Private Harm, are similar to those in the 1987 report.

After the report in 1987, I learned that advertising for the alcohol industry is powerful, vigorous and effective. To balance that, it is vital that there should be a forceful, effective education policy to alert everyone, especially the young, to the dangers of unwise drinking. I had two goddaughters who died of alcohol harm, and my mother-in-law, who was an alcoholic, also died early. I spent many years working with young offenders and alcohol was one of the problems involved their lives. Alcohol causes so much violence and family stress.

Recently, university students have died after rugby initiation drinking games. It appeared that they did not know of the dangers associated with drinking large amounts of alcohol over a short period of time. There should be far more forceful warnings about the dangers of excessive alcohol consumption across the country if we want to save lives. I thank my noble friend Lady Finlay of Llandaff for this report and I hope that the Government respond positively.

My Lords, I too congratulate the commission on its work in highlighting the harm caused by the abuse of alcohol. I wish to focus my brief remarks on the relationship between alcohol and domestic violence.

The statistics make this clear. Home Office figures indicate that alcohol is involved in up to 50% of cases of domestic abuse, as we were informed earlier by the noble Baroness, Lady Finlay. Though not necessarily a direct cause, it is frequently a significant contributary factor. What is more, when alcohol is involved, the abuse affecting children, as well as adults, is more likely to be serious, increasing the risk of physical, emotional and psychological harm. This has, of course, been a particular problem during the last year with the various restrictions that have been imposed to counter the coronavirus pandemic. The commission’s findings on this, as well as several other types of harm, must surely cause Her Majesty’s Government to rethink the statement made in January 2020 that they

“are not planning a stand-alone strategy”—[Official Report, 21/1/20; col. 1043.]

for alcohol. It would complement, rather than cut across, proposals made in the NHS Long Term Plan.

The commission strongly recommends a strategic approach that would not only address the link between alcohol abuse and domestic violence but take into account some of the factors that frequently accompany harmful alcohol consumption. These factors include educational exclusion, social deprivation, financial distress, employment worries and psychological pressures. I wholeheartedly commend the commission’s proposal that the domestic abuse commissioner role, which is being created as part of the Domestic Abuse Bill, must have a duty to have regard to the link between alcohol and domestic abuse in its work.

My Lords, introducing minimum unit pricing for England was a key recommendation of the commission. A strong evidence base for this was provided by a wide range of organisations, including the Children’s Society, the Association of Directors of Public Health, Cancer Research UK, the British Medical Association and several local authorities. A 50p minimum unit price in England has been estimated to lead to almost 22,000 fewer hospital admissions and 525 fewer deaths per year when in full effect. This would save the NHS £1.3 billion annually. As hospitals deal with the consequences of Covid-19, freeing up capacity is essential. People who live in poverty are more vulnerable to the effects of alcohol abuse. It is estimated that nine in 10 lives saved by minimum unit pricing would be from low-income groups. Yet the spokespeople for some business groups and right-wing organisations oppose minimum unit pricing, citing their previously rarely expressed concerns about poverty, when their real concerns are simply about profits. We need to remember that alcohol has a major impact on the public’s health.

Alcohol can cause over 200 conditions including cancer, heart disease, liver disease, stroke and mental health problems. When I asked a Question about this issue three years ago, the noble Lord, Lord O’Shaughnessy, then the Health Minister, cited evidence that

“in 10 years, minimum unit pricing could on an annual basis reduce alcohol-related deaths by 356, alcohol-related hospital admissions by 28,515, and crime by 34,931 crimes.”—[Official Report, 28/2/18; col. 654.]

But we were told to wait for more evidence from Scotland and elsewhere. We now have that evidence. The policy is working in Scotland; it is being introduced in Wales. We should not have to wait any longer in England.

My Lords, I add my thanks to those offered to the noble Baroness, Lady Finlay, for initiating this debate. I refer the Committee to my interests as set out in the register.

I want to make just one quick point today: my belief that we need to be more careful about how we talk about the negatives of consuming alcohol and the need to be balanced in the advice given. Throughout this pandemic, we have seen the effects which lower socialisation has had on people’s health and mental health. I have always believed that a society which socialises together is stronger and healthier. Although alcohol does not have to be integral to a healthy social life, moderate alcohol consumption undoubtedly plays a large part in British culture and the social lives of many millions of people who enjoy pubs, clubs, bars, restaurants or indeed entertaining at home.

It is widely acknowledged that the comments made by the previous Chief Medical Officer, Dame Sally Davies, when she said that women should think about the risk of breast cancer every time they reach for a glass of wine, were misjudged. They were ultimately rebutted and reworded, but the horse had already bolted. Another, more recent example is from Drinkaware, which advised people getting their Covid-19 jabs not to drink in the two days before the jab and for up to two weeks afterwards. That advice then had to be dismissed by Ministers and the UK’s Medicines and Healthcare products Regulatory Agency, not least because not one study has tested any correlation between alcohol and the efficiency of either of the vaccines on offer in the UK today, a fact that even Drinkaware acknowledged.

Questions should be raised with Drinkaware about how this irresponsible advice could ever have been given, not least by the drinks industry, which for some reason continues to fund it. The problem caused by this type of nonsense advice is that it helps create a sense that all advice on alcohol consumption is nonsense. It undermines sound and sensible advice given by Governments and related health industries. Yes, of course overconsumption of alcohol is unhealthy, but our modern-day temperance movement needs to temper creating fear and to start acknowledging that most people have common sense and just enjoy a modest drink.

As the noble Baroness, Lady Boycott, has withdrawn, I call the next speaker, the noble Baroness, Lady Fox of Buckley.