Westminster Hall debate on Alcohol Harm - Feb 2

Fiona Bruce (Congleton) (Con) 

I beg to move,

That this House has considered tackling alcohol harm.

It is a pleasure to serve under your chairmanship, Mr Flello, and to speak on the importance of tackling alcohol harm. It is a measure of the concern across the House that there are not one but three all-party parliamentary groups concerned with alcohol harm. It was the three chairs of those APPGs who applied for the debate: myself, as chair of the APPG on alcohol harm; the right hon. Member for Birmingham, Hodge Hill (Liam Byrne), who chairs the APPG on children of alcoholics; and the hon. Member for Sefton Central (Bill Esterson), who chairs the APPG on foetal alcohol spectrum disorder. I will leave it to those Members to speak of the harm caused to children and unborn children through alcohol consumption, but as vice-chair of those two APPGs, may I commend and say how much I fully support their work?

We are all here to express, with one voice, our gravest concerns about the harm caused by alcohol consumption to individuals, their families and wider society. As we will hear, one thing is clear: the Government’s alcohol strategy, which is now five years old, must be reviewed. Urgent and much more robust Government action is needed to address the devastating damage caused by alcohol harm. It all too often harms innocent bystanders, whether those injured in road traffic accidents, children and partners caught up in domestic violence, patients needing treatments for serious illnesses—they have to wait because precious NHS resources are being used to tackle the issue—and taxpayers, through the tax bill we all pay.

This is not about saying that people should not drink—like many other hon. Members here, I enjoy alcohol—but about promoting responsible drinking and the need to change our country’s drinking culture and our relationship with alcohol. It is also very much about social justice, because the poorest and most vulnerable disproportionately suffer the most amount of alcohol harm. The Government need to wake up to the urgency of their need to take a lead on this. Urgent words were expressed in the 2012 alcohol strategy, but appropriately urgent action has sadly not followed.

The Minister will doubtless point to a few improvements in recent years, and they are welcome, although with major reservations. For example, although the number of adolescents who drink has gone down, the volume of alcohol that they are drinking has not. That sadly indicates that although fewer adolescents might be drinking, those who do are drinking to excess. A 2012 YouGov report revealed that 41% of 18 to 24-year-olds are drinking at harmful levels. We also hear reports of women of a certain age—around my age—drinking too much, and even of much older people struggling with alcoholism as they try to cope with loneliness and isolation.

The fact is that there is a massive problem in this country resulting from alcohol consumption, both excessive and just above Government guidelines. To evidence that, I refer to the Public Health England report, published in December 2016 at the specific request of the former Prime Minister, David Cameron, entitled, “The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An evidence review”. It cannot be dismissed as just a thought piece; it has more than 200 pages of evidence-based information and conclusions, has been robustly peer reviewed no less than three times and was produced by Public Health England—an executive agency of the Department of Health that

“exists to protect and improve the nation’s health and wellbeing”.

The report paints a bleak picture. Paragraph 1 states that

“there are currently over 10 million people drinking at levels which increase their risk of health harm. Among those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill health across all age groups.”

It continues:

“In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years… More working years of life are lost in England as a result of alcohol-related deaths than from cancer of—”

there are many of these—

“the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.”

I deliberately read that out as I wanted it recorded in Hansard.

The Institute of Alcohol Studies quotes Public Health England, stating that

“167,000 years of working life were lost to alcohol in 2015”.

That is because alcohol is more likely to kill people during their working lives than many other causes of death—that is, it causes premature deaths. In fact, there were 23,000 alcohol-related deaths in England each year. Alcohol accounts for 10% of the UK’s burden of disease and death, and in the past three decades there has been a threefold rise in alcohol-related deaths.

Kelvin Hopkins (Luton North) (Lab) 

I congratulate the hon. Lady on everything that she has said. In the mid-1970s, a Home Office report showed that Britain had the second lowest level of alcohol consumption in the whole of Europe; we have risen rapidly while the rest of Europe has been coming down. They have learned from their previous mistakes, and we ought to as well.

Fiona Bruce 

I thank the hon. Gentleman for his intervention, which reflects his long commitment to tackling the issue. I also thank him for his involvement with our all-party parliamentary group.

The NHS incurs an estimated £3.5 billion a year in alcohol harm costs. Treating liver disease alone now costs £2.1bn a year, for example. However, that is just the financial cost, which I rather suspect is an underestimate. Many other costs are incurred as a result. The all-party parliamentary group on alcohol harm recently produced a report called “The Frontline Battle”, which described the impact on the emergency services—the police, fire services, A&E departments, doctors and so on—of treating or helping people who are inebriated or suffering as a result of excessive alcohol consumption. It found that, on a Saturday night, 70% to 80% of all A&E attendances are alcohol-related.

Mr Nigel Evans (Ribble Valley) (Con) 

The hon. Lady paints a graphic picture—some cities and towns are like warzones on a Friday and Saturday night. I am the president of the all-party parliamentary group on beer. Does she agree that the Government could work with the industry? For instance, AB InBev is looking to work on lower alcohol-by-volume beers. At the moment, anything below 2.8% ABV is incentivised, yet that is less than 0.5% of the market. If the incentivised ABV rate is increased to about 3.5%, it would introduce far more choice, could lead to people drinking lower strength beer and could hopefully attract people away from some of the higher ABV beers that cause so much harm, as she has so beautifully demonstrated.

Fiona Bruce 

My hon. Friend represents Ribble Valley, which I know contains many beautiful public houses, some of which I have enjoyed visiting. I would not want any Member here to think that we in any way wish to denigrate community pubs, which we consider to be community assets. He makes a vital point and has saved me from going into detail on that, which I was going to, having been briefed by AB InBev, which has a base in his constituency.

AB InBev UK and Ireland says that the introduction of a reduced rate of duty on beers produced at an alcoholic strength of 2.8% has not had the intended impact. In fact, it is providing only 0.15% of duty receipts. The impact could be achieved if 3.5% beer was included. I very much support what my hon. Friend says. Apparently, the Treasury has said that there is an EU structures directive that might cause a problem regarding that. It is fortuitous that, following yesterday’s vote, we should not be at all put off introducing a pro-health measure, for risk of upsetting our European partners.

Mr Evans 

Apparently there is legal advice that this can be done within the current rules. If it is for the health of UK citizens, surely the British Government ought to press on and do it now.

Fiona Bruce 

I absolutely agree. I am aware of that legal advice. I hope that the Government will do so and that the Minister will take note of that.

In preparing our report, the all-party parliamentary group discovered shocking harm, particularly to people working in our emergency services. I would like to refer to evidence we obtained from an emergency services doctor, Zul Mirza, whom I commend for his work in this area. He talked about how patients coming into his wards inebriated not only can be violent towards staff, but on many occasions damage valuable equipment needed by other patients. Our report also found that over 80% of police officers have been assaulted by people who are drinking. I was deeply concerned to hear one police officer tell us this:

“There is one thing that is specific to female officers and that is sexual assault. I can take my team through a licensed premise, and by the time I take them out the other end, they will have been felt up several times.”

That is shocking.

Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP) 

I thank the hon. Lady for bringing this extremely important debate to the Chamber. Given the figures she describes, does she agree that alcohol-related aggression needs to be addressed in terms of treatment? Having worked in the criminal justice system, I agree on the wide-scale aggression that is found in A&E departments at weekends and that the police face mainly at weekends, but also on many days of the week. Given that a low number of Members have turned up to this debate, does the hon. Lady agree that politicians should be taking the issue more seriously? More politicians could probably be found in the bars of Westminster today than here in this debate. We should be addressing this problem.

Fiona Bruce 

The hon. Lady is absolutely right. It is tragic that only 6% of dependent drinkers in this country access treatment, despite it being very effective. We need to do much more to make treatment available to them.

A concerning finding of our all-party parliamentary group’s report was that many of those in the emergency services themselves are suffering from depression or are even thinking of leaving the services simply because coping with this kind of pressure day in, day out is proving too much for them. We must tackle that.

After reflecting on the many and varied aspects of alcohol harm in this country, the Public Health England report goes on to say:

“This should provide impetus for governments to implement effective policies to reduce the public health impact of alcohol, not only because it is an intrinsically desirable societal goal, but because it is an important aspect of economic growth and competitiveness.”

What does this Department of Health review recommend? It talks about tackling three things: affordability, availability and acceptability. Affordability means price; availability means the ease of purchase—in other words, the number of outlets and the times at which alcohol can be bought; and acceptability means tackling our drinking culture. I want to give other Members time to speak, so I will not talk in detail about all those things, but I will touch in particular on affordability.

I had the privilege of asking Public Health England’s senior alcohol adviser this week what his top recommendation to Government would be to tackle alcohol harm, in the light of this substantial report. Without hesitation, he replied that it would be tackling affordability and putting in place policies that increase price. The report is absolutely clear:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement. For example, an increase in taxation leads to an increase in government revenue and substantial health and social returns.”

However, since 2012 the Government have done the opposite: they cut the alcohol duty escalator. The report states:

“According to Treasury forecasts, cuts in alcohol duty since 2013 are projected to have reduced income to the Exchequer by £5 billion over five years”.

The very first recommendation in the 2012 strategy was to implement minimum unit pricing. Indeed, the most recent review states that minimum unit pricing is

“a highly targeted measure which ensures tax increases are passed on to the consumer and improves the health of the heaviest drinkers. These people are experiencing the greatest amount of harm.”

In the foreword to the 2012 strategy, the then Prime Minister said:

“We can’t go on like this… So we are going to introduce a new minimum unit price.”

Five years on, that has still not been done, while the alcohol duty escalator has been cut, even though the No. 1 policy recommendation to tackle alcohol harm in the Government’s own review is to address affordability. Will the Minister, who I know is a good woman, now take a lead on this and make it happen?

The Government introduced a ban on the sale of alcohol below the cost of duty plus taxation, but the review states:

“Bans on the sale of alcohol below the cost of taxation do not impact on public health in their current form, and restrictions on price promotions can be easily circumvented.”

Let us consider for a moment white cider products such as Frosty Jacks, which are almost exclusively drunk by the vulnerable, the young, the homeless and dependent drinkers. Just £3.50 buys the equivalent of 22 shots of vodka. The price of a cinema ticket can buy 53 shots of vodka. The availability of cheap alcohol, bought because of its high strength, perpetuates deprivation and health inequalities. Homeless hostels say that time and again the people staying with them drink these products, and many are drinking it to death.

Ciders of 7.5% ABV attract the lowest duty per unit of any product, at 5p, compared with 18p per unit for a beer of equivalent strength. There simply is no reason not to increase the duty on white cider, and 66% of the public support higher taxes on white cider. It is a matter of social justice that the Government should do that, and do it quickly. It need not impact on small, local brewing companies, which could have an exception, and it will not impact on pub sales. Tackling it would benefit the youngest and most vulnerable and save lives.

As I mentioned, the ban on below-cost sales has had no impact on sales of strong white cider. The current floor price of white cider, at 5p to 6p per unit—that is duty plus VAT—is so low that it can be sold for 13p a unit. Will the Minister ask our right hon. Friend the Chancellor of the Exchequer to increase the duty on white cider in the spring Budget on 8 March? This is not the first time that has been asking. Three hon. Members —my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) and I, and no less a person than the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston)—tabled an amendment to the Finance Bill last September, asking for the duty regime for white cider to be reviewed. I urge the Minister to read the excellent speech made by my hon. Friend the Member for Enfield, Southgate on 6 September. Indeed, my hon. Friend the Financial Secretary to the Treasury, who responded, said that the matter needed to be looked into.

Will the Minister press the Chancellor not only to work with her on that, but to introduce the promised minimum unit price and reintroduce the abandoned alcohol duty escalator, so that the tax system not only tackles alcohol harm, but incentivises the development of lower strength products and provides much-needed funding to help with treatment? Looking at all the evidence, we see affordability come out again and again as the most important driver of consumption and harm. Increasing the price of alcohol would save lives without penalising moderate drinkers.

Apart from tackling price, there are of course many other recommendations, both in the Public Health England report and in the APPG report, which came out a week before, that I would be grateful if the Minister would consider. I am grateful that she has already agreed to meet the APPG to discuss our report. Our chief recommendation is that the Government develop a cross-departmental national strategy to tackle excessive drinking and alcohol-related harm. Will the Minister take a lead on that?

Another key recommendation in the APPG report, which again is supported by the PHE report, is the implementation of training and delivery of identification and brief advice programmes and investment in alcohol liaison teams. I remembering hearing one suggestion for brief advice to be given whenever anyone is having their blood pressure tested. Just in those few moments, it would be effective for whoever is doing the test just to ask the individual, “How is your alcohol consumption? Do we need to discuss that?” That kind of brief intervention can make people stop and think.

We must pursue earlier diagnosis of those with alcohol problems or potential alcohol problems. There are 1.5 million dependent drinkers, only 6% of whom access treatment. Many people are just drinking in excess of the chief medical officer’s low-risk unit guidelines. In fact, Drinkaware’s research shows that 39% of men and 20% of women are drinking in excess of those guidelines. It says that nearly one in five adults drink at hazardous levels or above. Many people need help through early intervention programmes, as well as more comprehensive treatment and support. Why are we not providing that when we know that it works?

Implementing such interventions is cost-effective for the NHS. I will give a powerful example that was drawn to my attention by Alcohol Concern. St Mary’s hospital in London has trained staff to give brief advice to patients presenting at A&E. It has designed the one-minute Paddington alcohol test to identify and educate patients who might have an alcohol-related problem. That is called the teachable moment and it has resulted in a tenfold increase in referrals to the alcohol health worker, who then carries out further brief interventions, resulting in a reported 43% reduction in alcohol consumption by the people referred. That is a very effective intervention.

It is interesting to note that the Public Health England report confirms that health interventions aimed at drinkers already at risk and specialist treatment for people with harmful drinking patterns are effective approaches to reducing consumption and harm and

“show favourable returns on investment.”

However, it points out that their success depends on large-scale implementation and funding. Will the Minister look at how her Department can give a national lead to share and implement best practice in this field, such as that which I have described?

I would like to say much more on the subject, but I will turn now to the issue of drink-driving. Unpopular as it might be to talk about this in policy terms today, the Public Health England report is clear. It states:

“Enforced legislative measures to prevent drink-driving are effective and cost-effective. Policies which specify lower legal alcohol limits for young drivers are effective at reducing casualties and fatalities in this group and are cost-saving. Reducing drink-driving is an intrinsically desirable societal goal and is a complementary component to a wider strategy that aims to influence drinkers to adopt less risky patterns of alcohol consumption.”

That could not be clearer. The UK is out of line with almost all of the rest of Europe when it comes to drink-driving alcohol limits.

Liam Byrne (Birmingham, Hodge Hill) (Lab) 

The hon. Lady might have seen the statistical release from the Department for Transport, which I think came out this morning, that says there has been a statistically significant increase in the number of drivers and riders who are killed or injured while driving over the limit in the last year.

Fiona Bruce 

I have not seen that release, but I am very interested to hear of it. I hope that the Department of Health will look at that and work with the Department for Transport to review the policy. The APPG would like to see a reduction in the drink-drive limit in England and Wales from 80 mg of alcohol per 100 ml of blood to 50 mg. As we have heard, there is a direct link between increased alcohol consumption by drivers and an increased risk of accidents resulting in injuries or fatalities. The Government need to consider lowering the legal limit and possibly a further lower limit for young drivers. They also need to ensure proper enforcement and strong penalties. If we are taking stronger action against the use of mobile phones at the wheel because we know that such action will help to save lives, surely we should do that to reduce the damage from drink-driving. The signal that that would send out to reduce our drinking culture would be major.

I will close with this. During the first world war, the Government introduced controls on alcohol to help the war effort. The crisis of the war offered the opportunity to develop a national alcohol strategy. We have reached our own crisis today, and the Government must take action.

Kelvin Hopkins (Luton North) (Lab) 

It is a pleasure to serve under your chairmanship, Mr Flello, and it is an extreme pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made a superb speech. She takes a very strong lead on all the serious matters relating to alcohol, and we are grateful to her. She has also taken the lead by securing this debate, together with my hon. Friend the Member for Sefton Central (Bill Esterson) and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne). I have supported as best I can of all their efforts, and I am pleased to take part in this important debate. I admired the eloquence of the hon. Lady’s speech. Some of what I say may overlap with what she said, but I hope that that will just reinforce what she said rather than causing difficulty.

Many serious problems arise from inappropriate alcohol consumption. Alcohol is a subject about which I have been concerned since I first entered the House in 1997, shortly after which I was elected chair of the all-party parliamentary group on alcohol misuse, now the APPG on alcohol harm. Over many years I have spoken and asked questions in on the subject in the House, and I have tabled a number of early-day motions during the past 17 years, expressing concern and asking for action on the damage to people’s lives and to society as a whole that is caused by alcohol. Several of my early-day motions have referred to foetal alcohol spectrum disorders —the lifetime damage to babies caused by alcohol consumption in pregnancy. I shall speak more about that later.

Just two weeks ago, I raised concerns about alcohol in my oral question to the Prime Minister, and a little earlier I put another oral question to Ministers about Britain’s high drink-drive alcohol limits. It was disappointing that I received a most unsatisfactory, perfunctory answer to the latter question, which was little more than a brush-off. The Institute of Alcohol Studies had briefed me before that question and has again provided compelling statistics about the costs, in lives, injuries and money, of drink-driving. Indeed, it has provided today the statistics that my right hon. Friend the Member for Birmingham, Hodge Hill referred to. The total number of drink-drive accidents rose by 2% to 5,740 in 2015, there was a 3% rise in overall drink-drive casualties to 8,480 in 2014, and about 220 people are killed in drink-drive accidents each year. Going back, there were 240 deaths and 8,000 casualties just in 2013.

Our drink-driving limit is sadly higher than that in every other country in Europe except Malta. A lower limit would prevent a minimum of 25 deaths and 95 serious casualties a year—I suspect it would actually prevent a lot more. When the lower limit is imposed, as I am sure it will be at some point, rather than people perhaps having a couple of pints and thinking they are probably under the limit, the limit will be low enough to deter people from drinking at all before they drive in case they get too close to the limit. Reducing the limit to European levels would have a disproportionately beneficial effect. There is also wide popular support for a lower limit: 77% of the population, rising to 79% in towns. The limit must be reduced. In 2013, the death toll from drink-drive accidents rose by 25% in just one year.

Another serious component of Britain’s alcohol problem—especially England’s alcohol problem—is the burden on the health service, as the hon. Member for Congleton mentioned. That is another matter I have raised with the Prime Minister. According to statistics provided by the Alcohol Health Alliance UK, the NHS’s costs related to alcohol are £3.5 billion a year—the hon. Lady was absolutely right in suggesting that is probably a significant underestimate—and one in five hospital admissions are alcohol-related. In the nine years to 2013, hospital admissions related to alcohol rose by a staggering 51%.

To bring us up to date, 70% to 80% of all A&E attendances on Friday and Saturday nights are alcohol-related, resulting in a massive burden on hospital staff and resources as well as assaults on staff. I also understand from the report the hon. Lady mentioned that other patients, particularly children and elderly people, are often frightened by violent drunks on Friday and Saturday nights in A&E. Some 80% of police officers have been assaulted by people who have been drinking. As I said in my question to the Prime Minister, alcohol is heavily implicated in domestic violence and attacks on women. After that question, I was contacted by people concerned about child abuse, who again said that many cases of such abuse involved alcohol.

By far the most tragic of all the problems caused by alcohol, in my view—this view is probably shared more widely—are foetal alcohol spectrum disorders. Estimates suggest that each year some 6,000 babies are born damaged for life by alcohol consumed in pregnancy. It causes misery for those children and their families and costs the state vast sums of public money every year. In Canada, the lifetime cost to the state has been calculated as up to $3 million dollars for every child suffering from FASD. The children concerned are referred to, somewhat unkindly, as “$1 million-dollar babies”. I have a good friend who lives in Canada—a former school friend—and he tells me about the situation there.

FASD also causes learning difficulties and behavioural problems. A high proportion of people convicted of crimes and in our prisons are victims of FASD. Research by the Medical Research Council has concluded that even moderate drinking in pregnancy has an impact on IQ and learning abilities. There is no safe level, and that must be communicated to all women planning and experiencing pregnancy and, above all, to all professional medical staff. The recent report by the all-party parliamentary group on foetal alcohol spectrum disorder, which I was happy to contribute to, made strong recommendations on such information; I was pleased to emphasise the information that is required. FASD is the leading known cause of learning disabilities, and much of what is thought to be autism is actually the effects of alcohol consumed in pregnancy. The Government must wake up to the tragedy of FASD and take urgent action to ensure that all women know about it.

Again, in Canada the Government take the matter so seriously that girls are made aware of the problem in primary school. They are asked in class what they must not drink when they have a baby in their tummy, and they all say, “Alcohol.” They know about the problem. In the US and elsewhere, alcoholic drinks containers are required to have warning labels—not just a small symbol of a pregnant woman, and not on a voluntary basis. The Government warning in the US states:

“According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.”

If every woman was aware of that, I am sure that the levels of drinking in pregnancy would drop like a stone. However, women are not aware of that—even women I know have not been aware of it. I should say that my daughter-in-law did not drink at all during her pregnancies, and we have two delightful and very healthy granddaughters as a result.

Such a warning should be compulsory on all UK alcoholic drinks containers and should also be displayed in all NHS medical facilities—GP surgeries, clinics and hospitals—as well as all establishments selling alcohol. Women cannot be blamed for not knowing about the dangers, but the Government must be responsible for ensuring that in the future all women are alcohol-aware and know the dangers of drinking during pregnancy. Tackling FASD must be the priority for the Government’s alcohol policy.

Finally, we must do something to help prevent the consumption by young people in particular of strong, cheap alcohol, which the hon. Member for Congleton mentioned. It can, and does, quickly lead to addiction. In recent decades we have seen people as young as 30 dying of cirrhosis of the liver, which is quite appalling. That used to be a disease of older people, but now it is a disease of young people who are drinking vast quantities of cheap, strong alcohol.

As the hon. Lady said, minimum pricing is absolutely essential for reducing alcohol abuse and addiction. I emphasise addiction again because so many people talk about this as though it were a matter of choice. If any of us drank to excess over a prolonged period, we could become addicted. It is a serious danger. A 50p unit price would have no effect on pub prices—I am a lover of the great institution of the British pub and drink wine—but would stop the selling of vast quantities of cheap alcohol by supermarkets. In some cases, as has been reported many times, alcohol is actually cheaper than bottled water.

In recent decades Britain has had a dangerous love affair with excessive and damaging alcohol consumption. That must be stopped. Moderate and sensible consumption —as I have said, I drink myself—would not be effected. What I am suggesting would actually put a brake on the booze bandwagon, which has been out of control for some years now and has to be stopped.

Bill Esterson (Sefton Central) (Lab) 

It is a pleasure to see you in the Chair, Mr Flello. I congratulate the hon. Member for Congleton (Fiona Bruce) on leading the charge to secure this debate, and my right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) on the work he does on this subject.

If we all knew that every year in this country 35,000 children were born with brain damage that could be prevented completely, we would of course do everything in our power to prevent it. Yet worrying evidence is emerging that that may be what is happening every year, and that the figures may be going up rather than down. I want to speak about the incidence of foetal alcohol spectrum disorders, which my hon. Friend the Member for Luton North (Kelvin Hopkins) just spoke so well about, among other things. I chair the all-party group on the subject and we produced an excellent report on it just over a year ago.

The worrying sign is that the numbers of people drinking in this country in general are increasing, as we have heard, including the numbers of women. That is especially worrying. It was the culture in the 1970s that few young people, especially young women, drank alcohol at all. That changed from the 1980s onwards and we now see an increase in the numbers. It was very unusual to come across children with foetal alcohol spectrum disorders or, as a recent report in The Lancet put it, “prenatal alcohol exposure”—I will come back to that report, but these days it is increasingly evident. I became interested in this subject because as an adoptive parent, I discovered how common it is among children who are adopted, including my own two children; I should declare that interest.

Fiona Bruce 

If the hon. Gentleman recalls, when the all-party group received evidence about the impact of foetal alcohol syndrome on adopted and fostered children, one survey indicated that up to 70% of the cohort of adopted and fostered children assessed were affected.

Bill Esterson 

Yes. I thank the hon. Lady for being the vice-chair of that group, and for the immense support that she has given to everybody in it. She is right; we took evidence from professionals in the children in care sector that as many as three quarters of children in care could be affected by alcohol damage during pregnancy. It is one of the major factors contributing to them ending up in care in the first place. I am glad that she raised that point. We also heard a suggestion that many children put up for adoption are damaged in that way, and we heard adoption described by one adoptive parent as a family-finding service for foetal alcohol spectrum disorders. It is a family-finding service with inadequate support; I will come to that shortly.

In our report, to which the hon. Lady rightly brings me, we identified that increasing prevalence, as well as the impact on children for life—not just while they are children—of irreversible brain damage and the impact on carers, parents, schools, health professionals and society of so many people with brain damage being unable to function fully in society, and all that that brings with it. As The Lancet reported on 12 January, the most extreme end of the spectrum, which is generally referred to as foetal alcohol syndrome, includes

“intellectual disability, birth defects and developmental disorders”.

The article goes on to list

“secondary disabilities including academic failure, substance misuse, mental ill-health and contact with the law due to illegal behaviours, with huge resultant costs to our health, education, and justice sectors.”

In our inquiry, we heard that 40% of people in prison exhibit symptoms of foetal alcohol spectrum disorder. High numbers of care leavers and people with mental illness end up in prison. Given the evidence that I have heard, it would come as no surprise to me, once we start to explore the root cause—I hope that such work can be carried out—to find that alcohol during pregnancy is a primary contributory factor.

Our inquiry took evidence from professionals who made the case that action must be taken. My hon. Friend the Member for Luton North spelled out how those in north America have managed to calculate the economic costs; the same will be true here. The societal costs are fairly obvious, from what I have described, but there is also an impact on families. If they must care for a child with the kind of disability that we are describing—believe me, it can be pretty challenging at times, from my personal experience—it can often have a dramatic financial impact, because people have to give up work to care full time, with little or no support.

Liam Byrne 

My hon. Friend is making an extraordinary speech. As he will be aware, half of families living in poverty in this country have somebody with a disability in the household. It is not just a family issue or a public health issue; it is an inequality issue too.

Bill Esterson 

Yes, that is right. My right hon. Friend has described his experience before, and I am sure that he will say more later. Many people are affected by being children of alcoholics; I think that the issue is directly related and a similar concern and challenge. Poverty and inequality are clearly linked to the damage done by misuse of alcohol, and I am afraid that the group on which I am concentrating is one of the most affected in our society.

We heard in our inquiry about the lack of support. There is only one specialist clinic in this country to diagnose FASD—it is in Surrey, and is led brilliantly by Dr Raja Mukherjee, who gave evidence to our inquiry—but that simply is not good enough. If 35,000 children are affected every year, we need a lot more than one clinic to help diagnose them, because diagnosis is needed in order to ensure that support is available.

Kelvin Hopkins 

I applaud everything that my hon. Friend is saying in his speech. It was reported at one stage during our deliberations on the report that some medical staff literally do not know about FASD, even now. That is appalling.

Bill Esterson 

That is right. The symptoms are misunderstood and significantly misdiagnosed, and too many professionals dismiss them. I have seen entirely contradictory diagnoses—doctors have described FASD symptoms perfectly well and then said that the child does not have it, due to the kind of misunderstanding that my hon. Friend just mentioned. We must improve understanding among health professionals. We must improve awareness, information and education among professionals, not just in health but in education.

In our inquiry, we also heard that children often cope at nursery, reception and key stage 1, and well into key stage 2, and it is only much later—from about year 6 onwards, as the expectation of independence grows in the school system—that the real problems start to emerge. Children who are damaged in this way find it difficult to cope in the school system, but because they have not been diagnosed early—because there has been no awareness or understanding, and they have got that far in the school system—it is assumed that FASD is not the problem, and that it might be due to what is going on at home or other external reasons, when the true cause is a disability. Again, we need greater support, awareness, understanding and training for education professionals as well as those in health and elsewhere.

What is needed? The Government should consider the following objectives. One objective should be to reduce the number of children exposed to alcohol during pregnancy. The Lancet’s report goes into great depth: international research suggests that just under 10% of the world’s population of women drink during pregnancy, but in this country, the figure is 41%, more than four times the international average. A similar figure was presented last year in the evidence of the FASD Trust, which serves as the secretariat for the all-party group and for which I am very grateful. That level of drinking during pregnancy suggests that the incidence of FASD may be four times higher in the UK than in the rest of the world. If we follow that logic, the World Health Organisation’s international figure is 1%, so in this country it may be 4% or 5%—that is where the figure of 35,000 babies comes from.

As well as an objective to reduce exposure to alcohol during pregnancy, the Government should introduce an objective to increase support and understanding in schools, in the health and care sector, in criminal justice and in wider society. How should they go about that? During our inquiry, we heard that the phrase should be used is

“no alcohol in pregnancy is best for baby and you”.

That fits the description of the strategy that we should adopt in this country. I welcome the fact that the chief medical officer revised the guidelines after we published our report—perhaps not entirely because of it, but I am sure we contributed. That was a big step forward. The guidelines now say that women who are pregnant or are trying to conceive should not drink alcohol at all. That is right, but by no means does it go far enough, because people do not know the guidelines—I am afraid that the increase in alcohol consumption suggests that, sadly, that is all too true.

As part of our strategy, we have to increase awareness, not only among professionals but among the wider population, of the support needed for women before pregnancy. In north America, which my hon. Friend the Member for Luton North mentioned, information is displayed in all the health facilities, education facilities and even airports—I have seen big signs in Canadian airports that say “Don’t drink if you’re pregnant or trying to conceive”.

Kelvin Hopkins 

Another factor in America that I did not mention, because people draw back from it, is that people who are under the age of 21 cannot drink alcohol, and anyone who supplies alcohol to somebody under 21 can be sent to prison. That actually happened to a young Englishwoman who was on holiday in Florida: she provided alcohol to her younger sister and was sent to prison for corrupting a minor. It is taken very seriously indeed.

Bill Esterson 

I am sure that the Minister has heard my hon. Friend’s comments. I agree that we must raise awareness among girls—and among boys too, because it is really important that boys and men play their part in influencing their partners in abstaining from drinking.

Awareness among professionals of how to prevent drinking during pregnancy has to be part of our strategy, but so does the support that is needed afterwards. Drinking during pregnancy will still happen, however much we are able to reduce it. Very sadly, some of the worst damage happens straight after conception; if someone has a drink before they know they are pregnant, it is too late to do anything about that drink. Support is essential throughout society, and it begins with awareness.

I was really disappointed that the briefing note for this debate did not make reference to foetal alcohol spectrum disorder. It made some really good points about other issues that we have discussed today, but it did not mention FASD. Given that FASD was one of the topics clearly indicated in the bid for the debate, that was really unfortunate—I shall not say anything stronger.

Fiona Bruce 

The hon. Gentleman is making a powerful speech. I share his concern about this matter. I also share his concern that the chief medical officer’s guidelines on this issue have not been sufficiently promoted by the Department of Health. I know that some of the chief medical officer’s other guidelines were contentious, but the clear advice that women who are pregnant—or are considering pregnancy, I should add—should not drink has been received and accepted by everyone throughout the drinks industry and by all the organisations that seek to tackle alcohol harm. I join the hon. Gentleman in asking the Minister what her Department will do to ensure that that much needed guideline is much more adequately promoted throughout the country. It is shameful that that has not happened.

Bill Esterson 

The hon. Lady’s comments are so good that I cannot really add anything to them. However, they bring me to the 2012 alcohol strategy, which makes the risks very clear and which refers to lifelong conditions that can have a severe impact on individuals and their families. Those conditions are caused entirely by drinking during pregnancy, so they are completely preventable. It is all already there in the strategy, which leads to the question of why the Government have not done more to promote awareness and reduce the incidence of this terrible problem. I hope that the Minister will respond to that point.

Let me cite some evidence from elsewhere. In Denmark, improved education and awareness led to an increase from 69% to 83% in the proportion of women abstaining completely from drinking during pregnancy. It did not eradicate the problem completely, but that is a significant improvement and a significant reduction in the number of children affected. It worked in Denmark and it can work here.

In 2015, I presented a ten-minute rule Bill on labelling—I am grateful to hon. Members present who supported it. Labels are just not adequate. They are so small and insignificant that they are ignored or are not noticed, and they are not enough anyway. Again, in north America, such information is displayed in big letters on the walls of pubs, bars and so many other places. That is another suggestion for the Minister: more awareness in places where people are drinking and more information on the bottles themselves.

It is crucial that we get the point across, because many women think that it is okay to have one or two drinks. But define “one or two drinks”! How much is one unit or two units? Most people have very little understanding of or insight into how much alcohol they are drinking—and anyway the evidence is that we just do not know whether there is a minimum level, which is why the only safe advice is abstinence.

Fiona Bruce 

I apologise for intervening again, but I want to remind the hon. Gentleman of evidence that we have received. The reason that the recommendation has to be not to drink alcohol is that women’s individual alcohol tolerance levels during pregnancy are simply not known. I remember that he once mentioned a dramatic piece of evidence that showed—he will correct me if I have got it wrong—that a single drop of alcohol on an embryo resulted in that embryo becoming completely insentient for two hours. That is a startling piece of information.

Bill Esterson 

I am pleased that the hon. Lady reminded me of that piece of evidence. Perhaps we should tour the country as a double act, because this is turning into one: she can remind me of all the bits I forget.

The hon. Lady is right about how important this is. It is not just about individual tolerance; tolerance changes as women get older and as they have more children. In families in which, sadly, more than one child is affected by exposure to alcohol during pregnancy, it is invariably younger children who are damaged most.

We all know about the dangers of smoking—now, nobody would dream of saying anything other than, “Don’t smoke during pregnancy”—but we have not got to that point with alcohol. FASD was first diagnosed in 1973. It has been known about since then, so why has so little been done about it in this country? Much more has been done in other countries; they have approached FASD far more effectively. We had good progress from the chief medical officer, but we need so much more.

What do we need to do? We need to have a prevalence study to understand the situation in this country fully, including why women are still drinking during pregnancy. Some of it is about awareness, but there are some other findings from Sweden that I will draw to people’s attention. In a Swedish study, women mentioned societal factors such as peer pressure, not wanting others to suspect that they were pregnant, and insufficient education, as some thought that drinking small amounts during pregnancy was harmless, and we have just heard about the problems that causes. Personal factors were also important, for example not wanting to miss the enjoyment of alcohol. Those were reasons that women in Sweden gave to explain why they felt that abstinence from alcohol during pregnancy was so difficult for them. We must understand those factors in order to do something about them.

That is why it is so long overdue for the Government to go so much further than they have already. We need a prevalence study to understand whether the 35,000 figure that I have cited is correct, and to understand why women are drinking during pregnancy to the extent that they are. Then we can start to make progress in reducing the incidence of problems and providing the support that is needed, because the cost to those children who are affected by alcohol and their families is catastrophic, and it is hugely expensive for us as a society and economy. The situation cannot be allowed to continue.

I urge the Minister to act. I think this is the first time that she has been involved in a debate on this particular issue—

The Parliamentary Under-Secretary of State for Health (Nicola Blackwood) 

indicated assent.

Bill Esterson 

This is a chance for the Minister to start on the right footing and to really make some progress.

Patricia Gibson (North Ayrshire and Arran) (SNP) 

I am delighted to speak in this important debate and I warmly thank the hon. Member for Congleton (Fiona Bruce) for securing it.

The costs that alcohol imposes on our society—the social cost, the health cost and the cost to families and communities—simply cannot be counted, because of course that cannot always be measured in pounds and pence. Across the UK, alcohol accounts for 10% of our burden of disease and death, and it is one of the three biggest lifestyle risk factors for disease and death. Alcohol is 60% less expensive now than it was in 1980, and everyone knows that when the price of a commodity goes down, consumption goes up.

I will share with the Chamber today the alcohol-related challenges that we face in Scotland. NHS Health Scotland has reported that in 2014 retail sales data demonstrated that alcohol sales in Scotland were 20% higher than in England and Wales. Scottish sales of low-cost vodka are more than twice as high as those in England and Wales. It is estimated that one in three Scots are affected by a mental health problem each year, with depression and anxiety the most common illnesses. Alcohol and problems with mental wellbeing are closely related.

We in Scotland therefore have much greater and more pronounced challenges than the rest of the United Kingdom. The damage that alcohol is doing to our population is extreme, so bold solutions are required. In Scotland, such bold solutions have not been shied away from. The overall strategic approach in Scotland is different—I would argue that it has to be different—from that of the rest of the UK. A whole-population approach is required to reduce the harm caused by alcohol.

The important point is that, in addition to analysing existing data such as alcohol-related deaths and hospital admissions, our approach uses sales and price data from market research organisations to examine the relationship between price, consumption and harm. The effects of specific policies have also been examined, such as the policy on multi-buy discounts—it is worth noting that such discounts are now banned in Scotland. Scotland is the only part of the UK to produce such detailed information on alcohol, including sales data.

Whether we are talking about alcohol, gambling, obesity or lack of physical activity, we need to consider how all of our high streets and neighbourhoods can support good health, rather than contributing to our ill health. For example, we know that deprived areas have 40% more places to buy alcohol than more affluent areas. The more widely available and easily accessible alcohol is, the more we drink, and therefore the more harm that is caused.

As well as knowing that 20% more alcohol is sold in Scotland than in England and Wales, we know that Scottish male death rates are approximately 50% higher than those of other UK countries, while women’s mortality is 30% higher in Scotland than in other UK countries.

Kelvin Hopkins 

I think this statistic is true: life expectancy in central Glasgow is the lowest in the United Kingdom.

Patricia Gibson 

Indeed. That appalling and very sad statistic is one that has touched my own family, as I will come on to explain. Alcohol continues to cause premature deaths in some of our most socioeconomically deprived areas and we must take action—I will go on to say how the Scottish Government have taken action.

The hon. Gentleman’s intervention came at a very personal moment in my speech. Indeed, I have a very personal stake in this debate. By all accounts my own father, of whom I have no memory, was an extremely heavy drinker. Was he an alcoholic? He probably was, but alcoholism was not readily talked about in working-class communities in Glasgow in the 1960s. I did not witness my father’s heavy drinking, because he died when I was nine months old, not least because of his heavy drinking. My husband’s father was an alcoholic, which led to his early death. In Glasgow, where both my husband and I grew up, such deaths were not unusual in the past, and even today alcohol-related deaths are still more common in our communities across Scotland than many people would think.

Here is the main point: I am extremely proud of the fact that against much opposition—some of it, unfortunately, on tribal grounds—the Scottish National party Government in Scotland took a very bold decision. They decided that the damage that alcohol was doing to our population, our families and our communities could no longer simply be measured and talked about and that action was needed. What else could kill 22 people each week in Scotland, cause 670 hospital admissions each week in Scotland, cost Scotland £3.6 billion each year and not require bold action?

Such action came in the form of minimum unit pricing. In our supermarkets and similar outlets, alcohol can cost less than bottled water; in some cases, it sells for as little as 18p per unit, which is disgraceful. There is clear evidence from research that shows there is a direct link between changes in minimum pricing, and changes in alcohol harm and consumption. Estimates show that a 10% increase in the minimum price of alcohol is associated with a 32% reduction in the number of deaths that are wholly attributable to alcohol. Work undertaken by the University of Sheffield shows that a minimum unit price of 50p is estimated to result in 121 fewer deaths a year, a fall in hospital admissions of just over 2,000 a year, and a fall in hospital admissions of just over 2,000 a year by year 20 of the policy.

Minimum unit pricing is more effective than taxation, because it is better able to target the cheap, high-strength alcohol favoured by the heaviest drinkers. Such a public health measure is supported by Ireland, Norway, Finland, Sweden and the Netherlands. I know that England is looking at this measure and I urge everybody in this Chamber to support its introduction. It is bold, but it needs to be bold to help deal with the blight that alcohol has cast over too many of our communities.

Global corporations in the alcohol industry fought a hard legal battle against Scotland’s introduction of minimum unit pricing, but the measure was passed with overwhelming support in the Scottish Parliament. It has been tested in the European courts. The appeal against it in the Supreme Court, following victory for the Scottish Government when the measure was tested at the Court of Session, is the final stumbling block to the introduction of the policy. I hope and believe that it will be resolved by the summer at the latest and introduced in short order thereafter.

Responding to the points made by the hon. Members for Congleton (Fiona Bruce) and for Luton North (Kelvin Hopkins), in Scotland we have already reduced the drink-driving limit to 50 mg per 100 ml of blood. That means that the rest of the UK—this is a cause for great alarm—has the highest limit in the EU, alongside Malta. I urge the Minister to follow the lead of Scotland and the rest of our EU partners. Reducing the blood alcohol level for drivers saves lives.

Fiona Bruce 

I am interested to know from the hon. Lady directly how that change has not only saved lives, but changed the drinking culture. How have people changed their attitude towards drinking? One of the points that has been made to us about the Scottish experience is, “Well, it’s only a very few lives that have been saved,” but there is a bigger picture, is there not?

Patricia Gibson 

There is indeed a bigger picture. Laws do not necessarily change attitudes, but what they do over time is change a culture. They send out a clear signal. The point was made earlier that when people are out and using a car, they tend not to drink. They are more likely not to drink at all due to the reduction in the drink-driving limit. It has also been a great educator for people who are out drinking and not driving, but who might be driving the following day. They decide, “I had better not drink tonight, because I might still be over the limit tomorrow when I get in my car.” We know that many of the people who have been pulled over, had their blood alcohol level tested and been found to be over the drink-driving limit were simply not aware of it, because it was from the previous evening; they had not considered that they might still be over the limit.

Martyn Day (Linlithgow and East Falkirk) (SNP) 

On that point, does my hon. Friend agree that the lower drink-driving limit has been particularly effective with younger drivers?

Patricia Gibson 

Indeed. Our younger drivers are the most likely to be inexperienced. They are therefore not willing to risk it, after all the blood, sweat and tears to pass their test. The limit is helping to reduce the alcohol intake of young people for a whole variety of reasons.

Alcohol is killing too many people in our communities prematurely—I do not think anyone in the Chamber would dispute that. It is splitting up too many families. Its pervasive, insidious influence is the context in which too many of our children grow up. It is costing our NHS billions. It is exacerbating mental health challenges for too many people. It is rendering too many people economically inactive.

Alcoholism is a disease and, as with any disease, we need to find the cure. One silver bullet will not cure the disease. We need minimum unit pricing. We need all our high streets and neighbourhoods to look at how they can support and contribute to good health. There must be a presumption against an over-concentration of outlets selling alcohol, preying on our socially disadvantaged communities. All those things combined can make a difference, because they tackle price, availability and consumption. A serious problem and disease such as alcohol addiction or misuse requires a serious, bold solution. I urge the UK and Welsh Governments to look at the measures and the determination of the SNP Government in Scotland to tackle the issue head-on. It is one of the most serious health challenges of our time.

Liam Byrne (Birmingham, Hodge Hill) (Lab) 

It is a real pleasure to serve under your chairmanship for the first time, Mr Flello. I offer my thanks and congratulations to the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Sefton Central (Bill Esterson) for bringing this debate to the Chamber.

I am here this afternoon to speak on behalf of Britain’s 2.5 million innocent victims of drink. They are the children of hard-drinking parents, and I start my remarks this afternoon with heartfelt thanks to such charities as the National Association for Children of Alcoholics, Childline, Turning Point, Aquarius in my home city of Birmingham and many, many others for all the difference they have made to hundreds of thousands of children. For every child they have helped, for every life they have saved and for every life they have changed, I want to say on behalf of us all, “Thank you.”

I am here because I, too, am the child of an alcoholic. My father, Dermot, was an extraordinary man, and I would not be in politics—I certainly would not be in this place—had it not been for his inspiration. He was the son of Irish immigrants who came to Britain before the second world war. He was one of that generation of radicals in the 1960s. He was the first in his family to go to university. The first speech that really inspired him was Kennedy’s inauguration, with that immortal line,

“ask not what your country can do for you—ask what you can do for your country.”

That inspired him and my mum to go into public service. It was that ethos of public service that he handed down to me.

My father loved new towns. He was a practical idealist, and that is how I ended up growing up in Harlow. The reality was that as he rose up the ranks of Harlow Council to eventually become its general manager, his dependence on alcohol became deeper. When my mum died of cancer of the pancreas when she was just 52, it knocked him over the edge. He moved from being what I guess would be called a functioning alcoholic to becoming a non-functioning alcoholic.

For much of my life, I have grown up with that gnawing insecurity that is all too common for children of alcoholics—that constant feeling of guilt, constantly asking yourself whether you are doing enough. Why can you not do more to stop your mum or dad from drinking? I know what it is like to feel that cold nausea when you find the empty bottles hidden around the house. I know what it is like to feel sick when you hear your parent being sick first thing in the morning because they have drunk too much. I know what those feelings are like, and I know what the psychological reactions are like. I know all about the drive for perfectionism as you try to make the world perfect and impose some kind of order on it. I know what it is like to build up that kind of armour-plating so that nothing can ever hurt you, and I know all about the insecurity and the shame.

I know what it is like to have your parent on the front page of a paper because he has been caught driving four times over the limit. In fact, it was my little brother who was delivering those papers on his paper round. I know what that insecurity and shame feel like, and I know how it lasts a lifetime. I know what it is like to spend lots and lots of time in A&E. I know what it is like to spend lots of time in intensive care units. In my case, I was holding my dad’s hand as he suffered multiple organ failure, only to see him pull through and start drinking again. I know what it is like to spend the final days of your parent’s life in a hospital. It was almost two years ago, just before the last general election, that I was called to my home town of Harlow to be told that my dad only had days to live. I will remember for ever the compassion and care of the staff of the Princess Alexandra hospital in Harlow. I will remember for ever that cold dawn on St Joseph’s day nearly two years ago when the staff of the hospital folded down my dad’s blanket so that we could hold his hand as he breathed his last. I will never forget the compassion of those national health service staff and the way that they cared for us.

I know what those things feel like. I know how deeply they have affected me, and I know how deeply they have affected my brothers, but in a way I count myself as lucky, because since I first took the difficult decision to speak out on this a year and a half ago, I have been inundated with stories from colleagues here, whether they are in the House of Lords, staff or fellow right hon. and hon. Members. I have been inundated with stories from the public. I suppose I learned that like all children of alcoholics, we cannot change things for our parents, but we can change things for our children. What I want to do with others who are here is help use the experiences of the children of alcoholics in this country to change the policy of Her Majesty’s Government. That is why I am glad to see the Minister in her place today.

The stories I have heard are terrible, and I want to bring some of the voices of children of alcoholics to this place this afternoon. One person wrote to me to talk about their experience, saying:

“I felt alone, confused, guilty and second best.”

Another person said:

“Growing up with an alcoholic parent was not great. You feel like a failure, you feel like it’s your fault, you feel second best to the bottle. You never know what state you’re going to find your parent in.”

Another talked about the feelings of helplessness, hate, devastation, frustration and denial. Some felt worthless. Some were carers. Some had behavioural problems. I have teachers write to me about children they look after who are in that position.

Another person wrote and said:

“I am 36 and grew up in an alcoholic home. My mother drank heavily until she died in 2010. She was a lovely person until she drank when she became hateful and emotionally abusive…She was in and out of rehab, detox centres and mental health units for all of her life.”

Another said that they felt awful, that there was little love shown and that they felt alone the majority of the time, although luckily they had grandparents who were supportive until they passed away. Another described their childhood growing up with an alcoholic as

“horrible. I used to come home from school and see my mum drunk/passed out on the floor. I could never concentrate on school work because I’d constantly worry about her. Is she okay? Was she still alive for when I got home? It was a constant worry.”

Another person talked about their feelings of loneliness and how much they hated the signs that their dad had been drinking or in their mother’s speech. Another wrote:

“I wanted to die at 14. I tried but lived sadly.”

One person described their experience as

“losing my childhood, and becoming a parent to my younger sister and trying to shield her as much as possible. I was quiet and withdrawn, not wanting any attention and associating all attention with the embarrassment I felt when my mum was drinking.”

Another wrote about her experience of living in a household where “don’t mention Daddy’s drinking” was the byword. The year that he died, she got sober too. I could go on and on and on. These are not the experiences of a few people; these are the experiences of 2.5 million children in our country—that is one in five children.

From a public policy point of view, should we care? Of course we should, because the evidence is that those children will be twice as likely to develop difficulties at school, three times as likely to consider suicide, five times as likely to develop eating disorders and four times as likely to become alcoholics themselves. This great epidemic of agony is cascading down the generations. The cost of alcohol abuse that the hon. Member for North Ayrshire and Arran (Patricia Gibson) spoke about —that £21 billion, although some say it is £50 billion—is cascading down the generations. In this House, we have to stand together and break the silence and the cycle of this terrible disease.

Given the scale of the problem, we would expect that the Government, local authorities and the national health service would be all over it and on top of it, making sure there was action, yet the opposite is true. In a series of freedom of information requests that I conducted at the end of last year, we discovered that none of the 138 local authorities that responded have a specific strategy to help the children of alcoholics. Almost no local authority is increasing its drug and alcohol substance abuse budget, even though many of them are seeing rises in A&E admissions due to alcohol harm. Just 9% of the local authorities where A&E admissions are going up are increasing treatment budgets. A third are cutting the budgets.

In some parts of the country, referrals for alcohol treatment represent 0.4% of dependent drinkers. In other parts of the country, that figure is 11%. That is a wide variation. In some parts of the country, an average of £6.61 is spent per hazardous drinker. In other parts of the country, it is £419—that is in Sefton.

There is no uniformity in the data used to collect statistics across the system. What is clear is that children of alcoholics fall through the cracks because they sit at the junction and on the borders of three different systems: the adult social care system, the children’s social care system and the public health system. Not one of those systems has explicit defined responsibility for helping children of alcoholics. So what happens? Children of alcoholics just slide through the gaps.

That is why charities such as the National Association for Children of Alcoholics are so important. When I was in an agony of public shame after the last election, it was Hilary Henriques, whose son is here this afternoon, who got me back on my feet. I had the prospect of the Prime Minister wandering around the country waving the leaving note that I left back in 2010, and that brought me immense public shame. What I could not describe at the time was the private shame that I felt, having just lost my father to alcohol. I was at my lowest ebb after the last election. It was Hilary who helped me see that there was something constructive and productive that I could do to aid this particular cause.

NACOA has had 1 million contacts in the last 15 years by phone, email or through the website. The demand for its services is going up and up. What I find most troubling is that a third of people who contact NACOA have not told anybody else about their issues. These poor children are suffering in silence. They feel a profound sense of shame and insecurity. They feel that it is their fault. They curse themselves for not being able to do anything about it, and not only do the suffer in silence, but they feel like they are on their own. No wonder so many go on to suffer difficulties in the future.

On 13 February, we will mark international Children of Alcoholics Week, which is when we get the chance, around the globe, to stand up and speak for the children of alcoholics. Thanks to the concerted effort of the all-party parliamentary group on children of alcoholics, we will be able to launch on 15 February, the day after Valentine’s day, the first ever manifesto of children of alcoholics. It has not been written by me, NACOA or by charities, but by children of alcoholics, many of whose stories I read out earlier. I want to give the Minister some highlights.

First, the clear message is that the Government have to take responsibility for children of alcoholics—no one else is going to help these children. Their parents are not going to help. They cannot tell their neighbours. The Government have got to step into the breach.

We need a national strategy for children of alcoholics. We talk about children’s mental health and we talk about alcoholism, but, again, children of alcoholics are in the middle. They need a national strategy of support.

[Ms Karen Buck in the Chair]

We have to properly fund support for children of alcoholics. Helplines such as those from Childline or NACOA are run on a shoestring, yet they make a world of difference. They need a little bit of extra help from the Government.

We need to increase the availability of support for families. There is clear evidence now that family therapy can make an extraordinary difference. We should be boosting education and awareness among children and for those who have responsibility for working with children. I cannot count the number of times that I was involved in talking to the national health service about my dad’s condition. Even when I spent five days sitting on the ward of an intensive care unit, not once did anyone ever say to me or my dad, “Is there a conversation about alcohol that we need to have? And, by the way, are you okay?” We need to transform education and awareness among those who look after our country’s children.

As the hon. Member for Congleton said, we need to develop a plan to change public attitudes, and we need to revise the national strategy to focus on price and availability. The evidence from Canada and Ireland—and I hope soon from Scotland—is very clear that price makes an important difference.

We need to curtail the promotion of alcohol, particularly to students. When kids put up posters of football teams with alcohol brands plastered across their strips, alcohol is being advertised in their bedrooms. We have to think anew and afresh about how alcohol is promoted in this country.

I say in support of the hon. Lady that the Government should take responsibility for reducing the rate of alcoholism. This is a public health question, pure and simple.

Fiona Bruce 

The right hon. Gentleman gives me the opportunity to point out that the Public Health England report says that the evidence is sufficient to support policies to reduce children’s exposure to marketing. They are needed, and that is what the report says.

Liam Byrne 

The hon. Lady is absolutely right. There are a million and one ways in which we can do this. Someone called Gemma contributed to the report and said:

“Going down any street with a pub on it in the UK and there will be a sign outside with a quote such as ‘Drinking at 9 am doesn’t make you an alcoholic’. Well, to be honest, it probably does.”

There are common-sense restrictions that I think we should be debating.

Kelvin Hopkins 

My right hon. Friend is making a very good point about the opening of pubs at all times of the day. I am one of those who opposed the relaxing of licencing hours. Sadly, it was our party’s Government who did that, and I think that was a mistake. I hope that one day we shall get into power and reverse that, if it is not done before then by the present Government.

Liam Byrne 

Let us hope it changes even before then.

The Prime Minister has put great store on two things: first, restoring social mobility in this country, and, secondly, children’s mental health. I understand that it will not be too long before the social mobility strategy, or the social justice strategy, is produced. I do not mind or particularly care what it is called, but I look to the Minister for a cast-iron commitment that children of alcoholics will be discussed at the Cabinet Committee next week, and that we will insert into the strategy that is published in the weeks to come a commitment to develop some of the ideas I have talked about this afternoon.

The Government are well aware of our ambitions. We have written to all and sundry about them, including the Prime Minister. If the Prime Minister is in any doubt about the importance and urgency of this debate, I will close with a word from His Grace the Archbishop of Canterbury, who said:

“We all know that having a parent who abuses alcohol is one of the most disruptive experiences for any child and leads frequently to long-term effects in one’s self confidence, one’s capacity to relate, and even for some people in their own relation to alcohol itself. My experience, whether easier or more difficult than that of others, was fairly difficult...One of the things I most missed was the company of others who understood the issue.”

He concluded in the most powerful of ways:

“We are never ourselves when we are solitary, but in all of human history and community it has invariably been the case that it is in relationship that we become most fully what we are called to be, provided that relationship is healthy.”

Marie Rimmer (St Helens South and Whiston) (Lab) 

I applaud the right hon. and hon. Members who secured this debate with the hope of influencing the Government to update the alcohol strategy, which is absolutely necessary. In particular, the all-party parliamentary group for foetal alcohol spectrum disorder would like an update on action on point 5.15 of the strategy. It reads:

“Fetal alcohol spectrum disorders…result from mothers drinking alcohol during pregnancy. They are lifelong conditions that can have a severe impact on individuals and their families—leading to a wide range of difficulties including low IQ, memory disorders”—

such as forgetting how to swim, “attention disorders”, such as when people detach themselves from family members and adoptive parents—

“speech and language disorders, visual and hearing defects, epilepsy and heart defects. They are caused entirely by drinking during pregnancy, and so are completely preventable. We do not have good information about the incidence of FASD…FASD can be caused by mothers drinking even before they know they are pregnant; so preventing them is strongly linked to reducing the levels of heavy drinking in the population as a whole, and especially among women.”

The rate of alcohol consumption is much higher among women in my constituency than in many others. The alcohol strategy says that we need to reduce consumption in the population as a whole, especially among young women,

“including by increasing the awareness of health professionals.”

There is a lack of understanding and awareness about this problem.

Let me give a general overview. Some 10.8 million people in England drink at levels that pose a risk to their health. Most of us have a drink, which is why we do not recognise the problem—we say, “They are just having an extra one. They might have had a bit more than me, but they have not really got a problem.” Overall, alcohol costs the UK £21 billion every year. It affects millions of lives and places a huge burden on public services. The Government cannot afford not to do something about alcohol, because of the drain on the national health service, social services and children’s social care, and because of the number of children who have been placed in care or are up for adoption because of alcohol.

I have seen younger relatives die from alcohol. A great friend of mine died from alcohol—he was head hunted to work in this place some years ago. That professional, skilled person was lost to alcohol, and nobody recognised or faced the problem.

Alcohol is 54% more affordable now than in 1980, which has helped to drive the historically high levels of alcohol consumption. I could not believe, and could not convince my colleagues on the council, how much cheaper alcohol is than bottles of water. I took them round two local supermarkets where alcohol was cheaper than water—cheaper than milk, even. Supermarkets frequently use heavy discounts to sell alcohol more cheaply. The evidence is still around us today.

The figures suggest a modest drop in overall consumption in recent years, but we are still drinking at historically high levels. It is the culture where I come from. St Helens was born of Irish immigrants; it was as far as people could walk from the docks of Liverpool when they landed there after escaping the potato famine. They worked very hard in the pits and in glass and chemicals manufacturing, so it was normal to have a drink at night. But what has gone wrong is that many of the pubs and clubs where the working men could enjoy good company with their pals on a night out have closed down, largely because supermarkets are selling drinks so cheaply. People buy alcohol and drink it at home, where they do not get the company and other people do not see how much they are drinking—it is just their families, who are least able to cope with the problem.

Some 2.1 million children in England are negatively affected by other people’s drinking every year, and the Government have to do more for them. Children do not ask to be born. Young people in the UK tend to drink more and start drinking earlier than young people in other European countries because they see drinking in the house more. Children exposed to a lot of alcohol advertising are more likely to drink heavily and start drinking at an earlier age—10 to 15-year-olds in the UK view more alcohol ads on TV than adults over the age of 25. By the age of 15, 44% of girls and 39% of boys in the UK have been drunk at least twice.

In England, 100 children end up in hospital each week due to alcohol. I could go on and on with the facts, but I would like to give a general overview. More than anything, I want to focus on children. As a member of the all-party group for FASD, I was driven to this issue. I was alarmed by the number of cases coming up at my surgery, many raised by parents seeking to adopt children. It was heartbreaking. I want to talk about one family in my constituency that came to see me. They were a couple with two children in their late teens and they were on the road to adopting a young child aged eight. They had fostered her and had been given no information at all on health issues, but it soon became obvious that the child was a victim of FASD. She had detachment disorder and had forgotten how to swim, even though she had been taught. She displayed inappropriate behaviour towards visitors and their families, and visitors stopped coming to the home.

A dreadful battle ensued to get a diagnosis and a care package from the local authority. It was difficult because the child was not from the local authority area that the family were living in. They were advised that if the adoption was not completed in a certain timescale, the child would be removed from them. The adoptive parents had taken time off work, but had to return to their jobs. They were prepared to reduce their working hours to care for the child, but they needed a diagnosis and a care package. They were at risk of losing their home—that is how much they loved that child.

Bill Esterson 

My hon. Friend is speaking incredibly well. I pay tribute to her for the work she has done as a constituency MP and for the support she has given the all-party group as well. The point she is making demonstrates the need for support for adoptive parents. All too often there is no post-adoption support, particularly with this condition of FASD. It is even more important than perhaps we knew in the past, so perhaps I can make that point via my hon. Friend to the Minister to pass on to colleagues in the Department for Education.

Marie Rimmer 

I totally agree with my hon. Friend.

My constituents needed diagnosis and a care package. They were at risk of losing their home. They were heartbroken at the thought of the child being taken away from the family and put into another foster home, and then going through, again and again, more placements because families cannot cope with such children. It is so difficult to care for them and yet they are so lovable. The parents were absolutely heartbroken. Silent tears rolled down the cheeks of this professional couple. The tears rolled down quietly as they sat facing me. It was heartbreaking to watch them. The child was part of the family. The two teenage children were beside themselves at the thought of losing their little sister who had become a part of the family. It was only through my direct contact with the local authority chief executive that the child was allowed to stay with the family. In the end, the chief executive apologised and gave a commitment to the family that the necessary diagnosis, care and support would be provided.

More than 7,000 children affected by FASD are born in the UK each year. As a member of the FASD all-party group, I have raised the issue with officers at St Helens Council, where statistics show that alcohol-specific hospital admissions of females were the fourth worst in the country. It is a cultural thing. We see drinking in the family: it goes on, becomes the norm and then leads to an extra drink. Where I come from, we never used to see alcohol in supermarket baskets. There was certainly never any alcohol in our homes. Unfortunately, alcohol is in most homes now. That is where families and children see it being drunk and then becoming part of the culture. It becomes the norm and it is much harder to tackle.

In Peterborough, 75% of children referred for adoption have a medical history of pre-natal alcohol exposure. Most of the looked-after children in St Helens come from alcohol-related problem families. I have met officers at St Helens Council who have given me a principled commitment to progress matters. I am delighted that a training programme with all appropriate staff took place last year. It is estimated that 1% of babies born each year in Knowsley have FASD—that could mean 19 babies in the two wards in my constituency that are in that authority.

I am delighted that action is being taken locally by St Helens Council, but without a national response from the Government, FASD as an issue will continue to be overlooked by the population as a whole. As a local MP, I have done my best, but it is certainly not enough. I have supported the awareness strategy and campaign at Whiston Hospital maternity unit. A recent survey found that 72% of people in Merseyside believe the Government have a responsibility to reduce alcohol-related harm, which is a drain on services.

My understanding of where I live in the north-west—not just in the Merseyside authorities but outside—is that well over 50% of the children on looked-after registers and going forward for adoption are damaged by alcohol and are being raised in families with alcohol-related problems. How can the Government not look at that drain on services, but—more importantly—the damage to those children’s lives? What will they grow up to be? What quality of life will they have? They do not ask to be born. The Government must do more than they are doing now.

I commend the hon. and right hon. Members who secured this debate. So many people and families are distraught at the damage caused by alcohol. More must be done and I plead with the Minister to act accordingly.

Martyn Day (Linlithgow and East Falkirk) (SNP) 

It is a pleasure to serve under your chairmanship, Ms Buck, and to take part in this important debate. I congratulate the Backbench Business Committee on securing it and I praise the hon. Member for Congleton (Fiona Bruce) for leading it. She mentioned that we have as many as three all-party parliamentary groups relating to alcohol. I had not realised that, but it reminded me of a lyric from an old country and western song:

“One drink is one too many and a thousand not enough”,

which highlights the problem that many have—apologies for the corny remarks.

I am grateful for the hon. Lady’s points. Although they relate to the English and Welsh alcohol strategy, they will strike a chord north of the border in Scotland. Many of the points are totally applicable and I agree with much of what she said, particularly with regard to minimum unit pricing and drink-driving limits.

It will come as no surprise to anyone that Scotland has a long-standing and problematic relationship with alcohol. The damage that misuse causes is indeed stark. It causes harm to individuals’ health, employment and relationships, as well as to community wellbeing and public safety. Then we have the financial burden on the economy through costs to the NHS, police and emergency services, and lost productivity to businesses. Many points that illustrate that have been highlighted today by various speakers.

The hon. Member for Congleton advised us that 70% to 80% of accident and emergency admissions at weekends are alcohol-related, and that 80% of police officers have been assaulted by drinkers, which is absolutely shocking. The hon. Member for Luton North (Kelvin Hopkins) gave us a wonderful summary of the lifetime damage to babies and the costs that obviously creates through foetal alcohol spectrum disorders. He also highlighted the drink-driving statistics, which paint a totally frightening scenario.

The hon. Member for Sefton Central (Bill Esterson) included the risks to young women who drink. He highlighted the 40% of the prison population with FASD and the 41% of women who drink during pregnancy. Again, that is truly shocking in this day and age, given the knowledge we now have. My hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) reminded us that not every cost can be measured, which is entirely true. I am an ex-banker and I always think in terms of numbers and statistics, but it is the human tragedy that is more important. The problem falls disproportionately on the sections of society with the fewest benefits, and the most disadvantaged are at the greatest risk. In fact, the simple horror story is that alcohol is 60% less expensive than it was in the 1980s. Some things have not kept pace.

The right hon. Member for Birmingham, Hodge Hill (Liam Byrne) gave a powerful personal account that dealt with the psychology of the issue. One of the inspirational points that he made was that we can change things for the next generation. That is a message we must all take away from the debate. The hon. Member for St Helens South and Whiston (Marie Rimmer) highlighted the many avoidable conditions related to alcohol—they could so easily be prevented—and the need to improve health professionals’ knowledge. I fully agree on that; there is great consensus in the Chamber today.

You will have noticed, Ms Buck, that I am male, Scottish and a Member of Parliament, which must be three of the worst demographics for alcohol harm, so perhaps I should confess that I finished a bottle of whisky last night, and when it comes to enjoying occasional refreshment I am certainly not teetotal. However, perhaps I should clarify that I opened the bottle in June 2015—I hope that I will be seen as an example of moderation, not excess. Sadly, not everyone’s experience with alcohol is moderate. Excessive consumption has been responsible for many issues in society, including, at worst, the rates of alcohol-related deaths. Scotland’s figures have shown higher death rates for males over the past 20 years than the other UK nations. The 2014 figures put that at 31.2 deaths per 100,000 compared with the English rate of 18.1.

Kelvin Hopkins 

Another horrifying statistic is that Russia’s population has been in fairly serious decline in recent years, and the major factor in that is alcohol consumption, which is epidemic.

Martyn Day 

I thank the hon. Gentleman for making that point.

There is sufficient evidence to show a clear link between levels of consumption and of harm. My hon. Friend the Member for North Ayrshire and Arran has already given several examples. It is particularly worrying that retail sales data show that sales in Scotland are higher than in England and Wales—they were 20% higher in 2014—particularly for low-cost spirits. It might surprise Members to hear that since 2008 vodka has outsold blended whisky by about 20% in Scotland. In 2015, 10.8 litres of pure alcohol was sold per adult in Scotland, which is equivalent to 41 bottles of vodka, 116 bottles of wine or 476 pints of beer. When I consider my consumption rates, or those of my friends and family, many of whom take less than I do, the average means that there are people out there consuming a phenomenal amount of drink. On average, alcohol misuse causes about 670 hospital admissions and 22 deaths a week, and it is costing Scotland £3.6 billion each year, or £900 for every adult in the country. How much better that would be spent on other aspects of the NHS.

I served for 13 years on the West Lothian licensing board and in that role learned a lot about the licensed trade and alcohol issues within many of the communities that I now represent in Parliament. One of the more encouraging developments that I saw during those years was the Best Bar None award scheme, which is a great example of partnership working. It has operated in West Lothian since 2008 and has 20 accredited venues, with the Glenmavis Tavern in Bathgate nationally winning overall best bar at the awards in 2015. Best Bar None is administered by the Scottish Business Resilience Centre, whose remit is to create a secure Scotland for business to flourish in. It promotes responsibly managed licensed premises in Scotland, with the aim of partner agencies working together with licensed premises to create safer and more welcoming city and town centre environments. The crux is that it is also about changing Scotland’s relationship with alcohol—something that I believe can be achieved only by working together as a society.

The Scottish alcohol strategy, published in 2009, recognises that a whole-population approach is needed to reduce alcohol harm. Harry Burns, who was the chief medical Officer of the Scottish Government at the time, said:

“Every one of us must ask frankly, whether we are part of the problem and whether we are going to be part of the solution.”

I wholeheartedly agree with that comment. The approach is correct, and indeed we have encouraging signs that it is working. Scotland had the steepest fall in alcohol-related deaths between 2004 and 2014. The rate fell from a staggering 47.7 per 100,000 to the current 31.2. Significantly, the fall in death rates over the period was greatest among the lowest income groups, which helped with some of the country’s inequality issues.

A measure that has been particularly effective is the multi-buy discount ban, which has accounted for a 2.6% reduction in consumption, as my hon. Friend the Member for North Ayrshire and Arran has pointed out. In December 2014 the drink-drive limit was reduced from 80 mg to 50 mg, bringing Scotland into line with the majority of European and Commonwealth countries. There is international evidence that lower limits are effective in preventing alcohol-related road accidents.

Controlling availability through licensing has also been a feature of the Scottish strategy. There is a presumption against granting 24-hour licences to on-trade premises, and off-sales are allowed only between 10 am and 10 pm. There are also strict controls for displays and marketing materials, which are limited to single designated areas in supermarkets and shops. I agree with the point made by the right hon. Member for Birmingham, Hodge Hill about sports advertising, and the UK Government should take that on board. We have seen the effectiveness of limiting marketing in supermarkets; cutting it out of people’s bedrooms would have a massive effect. Scottish licensing legislation puts the objective of protecting and improving public health into the mix, and licensing boards may consider that when making decisions. My understanding is that there is no such public health objective in England and Wales. That is something that UK Ministers might want to consider.

Several hon. Members have mentioned the fact that pricing to reduce affordability is a key component of tackling alcohol harm. I believe that taxation is a means of doing that, but it does not deal with the reality that the availability and relative affordability of the cheapest and strongest drinks is at the heart of the problem. Minimum unit pricing is a more effective tool in targeting those cheap, high-strength products that are excessively consumed by heavy drinkers.

As my hon. Friend the Member for North Ayrshire and Arran informed us, evidence from Canada suggests that there is a direct link between changes in minimum price and changes in consumption. It is estimated that a 10% increase in minimum price might be associated with a 32% reduction in wholly alcohol-attributable deaths. That is significant, and it is an approach worth taking. As we heard, using updated modelling from the University of Sheffield, it was estimated that a minimum unit price of 50p would result in 121 fewer deaths and a fall in hospital admissions of about 2,000 per annum in Scotland. Significantly, 51% of off-sales are sold for less than 50p per unit—some for as little as 18p.

The Scottish Government will ensure that a minimum price policy is implemented as soon as possible. The policy had overwhelming support in the Scottish Parliament and it has twice been approved by the Scottish courts. The Court of Session’s Inner House granted the Scotch Whisky Association and its partners permission to appeal to the United Kingdom Supreme Court in December 2016. The appeal will be heard in 2017.

In conclusion, our nations have a long history with alcohol, and somewhere along the way things have got out of hand for many in our society—often those from the most disadvantaged areas. There is much that can be done, and we must all take responsibility. There are many reasons why we need to take action, including the impact on police workloads and the weekend A&E admissions, all fuelled by alcohol. Perhaps the most important reason is premature death—20 years earlier than the average for a heavy drinker—and its impact on families and communities. Tackling that issue alone would greatly help reduce inequality in society.

Jonathan Ashworth (Leicester South) (Lab) 

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate everyone who has contributed to a well-informed and powerful debate. I pay particular tribute to the hon. Member for Congleton (Fiona Bruce), who opened the debate with a comprehensive overview of the issues related to alcohol harm. I cannot do her speech justice—she was superb—but a couple of points struck me. Her point about attacks on emergency services workers was well made. I do not know whether she is aware, but there is currently a campaign to make such attacks a specific criminal offence, which I would support. I believe that other nations in the UK currently have, or are looking at, such measures. Perhaps the Minister would reflect on that. It was a superb speech, and I congratulate the hon. Lady on the way she made her remarks.

Other right hon. and hon. Members also gave impressive speeches. I pay particular tribute to my hon. Friend the Member for Sefton Central (Bill Esterson) for his personal speech about working with children with foetal alcohol spectrum disorder, including his own story about his adopted children. The detail he went into shows how deeply he has thought about it. He will campaign on alcohol harm for the weeks, months and years ahead.

I hope that through the work of my hon. Friend the Member for Sefton Central and of other hon. Members, such as my hon. Friends the Members for Luton North (Kelvin Hopkins) and for St Helens South and Whiston (Marie Rimmer), who raised similar issues, we can see a change of public policy on such matters. I hope that the Minister will respond to some of what has been said today. If she cannot give us reassurance today, perhaps she will take the subject away, put it through the various policy-making machines behind the scenes in Government and get back to us with some proposals, because the points that have been made today, in particular by my hon. Friend the Member for Sefton Central, were very powerful.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) brought us the Scottish perspective. I sensed that she might be suggesting or hinting that my colleagues in the Scottish Labour party are not entirely supportive of some of the policies that the Scottish Government are pursuing. Her argument, however, was well considered. As Labour’s shadow Health Secretary in Westminster, I will look into what she was talking about. I enjoy political argument as much as anyone else, but we must learn from best practice, even if it comes from our political rivals.

My right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) delivered an incredible, powerful and staggering speech, for which I pay full tribute to him. The way in which he put his personal experiences on the record was incredibly courageous. For most of my speech I will focus on the children of alcoholics, but at the outset I want to say that his bravery and his work for the APPG inspired me to tell my story as well, which I did over Christmas. I will go into that in more detail. My right hon. Friend made a fantastic contribution—I think your father would be proud today. [Hon. Members: “Hear, hear!”]

I will now run through some of the figures—they have been rehearsed already, so I will not go into great detail. We know that the effects of alcohol have a huge impact on society and a huge financial cost, whatever the figure—some have suggested £21 billion, while others say it could be as high as £50 billion. The cost to our society is not only to our health, to the emergency services and through crime and antisocial behaviour; there is also the drag on our economy and economic growth, because of the drag on workplace productivity.

Alcohol abuse and harm is the third biggest health problem after smoking and obesity. Ultimately, it can have devastating consequences. About 307,000 admissions are attributed to alcohol and 65% of those are male. It is estimated that about 35% of all A&E attendances at peak times at weekends are alcohol-related. The number of hospital admissions with a primary diagnosis for alcohol-related diseases has increased about 100% in the past 13 years. Alcoholic liver disease is the most common cause of death, according to recent statistics. The number of deaths related to alcohol has fallen since a peak in 2008, but it remains considerably higher than it was in the mid-1990s. I therefore join the call that others have made for the Government to come forward with a renewed alcohol strategy. I hope that the Minister will tell us whether that is in the offing.

In recent weeks in my own Leicester constituency I have had the privilege of seeing specialist GP services supporting people with alcohol and other dependency issues, and to visit and learn about the Anchor Centre, which is dedicated to supporting people with alcohol problems. However, they tell me that they are worried about the future commissioning of those services, because decisions are made locally and they might not be able to be made in future because of tight budgets. Will the Minister therefore assure us that adequate resources will be put in place to ensure that such specialised alcohol treatment services are at least maintained, or even built on in future? We also heard about the Scottish experience of minimum unit pricing, so will the Minister update us on the Government’s position on that at the moment?

My right hon. Friend the Member for Birmingham, Hodge Hill made a powerful point about football team posters in people’s bedrooms—people obviously want a poster of the Leicester City side, although perhaps not this season, but they might have done last season. His argument was about marketing, and we ought to reflect on that. The previous Prime Minister was prepared to take radical action on the marketing and advertising of sugary foods. If we are to believe the rumours in the newspapers—I do not always believe them—this Prime Minister has crossed all of that out of the obesity strategy. I am interested to know what the Government’s position is on the advertising and marketing of alcohol, particularly as it affects an audience of children. I would be grateful if the Minister could tell us a little about that.

I said that I wanted to focus on the children of alcoholics. As the shadow Secretary of State, I have chosen to speak in today’s debate, although the usual practice is for another member of the team to speak, because I, too, am the child of an alcoholic. My parents divorced when I was about seven or eight years old. To be frank and candid, they divorced because of the strain that my father’s alcoholism placed on the marriage. I am an only child and I lived during the week with my mum and at weekends with my dad. My dad would spend the whole weekend drunk. In fact, from the age of eight I was in effect the carer at the weekend. It was typical for my dad to pick me up from school, but literally to fall over because he was so drunk. This was before the days of mobile phones, and I recall going to a phone box to call a taxi to take us home. The walk was not far, to be fair, but he could not walk up the street and I was a child.

On a Friday I would go back to my dad’s and open the fridge, as people do when they get home from school and want some yoghurt, chocolate biscuits or whatever, only to find it completely empty apart from the huge bottles of white wine—four or five 1.5-litre bottles lined up; the supplies for the weekend. My job as a 10, 11, 12 and 13-year-old was to go down to the shops to get the food in for the weekend and to sort things out. There were loads of such occasions and similar stories. My dad was not bothered about Christmas or with having a Christmas tree, so I would have to go to the shop to get some decorations to make the house look a bit Christmassy, as my friends’ houses were.

On another occasion, my dad played in goal at a works football match—I do not know why, because he was quite short, like me, so not a natural goalkeeper. I was about eight or nine and quite excited to be watching a football game, thinking I was going to a stadium, which it was not—it was an astroturf in Salford. It was the first time I had been to a football game and I was quite excited to watch my dad. I remember vividly his mates in the crowd shouting, “Jon Ash is in goal. All you have to do is throw a can of Stella in that direction, and he will go for that rather than the ball.” That was a joke, just workplace laughing, but I remember thinking, “That’s my dad.”

Dealing with my dad’s alcoholism coloured my upbringing and my life. As I was sitting here listening to my right hon. Friend the Member for Birmingham, Hodge Hill, I remember all those feelings that he was talking about: the shame, the embarrassment, particularly as a teenager, and the anger. But I always loved my dad, and he always loved me. We were lucky; he was never violent or abusive. Millions of children—or perhaps hundreds of thousands—are not in that lucky situation.

To be frank, it was only when my right hon. Friend and other Members started speaking out about this matter that I began to realise that I was not unusual, that I was not alone and that other children were going through this. When he started publishing his reports and doing his newspaper articles, I began to look into the subject, too. That was when I learned that 2.6 million children—perhaps more, according to some estimates—are in these circumstances.

I attended this debate because I wanted to speak out, as my right hon. Friend has, and ask the Government to consider putting in place a strategy for children of alcoholics as well as an alcohol strategy. Like him, when I spoke out in the media over Christmas—entirely by accident, by the way; I was asked a question and sort of blurted it out—I was inundated by people getting in touch with similar stories and saying that they remembered leaving their parent in the morning to go to school, never knowing whether they would be the same person when they got home that night. People have also told me that they spent their childhood ensuring that they did not say something off-hand and just wanting to disappear into the background, because their parent had not only an alcohol problem but a problem with violence, and anything that they said or did might cause their parent to turn because of alcohol.

When we read all those stories and study the research, it is clear that something has to be done. My right hon. Friend used a brilliant phrase. He said that children of alcoholics sit at a junction, where it is not obvious which public service should step in to support them, and too often they fall between the cracks. Is it the school’s responsibility? Is it the local GP’s responsibility? Is it the responsibility of children’s social services? That is why I agree that we need a national strategy, and I ask the Minister to consider including in that strategy a statutory duty on local authorities to put in place local strategies, both to deal with alcoholism and to support children of alcoholics.

The arguments that have been made about collecting data are so important. We have heard that an estimated 2.5 million children are affected, but we are not entirely sure—some suggest it is 3.5 million—so please will the Government look at putting in place a way of collecting statistics so that we know the scale of the problem across the country?

I do not want to be partisan—this is not the place for that—but in a lot of communities across the country school nurses are being cut back. It strikes me that if we want to put in place an effective strategy to help children of alcoholics, school nurses would be a good place to start. I appreciate that such services are now commissioned locally, but will the Minister consider whether the Government can offer any more support to our school nurse and community health visitor networks? I also entirely endorse the comments that were made about labelling and support for mothers in pregnancy.

I am perhaps going off my portfolio as the shadow Health Secretary, but when the hon. Member for North Ayrshire and Arran mentioned the high density of shops and so on in more deprived areas, I wondered whether a community’s health needs should be taken into account in local authorities’ licensing decisions. Perhaps the Minister could reflect on that, although I appreciate that she is not a local government Minister.

My biggest regret in life is that my dad moved away to Thailand when he was about 59. He literally said to me one day, at Christmas, “I’m going to Thailand.” I said, “What?” He said, “I’m going.” I did not believe him, but he went, and that was that. He just went. Six months later, I got married. He promised me that he would come to the wedding. The day before, he phoned me and said he was not coming. I was so angry I could hardly speak to him. I wanted him to meet my new wife. To be fair, he had met her once, very briefly, but I wanted him to meet the new family. I was so angry that I could not talk to him, as you would expect. A few months later, he was dead. I had to go to Thailand to get the body and deal with the funeral. The friends he had made over there told me he was drinking a bottle of whisky a day. They told me he could not come to the wedding because he did not want to embarrass me. We were from a working-class family in Salford. I had gone to university and become a politician, and posh people would be at the wedding, and he felt that he would embarrass me by being there. I will always regret that.

I am the shadow Health Secretary, so I will do a lot of criticising the Tories, because that is my job, but I say to the Minister that I will work with the Government on a cross-party basis to put in place a proper strategy for supporting children of alcoholics because, quite simply, 2 million children are suffering. Let us send them a message that they should no longer suffer in silence.

The Parliamentary Under-Secretary of State for Health (Nicola Blackwood) 

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce), the hon. Member for Sefton Central (Bill Esterson) and the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) on securing this hugely important and deeply moving debate on tackling alcohol harm. I pay tribute to each of them for the work that they have done in leading their APPGs, raising awareness, holding the Government to account and developing policy. We have heard incredibly eloquent testimony from several Members about the harms that alcohol misuse can cause to individuals themselves, but just as much to their friends, family and children. We have also heard about the cost to wider society, and in particular to vital public services such as the NHS.

The majority of people who consume alcohol do so at low-risk levels and as a pleasurable part of their social lives. Pubs and restaurants play an important part in our communities, both as venues for gatherings and, as employers and businesses, as significant contributors to local economies. We should not forget that, but as we have heard, there are very serious harms associated with alcohol misuse that we must not forget either. I would like to take this opportunity to discuss those harms while noting that some progress has been made. I will outline some of the steps that the Government are taking to ensure that consumers have the information that they need to make good choices about their drinking, to equip frontline professionals with the training they need to intervene effectively and to invest in evidence-based services to help people cut back. Of course, that must all be underpinned by the right data and the expertise and advice of Public Health England.

My hon. Friend the Member for Congleton, who gave an outstanding opening speech, rightly pointed to the recent PHE evidence review, which tells us that alcohol is now the leading risk factor for ill health, early mortality and disability among 15 to 49-year-olds in England. It causes 169,000 years of working life to be lost, which is more than the 10 most common types of cancer combined. It is also a significant contributor to some 60 health conditions, including circulatory and digestive diseases, liver disease, several cancers and depression. As many colleagues have said, alcohol-related deaths have increased—particularly deaths due to liver disease, which rose by 400% between 1970 and 2008. That is in contrast with the trends in much of western Europe. More than 10 million people drink at levels that increase the risks to their health, and there are more than 1 million alcohol-related hospital admissions annually, half of which occur in the most deprived communities. It is important for us to face up to that as a nation.

As we have heard, the public health burden of alcohol, including its health, social and economic harms, is wide-ranging. There are direct and tangible costs to the health, criminal justice and welfare systems. According to PHE’s evidence review, the economic burden of alcohol is substantial; estimates place its annual cost at between 1.3% and 2.7% of GDP, and the estimated annual cost to the NHS is around £3.5 billion. Harms can also be indirect, including the loss of productivity due to absenteeism or unemployment, and they can be intangible and difficult to cost, such as the poor quality of life or emotional distress caused by living with a heavy drinker.

Much of that burden of disease and deaths is preventable, so it is right that the matter is given our full attention. Of particular interest to the Government is the strong inequalities profile of alcohol harms, which fall disproportionately on more deprived communities. We estimate that if all local authorities had a mortality rate that matched the most affluent areas, about 4,000 alcohol-related deaths would be avoided each year.

Though I note my hon. Friend’s calls for caution, there are some promising trends that give us cause for optimism. People under 18 are drinking less, attitudes are beginning to change and there has been a steady reduction in alcohol-related road traffic accidents. We have also seen real progress in Government working in partnership with industry. The industry removed 1.3 billion units of alcohol from the market through improving consumer choice of lower-alcohol products, and nearly 80% of bottles and cans now display unit content and pregnancy warnings on their labels.

As my hon. Friend the Member for Congleton—and my hon. Friend the Member for Ribble Valley (Mr Evans), who is no longer in his place—rightly said, partnership continues to play an important role in tackling alcohol misuse, and the Government are committed to that principle. In the report produced by the APPG that my hon. Friend the Member for Congleton, recommendation 9 is to educate the public about the harms of alcohol and do a better job in prevention. We are taking a number of actions to try to help people manage their alcohol consumption, because we believe that the most sustainable long-term solution to alcohol misuse is informed and empowered citizens and consumers. To ensure that that is possible, we have a responsibility to provide the most up-to-date and clear information to enable people to make informed choices about their drinking. That includes publishing the low-risk drinking guidelines, as we did last year, which a number of colleagues mentioned. Those guidelines provide the public with the latest information from the four UK chief medical officers about the health risks of different levels and patterns of drinking.

Officials are now working with partners in industry to update the advice provided on packaging and labelling to reflect the latest evidence. That is to ensure, as the hon. Member for Sefton Central mentioned, that awareness is raised and people understand exactly what those low-risk drinking guidelines mean.

Fiona Bruce 

The Minister talks about increasing knowledge and awareness, but her Department’s own report says:

“Although playing an important role in increasing knowledge and awareness, there is little evidence to suggest that providing information, education…is sufficient to lead to substantial and lasting reductions in alcohol-related harm.”

I support that action, but, without the type of policies I addressed in my speech, I do not believe we will see the difference we need to make.

Nicola Blackwood 

My hon. Friend is right that that is not enough in and of itself, but it was an important step, because we did need to review the latest evidence and provide updated risk guidelines. That is also why we remain committed to high-impact public education campaigns. Last year, PHE launched its “One You” campaign, which she may be aware of, which aims to motivate people to take steps to improve their health through action on the main risk factors, including alcohol consumption. “One You” has been used by more than 1.6 million people so far. It includes a drinks tracker app, which helps drinkers to identify risky behaviour and lower their alcohol consumption. PHE will launch a new “Days Off” app on 7 February to encourage people not to drink alcohol for a number of days a week, which is in line with the CMO’s guidelines. Evidence supports that as an effective way to reduce drinking and a good, effective and manageable way in which to use the guidelines.

Bill Esterson 

I am pleased that the Minister is making practical suggestions to address some of the problems that have been raised. I hope that she will take up the shadow Health Secretary’s offer to work together on this. As an initial step, perhaps she could sit down individually with the three of us who initiated the debate to take things further, because we have said a lot today but there is a lot more to the debate that may be of assistance to her.

Nicola Blackwood 

The hon. Gentleman put his finger on it when he said that a huge number of issues have been raised. I am trying to get through as many as I can. It is likely that I will not get through every point, so, if I do not, I will try to write. I will certainly try to give as much detail as I can. I think I noted everything down, but, if I did not, I am sure hon. Members will remind me with interventions. If they will let me make a bit of progress, I shall do my best.

In the report produced by my hon. Friend the Member for Congleton, recommendations 3 and 4 were to increase awareness and training for health professionals. A number of colleagues raised that as an important issue for identifying earlier and intervening on those who are misusing alcohol. We recognise that as important. All health professionals have a public health role, and we need to ensure that our frontline workforce are properly trained to tackle such challenges, especially alcohol misuse and drinking in pregnancy. I will come on to the points made by the hon. Member for Sefton Central in a minute.

Kelvin Hopkins 

To be specific, will the Minister look carefully at what I suggested in my speech? We should have notices in all medical establishments and all areas where alcohol is consumed or purchased with the wording used in America about birth defects, and we should ensure that all medical professionals know about that problem and tell all women about it.

Nicola Blackwood 

I will come in a moment to how we are dealing with the issues of foetal alcohol syndrome and foetal alcohol spectrum disorders, but I want to talk first about training for professionals, if that is okay.

By 2018, about 60,000 doctors will have been trained to recognise, assess and understand the management of alcohol use and its associated health and social problems. We think that is important so that future doctors can better advise on the health impact and effects of substance misuse. One of the key areas for that must be primary care. Since April 2015, the standard GP contract has included the delivery of an alcohol risk assessment to all patients registering with a new GP, which offers the opportunity to raise awareness of alcohol as a risk factor. In addition, the inclusion of an alcohol assessment in the NHS health check is a good opportunity for healthcare professionals to offer advice. That check is offered to all adults between 40 and 74 in England.

That large-scale intervention has the potential to make a real difference, because we know that one of every eight people who receive the intervention moderate their behaviour. Put simply, evidence shows that that is one of the most effective interventions available to us. Since we mandated the alcohol assessment and advice component in 2013, more than 10 million people have been offered a check, and nearly 5 million people have taken up the opportunity, which is a take-up rate of about 48%. That is progress, but we want to go further.

Recent research has shown that referrals to alcohol services following an NHS health check are about three times higher than among those receiving standard care. We therefore think that the health check is a good way to prompt an adjustment in behaviour. We will continue to deliver it, although we will be happy to hear recommendations on how we can improve it.

Another thing we are doing to support frontline professionals to identify those who might need more significant intervention is that Public Health England is currently leading a review of the higher-risk drinking advice. That is being undertaken in partnership with the devolved Administrations, and the updated advice will be published once the evidence has been considered.

The hon. Members for Sefton Central and for Luton North (Kelvin Hopkins) gave important speeches on the risks of FAS and FASD. They were concerned about the availability and understanding of the CMO’s guidelines. As I mentioned, we are working with partners in industry to update the advice provided on labels, which should disseminate those guidelines. I will certainly consider the comments made about putting that information on labels, in GP surgeries and in other appropriate locations. One of the other ways in which we are trying to get that information out is through the “One You” campaign and the drinks tracker, which I have just mentioned.

We are also trying to disseminate that information through health professionals in a more targeted way. Health professionals are supposed to discuss it with pregnant women as part of their routine work, but women who are heavy drinkers are much less likely to engage with antenatal care, so identifying them can be challenging. Over the past year, PHE has therefore been undertaking a piece of work to identify those at risk and provide advice. It has piloted in three regions of England a training programme developed in Wales called “Have a Word”, which sounds much like what the hon. Member for Sefton Central proposed. PHE is considering the findings from the pilots with a view to rolling the programme out across England if it is effective. We are particularly looking at the findings on how pregnant women can be targeted. I am happy to share those findings with the hon. Gentleman, as I suspect they will address his concerns on raising awareness and targeting pregnant women.

The hon. Gentleman raised the problem of professionals dismissing foetal alcohol spectrum, which sounds familiar. One problem I have been made aware of is the lack of research in this particular field and the need to increase it. Although the World Health Organisation has started a global prevalence study, which he called for, it recognises that information is lacking in many countries, including the United Kingdom. That creates a number of challenges, because the feasibility of estimating prevalence is difficult given the ethical challenges associated with research in that area.

Public Health England recently published the most comprehensive and up-to-date review of current harms of alcohols and the evidence on the effectiveness of alcohol control policies. We are currently engaged in further work to understand the impact of parental drinking on children; we discovered during the initial work that we did not have sufficient evidence on that, so we are going forward with that work. Public Health England is also developing prevalence figures at local authority level, as well a toolkit to support local authorities to respond to the issue of parental drinking. That is due to be published later next year, and I hope it will be of assistance to the right hon. Member for Birmingham, Hodge Hill in the work of his all-party parliamentary group as well.

One challenge we face is insufficient evidence, which is why we are trying to build the evidence base up so that we can assist medical professionals and local authorities as they try to make decisions; if they do not have the evidence, it is very difficult to make proper policy decisions in this area. I hope that reassures the hon. Member for Sefton Central, and I am happy to come back to him on any of the other points that he made.

We have also put several measures in place to ensure that children are provided with the information and tools they need, including through the Frank drug information and advice service. Family nurse partnerships help parents in vulnerable families to develop their parenting capacity, while tailored and co-ordinated support is offered via the troubled families programme. A lot of that needs to be delivered through local authorities; one of the recommendations in the report by my hon. Friend the Member for Congleton was to promote increased partnership through local communities. We believe it is right that local authorities should lead on that work as they are best placed to understand the different challenges in their areas; what is perhaps a challenge in Birmingham may be slightly differently represented in Bournemouth. However, we must make sure that local authorities are properly held to account when they lead on that, which is why we are keeping a close eye on whether they are delivering on these investments in the first place.

Our data show an increase in local authority spending on alcohol services for adults—from approximately £200 million in 2014-15 to £230 million in 2015-16—which we think demonstrates their understanding of the need for a commitment to invest in those treatment services. Our data also show that 85,000 individuals were treated in 2015, of whom 39% successfully completed treatment. The right hon. Member for Birmingham, Hodge Hill quoted different figures. I have not seen his freedom of information request or the response, so I am not sure why that is, but I am happy to investigate the variation between our figures and to discuss it with him to try to get to the bottom of exactly what is going on.

I am also happy to discuss the issues the right hon. Gentleman and the shadow Health Secretary raised regarding children of alcoholics; both made important and moving speeches about that. I thank the right hon. Gentleman for his leadership on this issue. I know it is not easy to speak out in this place about personal trauma and loss, and I know that we too often feel it will weaken us and expose us to personal attacks. I hope that by his standing up in that way, more people—not only in this building but across the country—will feel that they can be open about their personal experiences of addiction and of being in families with those with addiction, and will be able to seek help.

This is an incredibly important step in tackling addiction and the stigma that still exists around it. I thank both Members for the steps they have taken in progressing what is a very challenging cultural area in the UK, and I hope they will accept my commitment to working with them to trying to progress it as well. I want to put it on the record that we are trying to take steps, through the troubled families programme, to improve the situation for children of alcoholics. The troubled families programme has a responsibility to tackle problem drinking and to commission appropriate prevention and treatment services —including to support the children of those families.

Liam Byrne 

I pay tribute to the Minister and welcome her commitment to working together across the aisle, so to speak, to put a new strategy in place. The troubled families programme is very important, not least because there is a lot of money in it. That money is often focused on families in the most chaotic of circumstances, but our evidence shows that many families with alcoholic parents do not look troubled or chaotic to the outside eye—they are often functioning alcoholics. Our definition of what constitutes a troubled family may therefore need to be stretched a little in order to help those children.

Nicola Blackwood 

The right hon. Gentleman is obviously an expert on the issue, but understanding how to identify those at risk is not specific to this area of public health; it occurs in other areas and is familiar to me from my mental health brief as well. This will be something that we need to sit down and discuss to understand more accurately.

It may be that we need to look at the troubled families programme to see how that could be addressed in order to work more effectively to target those in need of assistance. The key message today is that children of alcoholics in the United Kingdom should not feel as though they are alone—they should feel as though support is there, and they should know that they will find help when they seek it. I must go on to talk about some of the other issues that were raised; I hope I am not taking too much time.

The NHS remains critical to the prevention of alcohol harms. We must incentivise NHS providers to invest in interventions to reduce risky behaviours and prevent ill health from alcohol consumption. NHS England and Public Health England have worked together to develop a national commissioning for quality and innovation—CQUIN— payments framework, which is an important intervention. For those less familiar with the CQUIN payments framework, it was set up to encourage service providers to continually improve the quality of care provided to patients. CQUIN payments enable commissioners to reward innovation by linking a proportion of service providers’ income to the achievement of national and local quality improvement goals. In this case, it means that every in-patient in community, mental health and acute hospitals will be asked about their alcohol consumption. Where appropriate, they will receive an evidence-based brief intervention or a referral to specialist services, which should improve the treatment of children in the care of alcoholics, as in cases like those raised by the shadow Health Secretary. That is something we should be pleased about.

More than 80% of hospitals offer some form of specialist alcohol service, and investment in similar alcohol care teams in every hospital would potentially provide the NHS with an opportunity to maximise its delivery of identification and brief advice interventions to patients. As I said, that has been identified as one of the most important interventions to change behaviours.

Hon. Members will be aware that the NHS and local authorities have been developing sustainability and transformation plans—STPs. Those are now published on NHS England’s website, and the vast majority include actions to reduce the harms from alcohol, including through investment in brief advice, which was one of the recommendations from my hon. Friend the Member for Congleton, and expanding the approaches for those with more problematic alcohol use. That is an encouraging sign. Underpinning all of our work is the expertise of Public Health England, as we have seen from its report. PHE staff work closely with local authorities and the NHS to try to tackle alcohol harms. Building on its recent review, we must ensure that it gives the right data analysis, so that local authorities know how to effectively target their policies.

One issue raised by a number of colleagues is the call for a review of the licensing legislation to include a health objective, as in Scotland. I have some questions about how effective that would be. Although it is easy to link a criminal justice problem to a specific location, it is much more difficult to link a health challenge to an individual establishment. It is quite hard to prove that buying a drink in an individual establishment has caused someone’s liver disease.

PHE is leading our engagement with the Home Office’s second phase of the local alcohol action areas programme and offering support and advice to participating areas that have identified improving the public health response to alcohol-related harms as a key focus of their approach. Successful applicants were announced by the Under-Secretary of State for the Home Department, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), on 27 January, with 18 of the 33 successful areas looking at how they can improve the health of their residents. That is one way in which this is being done.

The House of Lords Select Committee on the Licensing Act 2003 is looking at that Act and is due to publish its report in March. We will, of course, carefully consider its recommendations. I gave evidence to the Committee, which is looking at health as part of that issue.

Fiona Bruce 

On the issue of availability, the Minister’s Department’s own report indicates that reducing the number of hours during which alcohol is available and looking at density—the number of outlets where alcohol is sold—can help to reduce alcohol harm. I hope she will look at that as she proceeds. The local licensing objective could have real teeth if those issues were introduced into it.

Nicola Blackwood 

My hon. Friend is passionate about this issue. I understand the argument for introducing the health objective. The problem is proving the risk posed by the individual establishment. However, we will consider the evidence that comes forward.

I will briefly turn to taxation, which was raised by a number of colleagues, including Scottish National party Members. I have to say at the outset that making changes to taxation is a matter for the Chancellor and slightly above my pay grade. We also have to note that the UK currently has the fourth highest duty on spirits compared with other EU member states, and higher strength beer and cider are already taxed more than equivalent lower strength products. We are considering the introduction of minimum unit pricing in England and Wales but are waiting for the outcome of the court case in Scotland. Until we hear the Supreme Court’s decision, which is still unknown—we are supporting the process of that case—we cannot proceed with any policy decision in the United Kingdom. It is a little unfair to berate us for not introducing a policy that cannot yet be enforced in Scotland.

On targeted changes in taxation, I am advised that current legislation on alcohol duties requires that duty on wines and ciders is paid at a flat rate within defined bands of alcoholic strength. I understand that my hon. Friends the Members for Congleton and for Ribble Valley have advice that it is possible to do something else, which I would be pleased to see, although that is a Treasury matter. At the moment, my understanding is that the EU directive sets bands for alcohol products in relation to strength and that while we have some flexibility to set rates within the structure of those bands, we are not able to link a duty absolutely to alcohol strength. Obviously, with our vote just yesterday, there is an opportunity with Brexit to consider these issues more specifically going forward, but that is my understanding of EU legislation as it stands and the advice I have received on this specific point.

Fiona Bruce 

The information I have received is that the Government could just split the general rate into two separate brackets, therefore achieving their goal without the need to go through the EU. If the Minister will permit me, I will pass to her the opinion we have received on that.

Nicola Blackwood 

My hon. Friend is very kind; I would be happy to see it.

I will close now, as I have cantered through a large number of issues and am sure hon. Members are tired of hearing my voice. I thank colleagues from both sides of the House for taking part. This has been an important debate. There have been very moving speeches, especially from the hon. Members for Sefton Central and for North Ayrshire and Arran (Patricia Gibson), the right hon. Member for Birmingham, Hodge Hill and the shadow Minister. They all illustrated powerfully the devastating impact that addiction and alcohol misuse have on not only people’s own health but, as we heard so eloquently, their families, children and local communities, not to mention the health and social care systems and wider society.

We have to give credit where it is due. We have to thank the many NHS workers, local authority staff, charities such as ChildLine and Aquarius and volunteers who are making such a difference in this area already. They are saving lives. We must recognise progress where it is being made, especially in the changing attitudes among young people. We must not despair.

However, as we have heard from today’s debate, stories and statistics, we cannot be satisfied with this. There is much more we can and must do, and I hope I have reassured colleagues today of my personal commitment to ensure we strengthen the information, support and, if necessary, treatment we give people to reduce the harms of alcohol misuse. With a health challenge as culturally entrenched as this, it can sometimes feel as though it is a mountain we will never successfully climb, but I take courage from today’s debate. Great social change requires three things: long-term political will, non-partisan partnership and bravery. I have heard all three of those today. I hope that each Member who has spoken here today will continue to work with me as we fight on to tackle this social injustice.