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Speech by Rt Hon Dawn Primarolo MP, Minister of State for Public Health, delivered 5 November 2008 to the 3rd National Alcohol Conference

Thank you. I’d like to add a health perspective to what has already been said.

There is an argument – a very strong argument - that problem drinking is, in a sense, becoming ‘the new smoking’ in terms of the challenge that it presents to public health.

The scale of the problem is certainly comparable. Twenty-six per cent – about 10 million adults in England – currently drink more than the Government guidelines. By contrast, 22 per cent smoke – and that has fallen considerably in recent years.

But it’s the numbers at the top end of the drinking spectrum that are most troubling. More than two and a half million adults are drinking alcohol at a “higher risk”. That is 1.6 million men regularly drinking more than 8 units a day or 50 units a week, and a million women regularly drinking more than 6 units a day or 35 units a week.

We are already seeing health problems now as a consequence. But they serve notice of a much bigger danger to come: a wave of preventable death, disease and injury.

The numbers are already stark enough.  About 15,000 people die because of alcohol every year – about 3% of all deaths in England.  In younger people, accidents and self-harm are the big threats. And among older people, it’s a litany of chronic diseases – cirrhosis, cancers and cardiac problems.

And we also know that issues around alcohol raises of health inequality.  The poorest areas have more than double the mortality rate than affluent areas do, and up to five times higher hospital admissions rates.

Now of course inequalities and health are very complex – where you are born and live are very big determinants, but when you add to that the other pressures on health - alcohol, smoking and misuse of drugs - we can see quite clearly in looking specifically at alcohol that it’s also a fight for social justice, and it’s also a fight to sustain our health services.  The statistics really speak for themselves:

- Six per cent of hospital admissions are alcohol related.
- Up to 35% of all A&E cases and ambulance costs are alcohol related.
- This produces a combined NHS bill of £2.7 billion – all alcohol-related.

This is a massive drain on public resources – nationally and locally.  And it is largely preventable. And that’s before we put into it the individual misery, the pressure on families and the intense problems that we see in communities

So we need to step in. Not because we are killjoys; not because we are not prepared to recognise the cultural relationship people have with alcohol, but if we don’t step in, the consequences are enormous for our communities. And the starting point has to be Whitehall, and strong cross-Government action is a good starting point.

Safe, Sensible and Social reflects our commitment to act on this.  And I am delighted to share the platform today with Alan [Campbell] and Delyth [Baroness Morgan] and who we’ve just heard from.

Because the strong relationship between our respective Departments mirrors the strong partnerships that are developing locally.

And it mirrors the importance you attach to the issue – and we can see that reflected in the fact that 99 PCTs and 73 local authorities have made it a priority, either in their local operating plans or local area agreements.

We must now turn this recognition into action by making sure that you get the all support you need centrally, in order to deliver what you want to achieve locally.

So today, I’m really pleased to announce a new and wide-reaching Alcohol Improvement Programme to accelerate progress.

I want to take a moment to talk about the various parts of the programme, and explain how it will help you make a greater impact.

First of all, to assist you with delivery, the programme will improve the evidence base – helping you to develop the right support for people the in your area.

There will, for instance, be new data on hospital admissions broken down by each of the medical conditions listed in Vital Signs Indicators. An incredibly useful report, it personalises and makes people realise how it impacts on their lives.

And the National Alcohol Treatment Monitoring System will also collect information from providers on the numbers receiving specialist alcohol treatment, and these figures will help PCTs correct the deficiencies that we know in the system.

Robust commissioning is also a bedrock of better partnership working between services.

Partnership is, of course, the big theme of today. I realise it’s something that’s easy to say in a conference hall, but more difficult to achieve in the real world, where institutional boundaries, cultural differences, funding issues, sometimes even the personalities involved can make it hard for us to work together as well as would like. This isn’t uniquely local, it’s an issue at every level and certainly in central Government.

So we are currently working with Regional Public Health Groups to establish Regional Alcohol Managers in every part of the country.

These managers will be, if you like, ‘partnership champions’ breaking through the boundaries, helping PCTs make the right connections with SHAs, councils and my Department, and providing a clear point of co-ordination to help us collaborate on the key indicators.

I’ll give you one example of what this means in practice.  We are establishing a North East Alcohol Office that will bring together a number of agencies including the police, the local authority, the Mental Health Trust and Children’s services, among others.

It will work to create safe, healthy communities through more effective law enforcement and better treatment services.

Good multi-agency working like this isn’t just the right way forward, it’s the only way forward.
So … good data, good commissioning, good partnership working: three pillars of a better approach. But, of course, the acid test is what happens on the ground. And here we also want to help practitioners make faster inroads.

It’s clear we’ve got to focus all our energies on ‘high impact changes’ that can make the biggest difference.

By that I mean:

- Improving access to specialist alcohol treatment, which we know yields the fastest results, but isn’t always available to those who can benefit most.
- Making better use of Identification and Brief Advice across all services – not just in primary care but in A&E, in criminal justice and in specialist settings.
- And developing strong local advocacy, with senior champions pushing things forward, banging on the door of the Director of Finance, talking to the Public Health Director and creating the traction for change across services out into the wider community through social marketing programmes.

It’s also clear we need to capture good practice and universalise it as much as possible – particularly in hotspot areas where we have most to gain.

So today, I am also announcing which PCTs will be our Early Implementation sites. They will receive a share of additional monies from a three million pound pot of cash to trail blaze new approaches, and share their experiences with other PCTs around the country.

These ‘early implementer’s are all located in health inequality hotspots. We know that reducing alcohol problems is key to reducing inequality, so we want them taking bold steps, together with the National Support Teams and local partners, to get to grips with the problem.

I’m pleased to say two of the PCTs are from this region – Leicester and Nottingham are among the 20 we’ve selected in the first wave.

But, of course, we want all areas to benefit from the insights and experience of these Early Implementation sites. So we’re also launching a new Alcohol Learning Centre to provide a central repository of best practice for healthcare professionals. Quite simply, to help you learn from the very best out there.

In addition, we will provide direct support to Early Implementation PCTs, by setting up local and regional networking events to bring professionals together to discuss common problems and arrive at new solutions. Much like we’re doing today, but on a local and regional scale.

It will also feature a new website (www.alcohollearning centre.org.uk)  to collect, co-ordinate and disseminate a range of good practice.

I should also plug the new e-Learning resource for GPs and practice nurses. This is an interactive programme – it takes about two hours to complete – and will help them learn how to identify and advise patients who are drinking at increased and higher  risk levels. We hope over time that additional modules could be added for other professionals across health, social services and the criminal justice system.

And that strikes at the central point. Primary Care is clearly vital in reducing alcohol-related harm – which is why we’re also offering new incentives for GPs and health centres to screen and advise all new patients. But we all know the heaviest drinkers don’t necessarily approach their GPs. Those that do may underestimate the amount they drink and fall under the radar.

So this has to be a battle fought on many fronts, and at many levels. At the highest strategic level, we need the three-pronged approach of prevention, enforcement and intervention that I and other Ministers have spoken about today. In practice, this has to translate to a greater willingness for criminal justice, education, health and social services to come together and work together to reverse the tide.

That’s why partnership is important, that’s why today’s event is important, that’s why we need a strong culture of collaboration across Government Departments and across local services.

I believe we’re getting close on this. The programme I’m announcing today will now help us move forward even faster.

So let me end by thanking you again for all you have done, and all you will do, to avert the multiple threats posed by excessive drinking. It’s a vital issue for all of us, and important that we put up a united front against it.

The bottom line is, we’re in this together – and together I believe we can make a massive difference. Thank you very much.