Chamber and committees

The policy has never been a silver bullet, and it has never existed in isolation as the only thing that we are doing. The paragraph that jumped out at me in the letter from the north-east of England branch of the Association of Directors of Public Health concerned the proportionately higher positive health impacts on people who experience the deepest health inequalities.

The letter said:

“The positive health impact of the policy, compared to what would have happened without MUP, can be seen both in annual death statistics before the pandemic struck, and when comparing the rise in alcohol deaths in Scotland to England, since. In the first full year after MUP was implemented, there was a 10% reduction in alcohol-specific deaths and a small reduction in hospital admissions from liver disease.”

One of the key areas is the high incidence of liver disease in Scotland and how we can tackle that to reduce the harms.

The letter went on to say:

“Changing drinking habits during the pandemic, combined with reduced access to services, led to a tragic rise in alcohol-specific deaths in Scotland between 2019 and 2021”.

We recognise that and are focusing work on it. However, the letter went on to say:

“this was substantially lower than the rise experienced in England and particularly the rise in the North East”.

The north-east of England branch of the association analysed the difference between not having minimum unit pricing in England, including in the north of England, and having it in Scotland and came to the conclusion that, in its professional judgment, minimum unit pricing targeted the areas where the biggest inequalities were, particularly in relation to hospital admissions and deaths. On the 156 lives that are saved, if one of those people was in your family, they would be a precious person. All 156 of those people continue to be precious.

Earlier, I made points in response to the question about the impact on women and other groups. I want to pick up and look at that, too.

I am a policy person who does not make policy without ensuring that the people who will be impacted by the policy are sitting at the table. That is the approach that I have taken in all my ministerial and parliamentary roles. Even in my past professional life, I did not make any policy decisions without such people sitting at the table, because their lived and living experience is absolutely key.

My answer to your first question—that I am open-minded—is the exact answer to your question about the process of uprating. Inflation might be a crude measure for doing it, given the economic impacts that we have had—a sharp inflation rise and then a drop in inflation. Therefore, that might not be the measure that we use.

As I said, my mind is open, and, if colleagues on the committee have ideas on how we can do it, please let me know. I am keen to work with the Parliament, stakeholders and across the Government to ensure that we get it right.

Due to the cost of living crisis, it is really difficult to know whether that is completely accurate. Some of the biggest impacts on people right now are from the cost of living crisis and its impact on their shopping bills, their energy bills and everything else in their life, so it is a bit more nuanced than just this one approach. There are other influences on the issues that people are facing, and the cost of living crisis is a huge one.

Others argue the complete opposite. Even in the consultation, the ideas and understanding that were expressed were pretty polarised.

I take to heart the expertise of Public Health Scotland, the University of Sheffield, front-line workers and public health directors in the work that I must do to make a difference, rather than listening to people who might be sitting on the sidelines criticising the policy without any real idea about how to approach it themselves.

I reiterate that I do not believe that this is a silver bullet—no one is saying that it is a silver bullet, because it is not. It is just one of the tools that we have in the box for tackling the issues that we face.

Yes. That was recognised in the letter to The Lancet from Professors Michael Marmot and Sally Casswell, who said:

“This summary of research on minimum unit pricing is comprehensive, including interviews with individuals who fear the policy will be detrimental to them personally or financially. The Public Health Scotland approach of emphasising population-level findings is the right one for assessing population-level interventions, such as minimum unit pricing.”

They were absolutely clear about the value of that analysis.

We will look for the best option that will allow Parliament to scrutinise any decisions that are made, but also ensure that we can continue the policy’s benefits.

Yes.

It is different for different retailers. Those in the off-licence trade—that is, bottle shops—can see the difference pretty clearly, but it has become difficult for supermarkets to separate sales, because people will buy alcohol along with whatever else is in their shopping. That said, HMRC might have some data on that, so we will follow that one up.

I am happy to move the motions. There is not much more to say, other than my key opening remarks that we believe, following the review, that now is the time to continue with the policy and to uprate the minimum unit price to 65p. I commend both sets of regulations to the committee and hope that it will support them.

I move,

That the Health, Social Care and Sport Committee recommends that the Alcohol (Minimum Pricing) (Scotland) Act 2012 (Continuation) Order 2024 [draft] be approved.

That the Health, Social Care and Sport Committee recommends that the Alcohol (Minimum Price per Unit) (Scotland) Amendment Order 2024 [draft] be approved.

That timeline runs over 17 or 18 years—which is a lot of time. In that time, there have been a lot of interventions, and a lot of work has been done to reduce drug and alcohol-related deaths and hospital admissions. We took the decision to continue to implement minimum unit pricing, because we saw the benefit not just in the short term but in the long term. That is why I am committed to continuing the policy and uprating MUP; we can see the definite change that is happening.

Have we been doing this long enough to understand that change at a population level? Probably not. That is why the reviews, the work and the modelling that are being done are incredibly important. Yes, we are talking estimates—but they can be only estimates, because it is a bit more difficult to disentangle health outcomes, particularly with regard to people who do not factor into the death statistics but who factor into the reduction in hazardous and harmful drinking. That is why the modelling and the analysis are being done in the way that they are, and it will also help us understand how we move forward. We want to uprate precisely because the differential has increased and we want to make sure that it increases again.

The director of public health in north-east England says that this policy works, and we can see that it works. We have made the comparison between Scotland and the north-east of England, and its recommendation is minimum unit pricing for England and Wales. That is an important point.