Meeting of the Parliament [Draft]

Meeting date: Thursday, February 8, 2024

Official Report 1157KB pdf

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Minimum Unit Pricing of Alcohol

The next item of business is a statement by Shona Robison on minimum unit pricing of alcohol. The Deputy First Minister will take questions at the end of her statement, so there should be no interventions or interruptions.

14:27  

Members will be aware that my colleague Elena Whitham resigned earlier this week for health reasons. She has been instrumental in progressing our work on alcohol, and I am sure that members will join me in wishing her well.

I recall making a statement to this chamber on 21 November 2017 on minimum unit pricing and our intention to reduce some of the harms that are caused in Scotland by alcohol. In May 2018, following the agreement of this Parliament, Scotland made history by becoming the first country in the world to introduce the policy. As I led the introduction of the policy, it is with great pleasure that I make this statement on the future of minimum unit pricing of alcohol in Scotland.

I am clear that alcohol continues to cause significant health harm to too many people in our country. The latest figures from the National Records of Scotland show that there were 1,276 alcohol-specific deaths in 2022. I take the opportunity to extend my deepest sympathy to all those who are affected by the loss of a loved one through alcohol.

We, as a Government, are determined to do all that we can to reduce alcohol harm. I announced back in 2017 our intention to introduce the policy as soon as we could, following the delay caused by several years of litigation in the Scottish courts, the European Court of Justice and the United Kingdom Supreme Court.

The minimum unit pricing legislation came into force on 1 May 2018 and contains—as members will already know—a sunset clause that means that it will cease to have effect unless the Scottish Parliament votes to continue it. In September last year, the Scottish Government published its report on the effect of minimum unit pricing in its first five years of operation. In order to inform that report, Public Health Scotland was tasked with leading an independent evaluation of minimum unit pricing, which was commended by internationally renowned public health experts including Sir Michael Marmot and Sally Casswell.

Public Health Scotland’s final findings were that, overall, the evidence shows that MUP has had a positive impact on health outcomes—namely, a reduction in alcohol-attributable deaths and hospital admissions, particularly among men and those living in the most deprived areas—and therefore contributes to addressing alcohol-related health inequalities.

There was no clear evidence of substantial negative impacts on the alcoholic drinks industry or of social harms at a population level. It was estimated that, during the study period of the evaluation, MUP reduced alcohol-attributable deaths by 13.4 per cent, or 156 such deaths, per year. It was also likely to have reduced by 4.1 per cent the number of hospital admissions that were wholly attributable to alcohol, compared with what would have happened had MUP not been in place.

Running in tandem with the evaluation was a review of the level of minimum unit price. In order to inform the review, the Scottish Government commissioned the University of Sheffield alcohol research group, which is an expert in the field, to undertake new modelling. Its research suggests that, if MUP is to maintain the current level of benefits that the evaluation was able to find at a price per unit of 50p, the price should increase to at least 60p per unit due to inflation. Scotland is facing a growing burden of disease over the next 20 years, and I know that all members will agree that action is needed to reduce the causes and effects of ill health in Scotland.

I am pleased to be able to update members about the conclusion of our review of minimum unit pricing and to set out the next steps for the policy. The Cabinet has now met and discussed all the available evidence, including the recently held public consultation, and has come to a final decision. I can confirm that it is our intention to lay before Parliament draft orders to continue minimum unit pricing beyond 30 April 2024 and to set the price per unit at 65p.

I know that some people do not agree with minimum unit pricing. We have considered their concerns and views in reaching our position. I also note business and industry concerns regarding some aspects of the policy. Although it is my view that our decisions are unlikely to have a significant effect on the alcohol industry and retailers, and although the evidence to date suggests that there has not been such an impact on those business groups, I understand the concerns that have been raised. We have considered the important role that alcohol production and sales play in Scotland, which is particularly important to the economies of our rural communities and to tourism. The evidence suggests that there will not be a significant impact on those businesses and our world-leading alcoholic drinks industry.

Many business stakeholders told us that implementing any price change quickly might be difficult. To address those concerns, I am pleased to say that, if Parliament agrees to the order increasing the minimum price to 65p per unit, it will not take effect until 30 September. We have listened to the views of businesses, including those of the refreshed regulatory review group, and we agree that an implementation window is necessary to allow them to take steps to prepare for the change.

Although this statement is an update on minimum unit pricing, I recognise that MUP is not a silver bullet. We must try to prevent people from experiencing alcohol-related harm in the first place. However, for those who are already drinking at higher levels, including people with alcohol dependency, specialist treatment and support are vital.

The Scottish Government continues to take action to ensure that people who require treatment and support in relation to alcohol can receive them. This year, we are providing £112 million to alcohol and drug partnerships, and, as part of that funding, we have set out the need to invest in specific initiatives such as stabilisation and crisis management for alcohol. We continue to see expansion in local assertive outreach services, which should also increase the number of people who are offered treatment. We have asked Public Health Scotland to investigate the reduction in the number of referrals to treatment services, as we need to ensure that referrals are made wherever appropriate and that services have the capacity to meet people’s needs. It is vital that we know what lies behind the data. Last autumn, we published our workforce action plan for alcohol and drug services, to help to shape recruitment, retention and service design. The plan sets out the key actions that we will deliver over the next three years to address the challenges that the drug and alcohol sector’s workforce experiences.

I am pleased to confirm the Scottish Government’s decisions on MUP. The Sheffield modelling that I mentioned has estimated that those decisions should avert an additional 60 alcohol-specific deaths and 774 fewer hospital admissions in the first year—not to mention the significant public health benefits that we expect in situations where alcohol is a contributor to causes of death and ill health.

I thank, in particular, the many stakeholders in the alcohol industry, retail, tourism and public health who have provided their views on MUP. Those views have supported our considerations around the decision. We will lay the orders before Parliament on 19 February, and I look forward to engaging with the committee further on the matter.

Alcohol harm remains a significant issue in Scotland. It continues to contribute to worsening health outcomes, and the decision to continue with MUP and increase the price shows that Scotland continues to be world leading in improving the health of our people.

The Deputy First Minister will now take questions on the issues that were raised in her statement. I intend to allow around 20 minutes, after which we will need to move to the next item of business. Members who wish to ask a question should, if they have not already done so, press their request-to-speak buttons now.

I declare an interest as a practising national health service general practitioner.

Cabinet secretary, you falsely accused me of not believing the evidence. Perhaps it is just a lack of understanding on your part, given that the Government had to change its release—

Through the chair, Dr Gulhane.

—as a result of my complaint.

Let us start with alcohol-related deaths: they are at a 14-year high in Scotland. Even a novice statistician would tell you that hospitalisation data is not statistically significant. There are 40 studies on the evaluation of MUP, and only one has claimed that there was a reduction in deaths. Saying that MUP has reduced deaths is not accurate, as that was an estimate based on statistical modelling and, if it had been compared with Northern Ireland and not England, it would have shown that MUP caused deaths.

The number of people seeking help for alcohol issues reduced by 40 per cent, along with referrals for treatment. The purpose of a policy such as MUP should surely have been to reduce consumption of alcohol by those who are dependent drinkers, but Public Health Scotland’s own data shows that those with alcohol dependence are forgoing food. MUP is not the magic bullet that the Scottish Government is continuing to laud it as.

If MUP was not designed to help those with alcohol dependence, what has the Scottish Government done to mitigate the harms that were obviously going to happen to those people over the past five years? What is its policy for dependent drinkers, whom it has clearly abandoned?

I will start by quoting Justina Murray, who is the chief executive of Scottish Families Affected by Alcohol & Drugs. At committee, in response to Sandesh Gulhane, she said:

“I think you are possibly the only person in the room who does not believe the evidence ... You know, we have lost over 11,000 people specifically to alcohol over the past decade. Families really do not understand why this is still being debated.”

Justina Murray encapsulates my feelings very well indeed.

In relation to alcohol-specific deaths, for the evaluation, the question is not whether deaths went up or down; it is whether deaths changed in comparison with what would have happened if MUP had not been in place. It is likely that, without MUP, we would—tragically—have experienced an even greater number of alcohol-specific deaths.

That view has been echoed by public health experts such as Michael Marmot in a letter to The Lancet. I am sure that, being a doctor, Sandesh Gulhane will know about The Lancet and its importance. The letter said:

“Policy makers can be confident that there are several hundred people with low income in Scotland who would have died as a result of alcohol, who are alive today as a result of minimum unit pricing.”

I know whom I listen to: the public health experts. I think that we will leave Sandesh Gulhane to talk for himself.

On behalf of Scottish Labour, I associate myself with the Deputy First Minister’s remarks—I wish Elena Whitham well and thank her for her work in this area.

I thank the Deputy First Minister for advance sight of her statement. Scottish Labour accepts, as per the evidence, that minimum unit pricing has a role to play in tackling alcohol harms, but we believe that it must be part of a wider package of measures over and above that. That position is shared by 30 public health-related organisations and charities. Does the Deputy First Minister agree that steps must be taken to explore how the additional revenue that is raised by minimum unit pricing can be recouped and invested in tackling alcohol harms in Scotland?

I welcome Carol Mochan’s support in principle for the policy and I agree with her. As I said in my statement, minimum unit pricing is not a silver bullet; many other things have to be done. I talked about the services that are being delivered, particularly for those who are alcohol dependent. All those things are important.

I think that Carol Mochan was alluding to the public health levy. As she will be aware—I recognise Labour’s support for this—we have set out that we will give due consideration to a public health supplement. That was in place previously—between 2012 and 2015, I think. However, we need to consult on that and take into account the many other aspects of the regulatory frameworks at the moment, not least minimum unit pricing but also other regulatory issues that are being looked at. We need to look at things in the round. I have been meeting business organisations, and colleagues have been meeting public health organisations. We will look at all of that in order to come to conclusions on how to proceed well in advance of the budget later this year. We look forward to working in a constructive way with Carol Mochan and others on those matters.

I refer members to my entry in the register of members’ interests. I hold a bank nurse contract with Greater Glasgow and Clyde NHS Board.

The Deputy First Minister has already quoted some of the evidence that the Parliament’s Health, Social Care and Sport Committee took on Tuesday on Scotland’s minimum unit pricing policy. We heard from numerous stakeholders, who spoke about the impact that minimum unit pricing has had on reducing consumption, hospital admissions and deaths. Indeed, a Public Health Scotland and University of Glasgow study indicated a reduction of 13.4 per cent in deaths wholly attributed to alcohol consumption in the first two and a half years after minimum unit pricing was introduced. Can the Deputy First Minister outline any further evidence that highlights the benefits of the policy?

As Clare Haughey will know, Public Health Scotland was commissioned to carry out a comprehensive and independent evaluation of MUP, which looked at its health impacts as well as its wider social and economic impacts. That wide-ranging evaluation covered the first five years of the policy’s implementation.

In a previous answer, I referred to the public health experts who have commented on that evaluation. I mentioned Sir Michael Marmot and Sally Casswell—I could also mention Ian Gilmore and Martin McKee—and their commending of the methodology and the approach that was taken.

It is also worth noting—I am sure that Clare Haughey will be more than aware of this—that other countries have since followed suit and implemented a minimum unit pricing policy in their jurisdictions. The wealth of evidence, not just from Scotland but from across the world, will help us with the policy going forward.

There should be bit more brevity in questions and responses.

I am aware that the cabinet secretary has had to step in at the last minute to replace Michael Matheson, so she may not be aware of all the facts. The facts are that Scotland has experienced a 25 per cent increase in alcohol-related deaths in the past three years alone and that, in the past 10 years, the number of people accessing alcohol treatment services has gone down by 40 per cent. Is the cabinet secretary really trying to tell us—and with great pleasure—that a huge hike in drink pricing in a cost of living crisis is the best solution?

I do not know whether Jackson Carlaw is in the chamber. All that I can do is reflect with an element of sadness on how far we have travelled from the very constructive and evidence-led approach that has been taken by the likes of Jackson Carlaw, who set politics aside to support minimum unit pricing when it was introduced.

On being in full command of the facts, Tess White should perhaps remember that it was me who took minimum unit pricing through the Parliament way before she was a member. Therefore, I am very much aware of the facts, and at no point have I stated that minimum unit pricing is somehow a magic bullet. In fact, I just said to Carol Mochan, in recognition of that, that it is one part of the jigsaw of how we tackle alcohol-related harm.

I also answered Tess White’s colleague on the complex issue of alcohol-related deaths and why the evaluation takes account of the impact of other issues—not least in relation to the Covid years. I also answered, on the issue of referral to treatment services, that we need to understand why there is a reduction in the number of people being referred to treatment services. That is why Public Health Scotland has been asked to investigate all of that.

I said that in my statement. If Tess White had been listening, she would have heard that.

Thank you, Deputy First Minister. I will have to speed things along a bit. There is a lot of interest in asking questions and I want to get through as many as I can.

I remind members that I am currently a registered nurse with the Nursing and Midwifery Council.

The cabinet secretary mentioned other countries. The Northern Territory Government in Australia introduced a minimum unit price for alcohol in the same year as Scotland. How does Scotland’s experience from then to now reflect that of other countries that have taken such an approach? Has the Government considered any international learnings that might be applied here?

I thank Emma Harper for pointing out that many countries have followed Scotland’s lead on minimum unit pricing. Other countries have introduced other pricing policies, including Ireland and Wales. However, Scotland has led the way, including with the substantive evaluation of the operation of MUP, which I am sure that others will look to.

Many other countries are considering their approaches and will look at our uprating of the price as part of that. For instance, an article published by the Public Health Association of Australia noted that it considers Scotland’s approach to evaluation to be credible and that it should give confidence to parliamentarians in Scotland. In a separate publication in South Africa, academics have considered the experience of MUP in Scotland. Whether it is Australia or South Africa, we are keen to work in the international arena to share some of that best practice.

I also extend my best wishes to the member for Carrick, Cumnock and Doon Valley. I appreciated her collegiate approach and her personal passion to tackle Scotland’s drug deaths crisis.

Labour agrees with the cabinet secretary that minimum unit pricing is not a silver bullet to tackle alcohol-related harm. However, if the Government really believes that it can undertake specialist treatment and support as important parts of our efforts to reduce harm that is caused by alcohol, why has it cut the funding for alcohol and drug treatment by £46 million in real terms over the past five years?

I welcome Paul Sweeney’s comments about Elena Whitham. On the idea of a silver bullet, I accept what he is saying. Minimum unit pricing is not a silver bullet, but it is part of the armoury to tackle alcohol-related harm. On specialist treatment, we are providing £112 million this year to alcohol and drug partnerships. As part of that funding, we have set out the need to invest in specific initiatives such as stabilisation and crisis management for alcohol.

I am sure that Paul Sweeney will be aware that some innovative projects are looking at people who are alcohol dependent, and some of the evaluation of that is very interesting. As I said to Carol Mochan, I am keen to try to build a broad coalition around some of the measures that we need to take, as Elena Whitham did. It is in all our interests to tackle what has been a scourge in our society for too long.

One of the concerns about minimum unit pricing was that it would just boost the profits of the supermarkets. Can the Deputy First Minister say anything about how that could be tackled, for example by a levy or a supplement on non-domestic rates?

In Public Health Scotland’s evaluation of MUP, it found that, although the sales data showed an overall increase in revenue from alcohol, it was not possible to determine the impact on profit.

As I said, in the budget, we signalled our intention to explore the reintroduction of a non-domestic rates public health supplement for large retailers in advance of the next Scottish budget, which would be similar to the alcohol levy that Alcohol Focus Scotland has called for. However, I also said that we will continue to engage with all stakeholders—retailers in particular—as part of our exploratory work. We need to look at the wider picture of other pressures and demands that will be put on the retail sector.

One of the first decisions that I took when I became the leader of the Scottish Liberal Democrats was to reverse our party’s previous opposition to the policy. I am pleased that the Government has increased the minimum unit price to 65p and I think that the supporting evidence is pretty compelling. Can the cabinet secretary try to understand the opponents of the policy whose arguments seem to imply that making alcohol cheaper will somehow deal with alcohol harm in this country?

First, I welcome Willie Rennie’s comments. The fact that he is honest enough to say that his party changed its position shows that, sometimes, on issues that are as important as this one, we have to try to take the instinctive politics out of it. I pay tribute to Willie Rennie for doing that. I have to agree with him: I cannot understand how there is any proposition, not least from those who have a medical background, that making alcohol cheaper would reduce alcohol-related harm. To me, that does not stand up to scrutiny or to the evidence. The public health experts have made the links between price and alcohol consumption very clear.

I am not going to be able to get in everyone who wants to ask a question; that is already obvious. I have to ask for briefer questions and briefer responses.

Some professionals have reflected that reduced affordability has driven individuals to seek treatment. What steps is the Government taking in order to ensure that treatment is widely available to those who need it?

I agree that we need to ensure that there is access to treatment for those who need it, which is why, as I have mentioned, more than £112 million will be made available to alcohol and drug partnerships in order to support initiatives and ensure that local services can respond. As I have said, we have asked Public Health Scotland to investigate current trends on the number of referrals to alcohol treatment services. We need to ensure that referrals are made wherever they are appropriate and that there is capacity within services to meet people’s needs. That is why the review is so important, and I will ensure that members are kept informed about it going forward.

I will go back to an evidence-led approach, Deputy First Minister. The evidence from the Scottish Government’s feedback report is stark, and indicates that MUP has had a “negative impact” on those people who are dependent on alcohol.

The Scottish Government has until 30 September to consider mitigations for that group. The clock is already ticking. The Government’s report says only that it continues to

“consider how it can provide support”.

What mitigations are being planned and/or considered to help that group, which will be further harmed?

MUP is a whole-population policy with a particular focus on hazardous and harmful drinkers. Those who are classed as dependent drinkers fall within the extreme end of the harmful drinking category. Given the clinical needs of that group of dependent drinkers, MUP alone was not intended as a key intervention to address their needs. As I said earlier, treatment and care services are critical for that group, which is why a range of services needs to be available. We will continue to provide those.

I join others in wishing Elena Whitham well. I welcome the cabinet secretary’s announcement that the minimum unit price will be raised. Although MUP is having an effect, retailers are pocketing any profits that are generated. I welcome the inclusion of a public health levy in the budget, which, as we heard at the Health, Social Care and Sport Committee, would be a potential win-win for public health. Can the Deputy First Minister outline the timeline for work on a levy? Does she agree that there is huge potential benefit for services in recouping that money?

As I said earlier to other members, it is important that we consult all stakeholders—not just those who are in favour of the measure, such as public health organisations, which clearly are. We also need to take account of the views of retailers, and we will do that to ensure that we have good engagement across the board.

The commitment was to consider a levy well in advance of the budget process for 2025-26. We are at the foothills of that, and there will be lots of opportunity for parliamentary engagement on the matter.

We all know that alcohol is a major problem for this country, and I find some of the lines of questioning from the Tories today to be quite dangerous.

As we have heard, evidence from Public Health Scotland’s evaluation of the policy is that it has had a positive impact on health outcomes, by reducing deaths that are directly caused by alcohol consumption, as well as hospital admissions. Can the cabinet secretary give us an update on what assessment the Scottish Government has made of the findings and on any research into the financial impacts of the policy?

Please answer as briefly as possible, Deputy First Minister.

Of course, in reaching our decision on MUP, Scottish ministers have carefully considered the evaluation findings, which are the result of a robust evaluation of the period that PHS considered in its report. Given the evidence, our assessment is that MUP, at the increased unit price of 65 pence, will continue to deliver a reduction in the health harms that alcohol causes.

We know the devastating impact that alcohol can have on families and communities. It can be difficult to attribute a monetary value to that, but PHS evaluation estimated that, for the period considered, the social value of deaths that are wholly attributable to alcohol that MUP averted is between approximately £134 million and £469 million.

Again, I apologise to those members whom I was not able to call. That concludes questions on the statement. Before we move to the next item of business, there will be a brief pause to allow front-bench members to change places.