Chamber and committees

The minimum unit price of alcohol was the route that we went down. I know that there was a lot of discussion at the time about the tax aspect of it and whether that money should come back to be spent on treatment and prevention. The policy landed well partly because it did not affect the livelihoods of people who sell alcohol and did not impact the alcohol industry, of which there is a lot in Scotland. Decreasing affordability without impacting the wider economy is quite a sophisticated way to tackle the problem.

We need to understand the impact of minimum unit pricing and how it has changed behaviour. We will have to wait a little longer for the full evaluation of that, but I will definitely keep the possibility of a social responsibility levy under review. I am interested in anything and everything that I can do to tackle the challenge. I do not think that this is about affordability; I think that we need a better understanding of the impact of minimum unit pricing, which acts in the same way. The two strands will be to look at whether it works and to review the unit price, before we consider introducing different approaches to taxation to tackle the same issue.

You are absolutely correct that the pandemic caused quite a disruption in this respect, as in many others. We have seen a steady reduction in the amount of alcohol that is being consumed. In the first year after the introduction of minimum unit pricing of alcohol, there was a huge decrease in the number of deaths. They reduced by 10 per cent, which I think is the second-largest decrease in any year since records began. In 2020, which was the first year of the pandemic, adults drank an average of 9.4 litres of alcohol per head, which is 18 units per adult, per week. That is the lowest level of average alcohol consumption in Scotland for 26 years, but it is still almost 30 per cent more than the recommended limit.

That does not tell us who was drinking and how they were drinking. There is a real suspicion that people who were drinking heavily before the pandemic consumed more alcohol during it, and that those who were drinking less drank even less.

There was also a big shift in where people drank, because of lockdown. There was much less drinking of alcohol in bars and far more consumption at home. There were also changes in the number of admissions to hospital and an increase in the number of deaths. You might think that, if there was an increasing number of deaths, there would be an increasing number of admissions to hospital, but we actually saw the opposite. That might be about the strain that was being experienced across the healthcare system at the time.

We have a lot to disentangle and to understand about what happened during the pandemic. We also do not know whether it was is a one-off or will alter the trend.

There is one crumb of comfort in all this—although it is really not comfortable at all. Every death is an absolute tragedy; 23 deaths per week is only the tip of the iceberg. Those are the deaths that are directly attributable to alcohol but, in addition, a large number of deaths are related to heart disease and cancer to which alcohol is a contributory factor. It is an absolutely tragic situation. However, the one crumb of comfort is that, although it is recognised that Scotland’s long-standing relationship with alcohol is harmful and that more Scottish people died from alcohol during the pandemic, the increase happened right across the UK and was not unique to Scotland. Actually, our rise of 17 per cent was slightly lower than that of the rest of the UK countries.

That gives me a hope that, perhaps, some of the work and strategies that we have in place were protective during that difficult time. For example, alcohol minimum unit pricing might have meant that, although we had a devastating increase in the number of deaths that year, they were not quite at the level in the rest of the UK.

Minimum unit pricing of alcohol is not the only feather in our cap, however; we have done a lot of work over a number of years. When a nation has such a harmful relationship with a substance such as alcohol, more than one thing has to be done to tackle that. We have therefore taken a range of actions to reduce the availability, attractiveness and affordability of alcohol, in line with the World Health Organization’s recommended approach. We will continue that with a whole-population approach that aims to reduce alcohol consumption and the risk of alcohol-related harms across the population.

However, two consistent threads run through our work; we are keen to focus on two target areas. First, our actions must reduce health inequalities. Secondly, we have to protect children and young people. We are therefore planning and consulting on potential restrictions, as I said, on alcohol advertising and promotion, particularly in order to protect children and young people.

We are keen to give consumers health information on labels, such as through placing on cans the 14 units recommendation. Among the four nations, we are also discussing putting calorie labelling on alcohol. We think that that will be helpful. In addition, over the course of the pandemic, we have twice run our “Count 14” campaign work, to raise awareness of all four CMOs’ lower-risk drinking guidelines that no more than 14 units per week should be drunk. We ran it for four weeks in March 2019, and for six weeks in January to March 2020.

The work that we have done so far—minimum unit pricing for reducing affordability—will help. Young people will see less drinking in society. However, one of the main areas that we need to address is alcohol advertising and promotion.

YoungScot, the Children’s Parliament and the Scottish Youth Parliament did an amazing report a couple of years ago, which made shocking reading. They came to Parliament and presented it: from the mouths of babes, we heard directly how much alcohol they were exposed to. Alcohol is ubiquitous in our children’s lives, and not just through advertising, although that is a big part of it. Children talk clearly about how, when they open the fridge door in the morning to get the milk out, there is a stack of wine there. Think about how our drinking has changed since the 1970s, when I grew up. It was not common to drink at home then; people did not really drink wine with dinner. Nowadays, children see a great deal more alcohol being consumed at home.

Children also see alcohol advertising on transport and on billboards on the way to school. I have previously made the point at committee that we cannot just protect children from alcohol advertising simply by throwing a ring around where they are; we cannot prevent alcohol advertising just around schools. Children are in our society and they see billboards and adverts as they navigate their way to school. They also see advertising in the cinema and on television. A shocking study was done on the amount of alcohol adverts that children were exposed to in sports promotions. I will find the statistic to make sure that I get it correct. However, when children watch sports, they see alcohol advertising literally a couple of times a minute. That is particularly harmful because sportspeople are heroes to them. [Interruption.] I am sorry. I am not sure what that noise is.

I am open to any approach that will work, but there are currently no plans to adjust the licensing laws. I do not think that we can simply say, “If we do this, the problem will go away.” I think we all accept that, given the level of the problem in Scotland and the harmful relationship that we have with alcohol, it is probably going to take multiple measures over a good period of time to shift the culture so that we have a significantly healthier relationship with alcohol.

You are right to say that it is not just about children and young people or impulse buying. The evidence suggests that people who are in recovery struggle when they see adverts for alcohol and will take steps to avoid them. They are another group in our society who find it hard to resist the lure or the attractiveness of alcohol as it is presented to us today.

Absolutely. The core purpose of the framework is to prevent disputes through close collaboration between the four UK nations while respecting the devolution settlement. That means enabling policy divergence. The aim of the framework is to avoid, where possible, the need to trigger the dispute resolution process.

In terms of scrutiny, Parliament will engage with the framework through the decisions that it will be asked to take on any change of legislation that is proposed in the policy area. In essence, the framework is a way of working. It sets down the mechanisms for working together with the other Administrations of the four UK nations that share these islands.

To be honest, we do not know about the effect—the most recent year that we have data available for is 2019-20, which was just before the pandemic hit. There were 75,616 ABIs in that year, which was 23 per cent more than the standard that we asked people to aim for.

We need a fuller picture of what has happened with ABIs over the pandemic. The committee knows from previous evidence sessions that I am a huge fan of Near Me, and there is an opportunity to use that technology. If ABIs can be a useful tool virtually as well as in person, we will try to get the evidence to support that going forward.

The work that is going on with Public Health Scotland to review ABIs began before the Covid pandemic. It will reflect on the experience of the pandemic across Scotland, and the actions are well under way, so I expect the strategy group to be convened in the summer.

It is difficult to have immediate actions to take and levers to pull, because we do not quite understand what happened or what the barriers were. We need to understand what led to the increase in deaths, which occurred across the UK, before we know what will be effective at reducing deaths in the future. We also need to understand whether such an increase will be repeated—whether it was the result of a consistent behaviour change or a one-off.

The situation is frustrating. I am desperate to solve the problem and I am keen to do what we can—the need is urgent. Every single one of these deaths is a tragedy, but we need to understand the situation better before charting our way forward.

I am satisfied that an effective process is in place. I hope that we do not reach the point of triggering it. For all that the impression that is given is that we are regularly in conflict with one another in the four nations, we actually work together closely on a number of issues across the board in health, and we have strong working relationships, particularly in my portfolio. Therefore, I expect us to be able to avoid triggering that conflict resolution process.

I will bring in Jennifer Howie to talk a little bit more about the detail of how the process will work should it be triggered.

Although the act was passed in 2020, it is still bedding in. We are still trying to understand the impact of that piece of legislation on our public health decisions, and I cannot at the moment think of an area in which we would be looking for exclusions.

The framework allows for divergence and respects the devolution settlements. For public health reasons, and all reasons, we prefer that mechanism for resolving issues of divergence.

We are very aware of that issue. Angela Constance and I work closely together, as do our officials. I will perhaps ask my officials to explain just how that works.

We recognise that there is learning from the national drugs mission that we need to apply in exactly the same way to our alcohol services. Some of the criticisms that are made of drugs services—that they are not person centred and do not respond rapidly enough—could equally and easily be made about our alcohol services. We are determined to learn the lessons.

Because of the way that services are structured, treatment for alcohol problems and treatment for drug problems usually happen in the same location. The services are co-located or are often the same services, so investment in one will benefit the other.

One of the pieces of the joint work that we did was the work to tackle stigma, which was quite successful. Stigma is a problem in relation to treatment in both areas, and taking a joint approach on that issue has proved to be quite helpful. Recently, we had an advertising campaign that talked about stigma, which covered both alcohol and drugs. I think that the campaign landed quite well and will make a difference to perception.

We are keen that we have a patient-centred, rights-based public health approach. We want people to be able to access those services easily and for there to be no judgment as they do so. That applies across the board in relation to addiction.

We are also keen to learn lessons. When we have the UK clinical guidelines for alcohol treatment, the work around medication-assisted treatment will be helpful when we think about how to implement the guidelines and ensure that MAT is adopted quickly and used on the ground. Maggie Page is in the drugs team, so I will ask her to come in and say a bit more.