Examination of Witnesses (Question Numbers
1020-1039)
GILLIAN MERRON
MP, SIR LIAM
DONALDSON AND
MR WILLIAM
CAVENDISH
16 JULY 2009
Q1020 Dr Naysmith: There has been
a lot of evidence about that and how it is done and so on. The
question is: is it working?
Gillian Merron: This is relatively
new of course and we have also increased the number of treatment
places up from 63,000 to over 100,000, so we are now reaching
approaching the proportion of the dependent population that we
need to. Locally there is action by PCTs and health services in
terms of targeting this group and I am very interested that we
work within the NHS to target the areas with the most need with
the highest risk drinkers, and in particular investing £4
million in 20 early implementing PCTs so that they can particularly
tackle this matter but also that we can get the good practice
in order that others can learn from them.
Q1021 Dr Naysmith: I would like to
make the question slightly more complicated in that we have been
to Scotland and studied what is happening up there and had some
really good evidence up there and it is clear that the higher
a society's alcohol consumption is, then the higher the number
of problem drinkers there are. There seems to be quite good evidence
coming from lots of different places, therefore the Government
should not just focus on this problem, but should try and reduce
overall alcohol consumption.
Sir Liam Donaldson: There is a
general principle governed by an epidemiologist, the late Geoffrey
Rose, called the Rose curve, and schematically he describes a
bell-shaped curve of this behaviour. It is never perfectly bell-shaped,
but for the sake of argument it is bell-shaped. At one end are
the teetotallers, at the other end are the heavy drinkers and
everybody else is in the middle and his principle is that if you
want to affect the most people then you have to shift the curve
to the left, which means concentrating on the mean and doing something
with the whole population. That does not mean that you ignore
the heavy drinkers but basically if you were to target the heavy
drinkers only at the right hand end of the curve and then believe
that everybody else would stand watching and then modify their
drinking, that does not work because people see themselves in
a different category. You have got to have a strategy that does
both; it provides for the heavy drinkers but it also influences
everybody else.
Q1022 Dr Naysmith: That is reasonable.
If you start encouraging people lower down the curve not to start
drinking, or to drink moderately when they are young or before
they start drinking heavily, it is bound to affect the other end.
Sir Liam Donaldson: The only thing
you do not do is to get the teetotallers starting to drink.
Mr Cavendish: For some groups
it can be a little more complex. For example, for young people,
the number of young people who are drinking has been dropping
over the last few years, but for those young people who are drinking
they say they are drinking more. There you have a slightly different
thing happening where we have been successful in getting less
young people starting to drink, but for those who are it is getting
to be increasingly a problem. There are different challenges for
different groups that we need to address.
Q1023 Charlotte Atkins: Minister,
do you support the introduction of minimum pricing as you are
sitting next to Sir Liam?
Gillian Merron: I certainly am
sitting next to Sir Liam.
Q1024 Charlotte Atkins: Do you support
the introduction of minimum pricing, as he appears to?
Gillian Merron: First of all,
as I am sure the Committee is aware, we work very closely with
the Chief Medical Officer and on this one I am very keen to talk
to the Chief Medical Officer in greater detail than we have already.
The first thing to put on record is that we are not ruling this
out. I am interested in exploring various pricing options. I know
the Committee is aware that it is a big decision should a government
decide to interfere in any way in terms of pricing, whether through
this means or any other. I would say, and I know that the Committee
will have seen the Home Office report, the consultation on the
new code of practice and the references in there and I think they
are important. I would make the point that this talks about further
research. For me this is not only about research, it is also about
working with the public because whatever route we may or may not
take forward we have to take the public with us, so in any thought
about discussion and movement I would very much want public involvement.
Q1025 Charlotte Atkins: We had a
rather depressing view from the Treasury that they could do very
little in terms of taxation, whether it be minimum pricing or
whether it be taxation and obviously if you have minimum pricing
that can actually increase the profits of the drinks industry
and supermarkets. Do you see any other approach that might come
up with the desired result of reducing the amount of heavy drinking
and also harmful drinking that people engage in at the moment?
Gillian Merron: I hope the Committee
sees, and I am sure you do, our commitment as a government in
terms of our consultation on the mandatory code, for example,
which I think is very important. We are actually calling time
on matters, we hope, such as "Drink all you can for a fiver"
or "Women drink for free", for example. On the particular
question, tax can be quite a blunt instrument in any case. Where
we have started what are we trying to achieve, what are options
for doing it and what is the best way to do it? I am very keen
that we work very closely with the public. My main message to
the Committee is that I am interested in this whole range of options.
The Committee will know that I am new in post and will be aware
of the pressure on us in the Department in terms of swine flu
at present. I am going to be very interested in what the Committee
also suggests to us.
Q1026 Charlotte Atkins: There seems
to be a lack of urgency by the Department of Health. This is one
of the biggest health problems facing our country at the moment.
The evidence in Scotland was startling and England is going the
same way. It really is a huge problem which does not appear to
be shared so much in Europe—they seem to be tackling it—and
we seem to be getting in a worse and worse situation.
Gillian Merron: Please do not
misinterpret my comments about swine flu. I was just asking the
Committee to understand that we were talking particularly about
pricing options and exploration of those. Will may wish to elaborate
on the kind of work that is going on, but we have seen progress
in just the last year alone and that will continue so there is
no let up on that. My comment was purely related to the working
on the pricing options.
Q1027 Charlotte Atkins: Sir Liam,
you told us when we were looking at our smoking inquiry that it
took some time for passive smoking to be heeded in Whitehall—that
is what your 2008 Annual Report says. Are you confident that minimum
pricing is an idea whose time will come in the near future?
Sir Liam Donaldson: I am. I think
it is a very neat solution to the question of acting on the evidence
that price, along with availability, is a major influence on drinking
patterns because it is good because it targets disproportionately
heavy drinkers. It does not do much to moderate drinkers. It does
not add to their expenditure a great deal. For once, in contrast
with the smoking ban, we cannot be accused of attacking the pub
trade because it would actually help them. The problem at the
moment is that the supermarkets are being used often by young
people to buy cheap drink and then drink it so that when they
go into the pub they do not have to pay such high prices. I know
that you are very familiar with this from having heard evidence
from the researchers and others, but that is why I think it is
a particularly neat solution. I do not feel particularly wedded
to 50 pence; it is just the principle of a minimum price and it
could be established in the public's mind and then adjusted rather
like the minimum wage according to circumstances.
Q1028 Charlotte Atkins: Rather spectacularly
during the smoking inquiry you told us that you had considered
resigning over the issue of the Government's lack of enthusiasm
for your proposed total ban on smoking. Do you see that this might
be an issue for resignation in the future?
Sir Liam Donaldson: No, I do not.
I think it is a slightly different situation. At the time of the
smoking ban we were fully aware that people were regularly and
daily being exposed to potentially 50 cancer-causing chemicals.
It was a serious environmental hazard and I felt that action urgently
needed to be taken and on this one it is one of a range of public
health issues which it is my role, along with others, to advocate
and I will be continuing to advocate it very forcefully.
Q1029 Charlotte Atkins: Would you
see alcohol as being virtually akin to smoking in the past as
one of the biggest public health issues that we have to face in
this country?
Sir Liam Donaldson: Definitely,
yes.
Q1030 Jim Dowd: Sir Liam, you just
mentioned the 50 pence minimum price per unit in the 2008 report.
You say here every year there could be 3,993 fewer deaths. I find
figures like that literally implausible; the fact that you can
get it down to "3" at the end is almost like the ludicrous
assertions that were made, and they varied widely, about deaths
from passive smoking. I think these things are just to cloud the
issue. How do you calculate that figure? What is the function
of 50 pence and can you gradate it in units of, say, 10 pence
to find out if there is a greater benefit? How is it done?
Sir Liam Donaldson: Essentially
I have relied on the research undertaken by Sheffield University,
of which I know you are aware, which says that the full effect
will be seen by 2019, which is where the 3,000 deaths and reduction
of 100,000 hospital admissions come in, but they also point in
the first year to an earlier benefit with 400 fewer deaths and
8,000 fewer hospital admissions. If you look at the Sheffield
report, they have calibrated the different levels right up to
70 and 80 pence and you can just read them off in the tables.
Mr Cavendish: I am looking at
the Sheffield study right now which goes from a price of 15, 20,
25, 30, 35, 40, so there is no shortage of—
Q1031 Jim Dowd: It is an arithmetical
extrapolation.
Mr Cavendish: It is a relationship
between an impact on price, on consumption, from consumption through
to health harm, from health harm through to mortality and they
have worked that through.
Q1032 Jim Dowd: Your opinion is that
that is well founded?
Mr Cavendish: It is a good study,
yes.
Q1033 Jim Dowd: Why has no action
been taken to implement your suggestions on minimum pricing and
where are you going to find a political champion for it from?
Sir Liam Donaldson: Both the main
political leaders at the time considered that this was not a good
time to be implementing a change of this sort, given the economic
climate and people's circumstances. Personally I think that this
needs to be kept on the agenda. I think the Minister has indicated
that it is still on the agenda and I am very pleased to hear that.
Gillian Merron: If I may add in
light of the earlier question from Mrs Atkins, we are taking action
on very cheap alcohol, which is a particular concern for people.
In terms of the mandatory code, we are consulting that alcohol
should not be sold below the level of excise duty and VAT. That
is the worst offender in terms of availability of cheap alcohol
and I think that is what people find most offensive.
Q1034 Jim Dowd: Minister, you mentioned
the Drinkaware campaign. You may be interested to know—you
will see it in our report in the fullness of time—that both
in this room and as far away as New Zealand we have received evidence
that these things are complete hypocrisy. Presumably you would
resist that?
Gillian Merron: I would resist
that, Mr Dowd. I think the evidence shows otherwise. Nearly three
quarters of people recognise the "Know Your Limits"
campaign. We have seen a five percentage point increase in just
one year of men understanding on the issue of the number of units
they should be drinking. I do not think the evidence stacks up
to that. Personally I happen to think that it is quite right that
we inform. We spoke earlier about the need to work with the whole
population. I think it is right and proper that we inform everybody
who is a drinker about what is the correct number of units that
will keep them healthy and also what a unit looks like. I think
we have a responsibility to do that.
Q1035 Jim Dowd: To come back to Sir
Liam on the minimum pricing proposition, it has been suggested
that were it to be introduced it would disproportionately affect
drinkers on low incomes and the Institute for Alcohol Studies
contend that each social group spends more on alcohol than the
one below it, except for the bottom one obviously, so therefore
it is actually the less well off who are going to be punished
and it will have no effect whatsoever on the principal consumers
of alcohol who are the better off. How do you respond to that?
Sir Liam Donaldson: The principal
consumers of alcohol are the better off? I am not sure that that
is true but I might be completely wrong about that. The data from
the Sheffield study allocates the extra expenditure to the individual
in the category of moderate drinking versus major drinking and
they show that the moderate drinkers pays relatively little a
year as a result of this change, whereas the heavy drinker would
pay a lot more. I think that is the benefit of it that we can
say that it is not going to make a big impact on the moderate
drinker as far as their drinking habits are concerned if they
choose to continue to drink.
Q1036 Sandra Gidley: Minister, you
made an interesting comment earlier in this session. I think you
said that the drinks industry did not want to be regarded as a
toxic industry. Presumably the tobacco industry had a similar
view a few years ago. What is the difference between the tobacco
industry and the alcohol industry, seeing as alcohol is actually
a dangerous drug?
Gillian Merron: I think the difference
is between tobacco and alcohol, first of all. In tobacco one cigarette
is damage and a danger to health. With alcohol we are not telling
people not to drink; we are actually informing them about what
is moderation and what is safe and healthy and I think that puts
not just the industry—I would not jump to that so much—but
it does put the two areas rather different to me and I think we
have to be smarter in how we deal with them differently because
they apply to people's lives very differently.
Q1037 Sandra Gidley: Did you see
the research published a couple of years ago that puts alcohol
as a more abusive substance than cannabis?
Gillian Merron: I appreciate all
of that but I think the important point is our message and the
reality of alcohol. As I said in my opening comments, most people
drink alcohol responsibly and we should not lose sight of that.
Of course, it can and does and we know that causes immense damage
which is why we are here today and why we do the work that we
do, but it is not in the same category. It is an interesting discussion
about tobacco where we are actually saying we would like to give
up completely. We have a totally different message and a totally
different angle, but I have to also say because we will know from
our tobacco discussions that tobacco is also a legal and acceptable
substance so we also have to take that into account.
Q1038 Sandra Gidley: Is it not really
the case that the Department takes too much notice of the alcohol
industry? I have heard that at almost every meeting there is a
representative from the industry there. I cannot imagine that
being the same for tobacco.
Gillian Merron: That is not true.
Q1039 Sandra Gidley: It is very difficult
for me to find out. I have tried to table PQs to find out who
attends these meetings and they have not been answered.
Gillian Merron: I can assure you
that the suggestion that somehow the industry is "on the
inside" on this in the way that is described is not true.
Our concern is to tackle the damage caused by alcohol in the ways
that we are doing it. The best evidence for the Committee in terms
of action by the Government is the one about consultation on the
mandatory code. The truth is voluntary action there has not worked
and so we are consulting on a mandatory code; in other words,
where working with the industry in a voluntary way did not produce
the results, we are taking firmer action. My view is that is absolutely
the right thing to do. You seek to work with the industry. If
the industry does not respond you have to move further and we
are doing that. Again, I know you have spoken to my Home Office
colleague about that.
| 
