Examination of Witnesses (Question Numbers
1060-1079)
GILLIAN MERRON
MP, SIR LIAM
DONALDSON AND
MR WILLIAM
CAVENDISH
16 JULY 2009
Q1060 Charlotte Atkins: Do we have
a national liver strategy?
Sir Liam Donaldson: Yes, there
is a strategy going to the National Quality Board in the near
future on liver; that is my understanding.
Q1061 Charlotte Atkins: We have had
an eight times' increase in liver disease since 1980 and we are
just now talking about a national liver strategy going to some
board.
Sir Liam Donaldson: It comes back
to the problem that I have talked about at previous select committees
that if you have priorities for services in the NHS not everything
can be a priority—heart disease, cancer, diabetes, elderly
care, mental health—all of those things have been priorities
and each of them has had a national service framework and a strategy.
Those strategies work best when they do have a level of a national
service framework because then people really listen to them. We
did some work on liver disease to develop a strategy on that and
it was decided that the National Quality Board, established by
Lord Darzi, should consider that and that is where it is going
to.
Q1062 Charlotte Atkins: You agreed
earlier on that this issue of alcohol abuse was one of the most
major public health challenges that we face in this country.
Sir Liam Donaldson: Yes, I did,
but not wanting to split hairs, a strategy for liver disease is
slightly different to an alcohol-related strategy that brings
in other factors as well.
Q1063 Charlotte Atkins: How much
of this liver disease would you put down to abuse of alcohol?
Sir Liam Donaldson: I would not
want to put a figure on it off the top of my head but it is not
the only factor; I think the fatty liver problem is also rising
as a concern.
Q1064 Charlotte Atkins: Could you
write to us on that because I think we do need to establish how
much of this liver disease is directly related to alcohol because
obesity can be linked to alcohol. That is another impact of alcohol
abuse is of course it does carry with it the risk of obesity as
well.
Sir Liam Donaldson: It does but
it is the minor cause of obesity. The majority is lack of exercise
and overeating.
Q1065 Dr Naysmith: Minister, you
began to talk about alcohol services commissioned by PCTs earlier
on and I interrupted you and said there would be questions later
on, so now is your chance. We have heard witnesses here who have
told us that they are not very impressed at all with the current
level of services. Why do you think they are so poor?
Gillian Merron: I think they are
patchy and that is the truth. We need to do better than that,
there is no question about that. I have mentioned the numbers
in treatment have increased from 63,000 up to 100,000. That is
an improvement and we need to do more. Until last year there was
not an indicator for PCTs and I do feel that will drive the kind
of change we are all looking for; something like two-thirds of
PCTs are prioritised focused on reducing alcohol-related harms,
including those with the most difficulty. For me that is heartening.
We also have work in place to improve the commissioning of services.
Again, it has to happen. Support to PCTs through the Alcohol Improvement
Programme means we are giving them seven high impact changes that
they can actually make the difference. The truth and simple answer:
yes, local services are patchy; yes, we can do better, but I think
we have now got the things in place that will allow that to happen.
That is something I will particularly focus on as I go around.
Q1066 Dr Taylor: You think it needs
more resources.
Gillian Merron: Resources are
given to PCTs, and rightly, as they make the local decisions.
Q1067 Dr Taylor: You say that they
have the resources; they have just got to use it properly.
Gillian Merron: What I am keen
to see is that they use their resources to address the local needs
and if that is not happening that obviously needs to change. I
know we are not talking specifically about this but that is another
push on infertility treatment, for example, which the Committee
will know a lot about. We are seeing improvements and it is a
question of, with resources, whether you are meeting the needs
of your population or not. That is why I used the word I am "heartened"
that the PCTs have taken up the challenge.
Q1068 Dr Taylor: Do you have views
on brief interventions by primary care professionals and GPs?
Gillian Merron: That is why we
have brought in what I described as a tap on the shoulder.
Q1069 Dr Taylor: I did not realise
that you were talking about that.
Gillian Merron: When you are engaging
with a new patient there is a turnover of something like 10%,
so that is quite substantial, we are actually giving incentives
to GPs to do that. What I like about that approach is that it
is actually people coming to their GPs, we are not seeking them,
so it is in the course of the work. We are also seeking the tap
on the shoulder at times when people are most open to the possibility
of talking.
Q1070 Dr Taylor: How can you assess
whether that is of any use at all?
Mr Cavendish: We have a fairly
major programme called the SIPS programme in our terminology but
it is looking at primary care, looking at accident and emergency,
and at probation services at what are the most effective ways
of doing this, at what time, who does it and what is the short
advice they give. From memory that is coming back to us in September
or October and it will tell us a lot more about what the effective
models are.
Q1071 Dr Taylor: You are still really
in the research phase.
Mr Cavendish: We are looking to
expand it, understand more about it and when we get that evidence
back it will be one of our key interventions that we will be promoting.
Q1072 Sandra Gidley: The Government's
alcohol strategy is very reliant on educating the public and that
is pretty much what the new campaign is all about, but several
experts have told us that education is ineffective compared with
increased taxation, so why are we relying so heavily on relatively
ineffective measures?
Gillian Merron: For me education
is a part of it; it is not the only thing. There is no one thing
that is going to deal with this problem that we have got before
us overall.
Q1073 Sandra Gidley: The experts
have told us that it is.
Gillian Merron: They may do but
that is not the evidence.
Q1074 Sandra Gidley: So the experts
are wrong?
Gillian Merron: I am happy to
provide further evidence because we have an independent assessment
of the value of education. I think I mentioned earlier that three
quarters of the population can recognise the "Know Your Limits"
campaign and there has been a shift in people's behaviour. It
is true that education on its own is not effective; that is true.
Research will tell us that and experts tell us that; that is absolutely
fine. It can be effective when it is part of a whole range of
things and that is where we are pitching. I would also assure
the Committee that we do ensure that we evaluate campaigns very
carefully and thoroughly and if there is any further information
I am very happy to provide that.
Q1075 Sandra Gidley: The Portman
Group and the Drinkaware Trust do actually agree with you but
the money given by the industry is not very good. If you think
about the money the supermarkets give, given their vast profits,
it is really quite pathetic. Does this show a lack of commitment
by the industry to tackling this problem?
Gillian Merron: I think there
are some in the industry who are funding Drinkaware very much
in line with their commitments. It is true that there are others
like the major retailers who have not done so. They were not signatories
to the original Drinkaware memorandum and for me commitment to
Drinkaware is part of the evidence and I would expect all sections
of industry to rise to the challenge. I would also emphasise,
as I said before, that we need to see more unit and health information
at point of sale and in advertising we do need to see that. We
are in a voluntary situation at the moment and we will see how
well that works. Yes, I would look for more commitment from the
industry and I would certainly agree with you on that.
Q1076 Sandra Gidley: We have had
an estimation that if everyone drank at the Government's weekly
recommended levels the drinks industry would actually lose 38%
of its sales. Do you agree with that figure?
Gillian Merron: I cannot respond
directly to the estimate in all honesty. I do still feel that
we should be encouraging social responsibility amongst the industry.
The evidence on the consultation on the mandatory code shows that
where we are not responded to positively we will act and that
needs to remain a very strong message.
Q1077 Sandra Gidley: Sir Liam, are
you familiar with that figure?
Sir Liam Donaldson: I am not but
I wonder what practical value it would have because I do not think
we would ever get exactly everybody in the population to drink
at that level, so I always look at statistics like that and wonder
in what way they can influence our thinking. It clearly draws
attention to the profitability of the drinks industry but I do
not know where we would go with it, even if it is a correct assessment.
Q1078 Sandra Gidley: Does it not
show that as the industry has to answer to its shareholder base
it really has no interest in reducing alcohol sales?
Sir Liam Donaldson: I suppose
that would be true of other industries like the food industry,
but over time you can modify their approach by all the measures
that we have been talking about today.
Mr Cavendish: We are currently
in the process of renegotiating the Drinkaware funding agreement
because the memorandum of understanding runs out this year so
we are looking for the industry to fund Drinkaware properly through
a sustained settlement across the industry and those negotiations
are underway at the moment. I did not want you to be unaware that
it is happening at the moment.
Gillian Merron: We have the Campaign
for Smarter Drinking which was launched today as well which is
industry contributing to people drinking more responsibly.
Q1079 Chairman: On that point, Minister,
could you tell the Committee when you got to know about the Campaign
for Smarter Drinking?
Gillian Merron: I have only been
in post for six weeks.
| 
