Health Committee - Minutes of EvidenceHC 132

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Oral Evidence

Taken before the Health Committee

on Tuesday 22 May 2012

Members present:

Mr Stephen Dorrell (Chair)

Rosie Cooper

Andrew George

Barbara Keeley

Dr Daniel Poulter

Mr Virendra Sharma

Valerie Vaz

Dr Sarah Wollaston

________________

Examination of Witnesses

Witnesses: Brigid Simmonds OBE, Chief Executive, British Beer and Pub Association, and Henry Ashworth, Chief Executive, The Portman Group, gave evidence.

Q129 Chair: Good morning. Thank you for coming to help us with our inquiries, as they say, about alcohol. Can I ask you briefly to introduce yourselves and your organisations, and then we will start some questions?

Brigid Simmonds: My name is Brigid Simmonds. I am Chief Executive of the British Beer and Pub Association.

Henry Ashworth: I am Henry Ashworth. I am Chief Executive of the Portman Group and cochair of the Responsibility Deal Alcohol Network.

Q130 Chair: Could I start with some general questions about what you perceive as being the alcohol problem, if indeed there is an alcohol problem? Let me ask a simple question first: what is the problem we are trying to solve, in your view?

Brigid Simmonds: We are trying to solve the problem that a minority of people are drinking too much. I listened to some of the people who came in front of the Committee previously who rather shared that view. Alcohol consumption, by any measure, has gone down. It has gone down by 14% since 2004 and, if you are looking at young people or people who drink too much, it is certainly going down. But we do have a problem with a minority of people who are drinking too much and we need to tackle that.

Henry Ashworth: I would add to that and say that we are trying to encourage more people to drink within the Government’s guidelines. According to the Alcohol Strategy, 78% of people are now drinking within the guidelines, but that does mean there are a large number of people who still are not drinking within the guidelines. While the trend for people who are drinking at harmful levels is reducing and has reduced from 6% to 3%, for example, for women or from 9% to 6% for men, of course-because 84% of the population drink-that is still a large number. What we are trying to do is help more people drink within Government guidelines and tackle that minority of people who are not. That is where the challenge lies.

Q131 Chair: Is it true that the numbers who are drinking to harmful levels are reducing?

Henry Ashworth: According to the Government’s statistics that we have seen-and I could quote from them if you like-

Q132 Chair: The previous panel of witnesses we were questioning suggested that there was a developing problem of people drinking at home, not necessarily at a level that creates a law and order problem, but that creates a longterm health problem for those individuals.

Henry Ashworth: Drinking within Government guidelines, according to the Government’s Alcohol Strategy, is 78% of the population. Therefore, drinking above Government guidelines, which could lead to harms over a period of time, is 22%. According to the statistics we have had from the Government of drinking at harmful levels-in other words, more than double Government guidelines-in 2010, 6% of men drank more than 50 units per week but in 2005 this was 9%, with the equivalent for women down to 3% from 5%.

Q133 Dr Poulter: It is quite dangerous to put those statistics forward to the Committee as being an idea that this country does not have a problem with alcohol, or that a lot of young people do not have a problem with alcohol. You are looking at what you consider to be harmful. We know, first of all, that very few people properly understand how much they are drinking in terms of units, so units are not always a good measure when we are doing surveys. Secondly, you are talking about harmful levels of drinking in terms of what are potentially immediately threatening to life, or have poorer outcomes and sequelae, but we know that a lot of the issues to do with alcohol are the cumulative effects over a number of years. It is somewhat misleading if we were to look at those statistics you have just put forward as being an indicator of the state of this country’s relationship with alcohol.

Henry Ashworth: I hear very clearly what you are saying. I would go back to my first point that 78% of people are drinking according to the Government’s Alcohol Strategy-within Government guidelines-so we must assume that 78% of people are drinking within the guidelines set down by the Chief Medical Officer of 21 units a week for a man and 14 units for a week for a woman. I absolutely accept that, therefore, there are 22% of people who are drinking over and above the Government’s guidelines and recognise that we are about trying to increase the number of people drinking within the guidelines, which will help reduce harms.

Q134 Dr Poulter: But there is also the problem-and it does not come over in what you have put forward-of binge drinking and its cumulative effect, particularly among young people, not only those of university age but also elsewhere. They may well be drinking within certain limits but doing themselves a huge amount of damage from a massive binge once a week. It is very easy sometimes to bandy around statistics that can put across a distorted picture of what the reality is out there in the high street on a Friday and Saturday night.

Brigid Simmonds: While the statistics do show that young people are also drinking less-and the Government have to take some credit for the policies that they put in place that have led to that fall-we will not yet see any fall in the sort of thing Sir Ian Gilmore was talking about, which is the number of people entering hospital who have chronic conditions. There is a lot more work that we need to do. We are not sitting here being complacent about it. We are saying that some of the policies and understanding have changed. If we need to change anything, particularly about university students, it is social norming. The suggestion that you go to university in freshers’ week and all drink too much-when a lot of young people who go to university do not necessarily want to drink too much-is a perception that we have to change over a period of time so that it becomes the social norm that you go to university and drink within sensible limits.

Q135 Dr Poulter: It is not to say that certain policies have not been effective; I am absolutely sure they have been. However, we heard in the evidence we were given by the medical experts last time that you can see fairly quickly-within a couple of years-an effect on A and E admissions in terms of binge drinking particularly, but also chronic alcoholism. We heard that A and E admissions are still greatly up now compared with where they were a number of years ago for binge drinking episodes, and we also heard that there is a similar problem with chronic alcoholism. So while there are some very good initiatives, some of which are having an effect, and there is laudable intent, the medical evidence we heard last time as to admissions related to alcohol-and, if anything, it was purported that they are under-reported-does seem to be pointing in the other direction as a trend.

Brigid Simmonds: The primary diagnosis for hospital admissions increased faster in 200203 but it has been slower in the last four years. Of course, the Government recently changed the way they report statistics. It is going to be primary diagnosis rather than the secondary diagnosis that we had up to now. To give you an example, I broke my leg when I was knocked down by a taxi. There was no alcohol involved, but under the old system a proportion of those sorts of accidents would have been included in the statistics. So it is a move forward.

Q136 Dr Wollaston: A proportion-

Dr Poulter: Quite rightly so. Actually, what was happening-I am sorry, Sarah, and I am sorry, Chairman, if you will let me go on-is some people, and youngsters on a Friday and Saturday night, will go out and may well be knocked over by a taxi or a car because they have had too much to drink. The point is that there may be some people who going to be hit by a taxi after, maybe, a glass of wine, but there are some people who are being hit as a direct consequence of drinking and that is the reason for their admission.

Brigid Simmonds: I was only saying that moving to primary diagnosis is important. I was giving, as an example, my case where there was no alcohol involved. Therefore, why should it be part of that statistic?

Q137 Chair: It must be right to have the statistics reflect whether alcohol was an issue or not, if we know.

Brigid Simmonds: Yes.

Chair: Virendra wants to come in because he needs to leave.

Q138 Mr Sharma: I am sorry; that is because I am leaving early. The Portman Group expresses concerns about alcohol trend data. What are the problems that you see and how would you like to see them resolved?

Henry Ashworth: One of the things-maybe this comes back to Dr Poulter’s question as well-we would like to see is the Government presenting a consistent set of data looking at trends that can be followed, not for any complacent reasons but so that we can see whether the measures in place at the moment are having an effect in terms of consumption patterns and so that the various people who are engaged in trying to tackle alcoholrelated harms can see consistently, from the Government, what is happening. We have been very carefully looking through the trend data coming from the Office for National Statistics, for example, or from the Department for Education. We think there should be one consistent set of data looking at all the trends around both alcohol consumption patterns, which are very important in regard to binge drinking, for example, and indeed alcoholrelated harms, as the Government have set out in the Alcohol Strategy.

Q139 Mr Sharma: Thank you. Were you involved in discussions with the Department of Health or any other part of Government during the preparation of the strategy?

Henry Ashworth: I am the chairman of the Responsibility Deal Alcohol Network and, obviously, I have had detailed conversations with officials because of that role. In the lead-up to the Alcohol Strategy, the unit reduction pledge was a live issue that we were trying to get signatories signed up to from across industry, so I was involved with the Department of Health and the Cabinet Office, absolutely.

Q140 Dr Wollaston: I wanted to make one point about the statistics you used. While, of course, everyone would welcome the fact that fewer young people are drinking, is it not the case that those who do are drinking more heavily and that we still have a very significant problem in this country with those young people who are drinking?

Henry Ashworth: I completely agree with you that we should obviously welcome the fact that the number of young people, for example, who have drunk-

Q141 Dr Wollaston: Yes. I am not disputing that. But it does not address the real problem we have with the proportion of young people who are drinking very heavily indeed, and in fact are going out to drink in order to get drunk.

Brigid Simmonds: We have to create a culture change, without a shadow of a doubt. We have to create a culture change that says that going out on a Friday or Saturday night and drinking to excess to get drunk is not acceptable. One of the things that I welcomed in the strategy was something around personal responsibility. That is not to suggest industry does not have a responsibility, but there was an attitude that, somehow, "It is not our personal responsibility when we drink to excess." We need to move that on in the Alcohol Strategy.

Q142 Dr Wollaston: Coming back to a point that, it seems to me, is often addressed by the drinks industry saying there is no link between the level of drinking and harm, is that not partly because you can reduce the overall amount that people drink-the total volume that is consumed-but it does not address the fact that most of the harms are coming from this small proportion of very heavy drinkers?

Henry Ashworth: I absolutely agree with you that there are, obviously, too many young people drinking beyond the guidelines. We should welcome the fact that the trends are generally moving in the right direction. For example, as to children of 11 to 15 years old drinking, there has been a 40% reduction in children who have ever tried alcohol in that age group in the last ten years. However, I absolutely agree with you that the very small number of children who are drinking are drinking too much and we must all work together collectively. That is absolutely a responsibility and it is exactly what the Portman Group is trying to achieve in conjunction with parents and individual responsibility.

Q143 Valerie Vaz: Dr Poulter asked you a question about the statistics and you seemed to imply that the statistics were wrong. I want to hear it from you. Do you think there is an alcohol problem in this country?

Brigid Simmonds: I think we have an alcohol problem, but it is a problem with a small minority of people who are drinking too much. There are an awful lot of people who drink responsibly but education has to move on in this area. For my generation, you drank one glass of beer on Sunday lunchtime. Our children-and I have three children of this age-have moved on, so we need to educate-

Q144 Valerie Vaz: I wanted to clarify something. I appreciate that more needs to be done in other areas, but, Mr Ashworth, do you believe there is a problem?

Henry Ashworth: I absolutely believe that more needs to be done, that we-

Q145 Valerie Vaz: But do you believe there is a problem?

Henry Ashworth: I think there is a problem with too many people who are drinking beyond the Government guidelines and there is a problem with the number of children who are still drinking. While the trends are positive and going in the right direction, we must all work tirelessly together to improve the situation at national level.

Q146 Valerie Vaz: Coming back to you breaking your leg, you did not tell us whether you had drunk or not. I am assuming that you did not have any alcohol when you broke your leg.

Brigid Simmonds: No. It was first thing in the morning, so definitely not.

Q147 Valerie Vaz: Do you accept the statistic that 70% of A and E admissions are alcohol-related?

Brigid Simmonds: I think we have to wait and see how this primary diagnosis works out.

Q148 Valerie Vaz: I was asking if you accept that or not. Wherever you get the figures from, that is a figure that has been quoted.

Brigid Simmonds: I am not sure it is a figure I have.

Henry Ashworth: The figure that I have does not give a percentage.

Q149 Valerie Vaz: Where does your figure come from?

Henry Ashworth: It comes from the Office for National Statistics.

Brigid Simmonds: It was 195,000 in England in 200910 and 142,000 in 200203.

Henry Ashworth: I am sorry. My figure comes from the NHS Information Centre. I am only using the Government’s statistics, which is why, in response, I am saying that it would be helpful for everybody involved-

Q150 Valerie Vaz: To use the same figures.

Henry Ashworth: For everyone who is trying to reduce the harmful effects of alcohol to use the same statistics.

Q151 Barbara Keeley: You raised the point of norms of behaviour and talked about students and freshers’ week. I have to say I think that is a very small part of the problem and I want to explore this idea of cultural change a little more. The concern that most people have-Members, police, lay advisers and the ambulance services-is the weekin, weekout flocking of young people into city centres like Manchester, which is an example that I know of. What happens is predrinking at home before they go out, drinking for many hours once they get into town, and then becoming argumentative-fighting and that sort of thing-being sick and becoming difficult to deal with, or vulnerable-falling, or potentially being at risk of being raped if they are young women.

You talk about cultural change, but I am surprised that the drinks industry does not take more responsibility for it. Apart from the predrinking at home, which I guess is from off-licences and supermarkets, we are still in the situation, in a centre like Manchester, of having very cheap shots advertised-shots of vodka and other alcohol-the sale of very large wine glasses so that people do not know how many units they are drinking, and things like "Buy two glasses, get the rest of the bottle free"-all those sorts of offers. So there is the cultural issue about young people feeling that what they want to do is to go out and drink a massive amount on one night-Friday, Saturday and so on-with all of that pattern of drinking, but also an industry that has got them into habits of drinking which are clearly not healthy. Anybody out for six or seven hours, after drinking at home, is going to drink a lot. Offering them cheap shots or the rest of the bottle free after two glasses-the sort of thing you see offered-makes it easier for them to end up drunk absolutely past where they should be.

Brigid Simmonds: I would like to make a number of points. First, the industry supports a number of responsibility initiatives. There are Business Improvement Districts, and the Nottingham Business Improvement District is specifically aimed at the nighttime economy. It has funding which provides street pastors and taxi marshals. If someone comes along and is behaving drunk they are asked to sit down and drink water, and they are only allowed to go home or into the venue when that has been sorted out. Business Improvement Districts have been hugely successful-there is one that is being operated in Newquay, which Henry knows as much about as I do-and we ought to take those further. There is also, on top of that, the Best Bar None scheme. The BBPA is the only trade association which puts serious money into Pubwatch, a voluntary organisation which allows people to be stopped from going in pubs in various areas. If you want to go and see the Reading Pubwatch or the Northampton Pubwatch, which has recently won an award for its work, I can arrange that. There is also Community Alcohol Partnerships. There is a range of initiatives. The industry is seriously interested in partnership. It is not in our interest that alcohol is sold irresponsibly. There has also been a change, coming to your last point-

Q152 Barbara Keeley: I have a further question before you go past the points you have made. A group of street pastors has started in Eccles, a centre of my constituency, but that is a new emergency service. They are good people who are going out on Friday and Saturday nights into Eccles town centre, taking a risk themselves and doing things like giving out flipflops to young women who are so unstable after drinking that they cannot walk any more and might do themselves damage, and protecting shop owners and people in small convenience stores from gangs of drunken people that intimidate them. That is beyond the police and ambulance services. They are a new community grouping. Funding street pastors is, to me, an acceptance that the problem is getting out of control, and not even in places like Manchester but in places like Eccles, which is quite a small town centre. As to stopping people going into pubs, why is there an assumption that somebody who is already drunk in a pub is going to be served in a pub? Why should you have to stop them going in? Is it not the responsibility of a licensee not to keep selling alcohol to people who have already had too much?

Brigid Simmonds: It is against the law to serve people who are drunk.

Q153 Barbara Keeley: How are people getting so drunk then in town centres?

Brigid Simmonds: We have also had a change in terms of promotions for the on-trade. There was a ban on some of the promotions that you are talking about. The police and local authorities have plenty of powers under the Licensing Act to take action against premises where behaviour is irresponsible, particularly-

Q154 Barbara Keeley: But you are talking about every pub or bar in Manchester city centre. How could the police, in a place like Manchester, deal with every pub and bar that is serving drinks to young people who probably turn up already having had more than the Government’s advised limit?

Brigid Simmonds: With the greatest respect, there are some really good partnership schemes and the BBPA would be very happy to help any local authority or police force who wants to set up a partnership arrangement with its licensees in a city centre.

Q155 Valerie Vaz: Where are they?

Brigid Simmonds: I run the BBPA, so the British Beer and Pub Association-

Q156 Valerie Vaz: Where are the partnership schemes?

Brigid Simmonds: The partnership schemes are everywhere.

Henry Ashworth: Can I give you an example, which is the Best Bar None scheme in Durham, where licensees have reported-and what is really important about partnership is that it works for everybody-an estimated 75% increase in trade because of the Best Bar None scheme? There has been a 50% increase in town centre footfall and an expected 87% decrease in violent crime. With inviting the on-trade in when it comes to Best Bar None, or through a Community Alcohol Partnership which involves the off-trade-retailers-working locally in partnership is a hugely important part-

Q157 Valerie Vaz: I understand that. I am just asking whereabouts because it is going on the record and it is quite nice for people to pick this up.

Brigid Simmonds: In Nottingham the industry puts in £250,000. There are examples like that all over the country. In fact, I think your next witnesses from Birmingham City Council will talk in a similar way about the schemes in their particular area. Most town and city centres have these schemes. There is a range of them and you decide how it suits your local partnership. We would be very happy to set them up if they do not exist.

Q158 Barbara Keeley: You have given a couple of examples but, obviously, we have very large numbers of city centres and it goes down even to town centres like Eccles. Could you say, where you have given examples, that they have eradicated that problem I talked about, which is young people staggering about the streets at night, vulnerable in themselves or abusive or ill, and giving a job to the ambulance services and the police? Is that problem eradicated in those places?

Brigid Simmonds: No, because it has to be a partnership in terms of personal responsibility, which is very difficult for any licensed trade to deal with, and how they behave. But I will say that it has improved the relationship between the police, the licensed premises and the local authority. Certainly in Pubwatch the police will go and brief and discuss with licensees where the particular problems are or what they have as an event coming up where there may be an issue. BBPA has recently issued some guidance in conjunction with the police and the Local Government Association in advance of the European football championships this summer. So we are looking to lead in terms of partnership and to put into practice partnerships between the industry, the trade-there are 51,000 pubs in this country, so there is one in every city centre that you are likely to be talking about-

Q159 Chair: Can I ask a simple question about this? When you look at one of those schemes, how do you determine whether you think it has been a success? What is the definition of "success"?

Brigid Simmonds: The definition of success has to be that the police have to intervene less often and, as Henry has given the example, that you get reductions in crime and bad behaviour. But it is cultural change that is going to change people’s, particularly young people’s, views on how much they drink, how quickly they drink and how they move on.

Henry Ashworth: I think, absolutely, looking at reductions, those examples, in terms of violent crime, drunk and disorderly offences, and drunk and incapable offences, should be measures of success. Other measures of success for a partnership should be that more people are able to go out and enjoy a sociable time in that city centre and that responsible businesses which are part of the partnership should see their businesses flourishing. The real success in this area is that we have thriving nighttime economies in which more people feel they can participate and the businesses thrive, and that the harms associated with the misuse of alcohol are reduced.

Brigid Simmonds: That was one of the reasons why the scheme in Nottingham was set up. It was partly because the chief constable at the time said, "Don’t come to Nottingham because you are going to get stabbed," and almost immediately people stopped wanting to go to university there. It was a partnership that was set up between the universities and the trade to make Nottingham a safer place to go out at night.

Q160 Chair: It is striking that when I ask you about what success is, the answer is in terms of the effect on the police and law and order, and on business success-both of which are legitimate policy objectives-but neither of you mentioned measures of longterm health outcome.

Brigid Simmonds: It is probably because we do not work in that particular area, but that has to be, for all of us-in Parliament or those who are making policy-what we are looking at: for people to enjoy our product responsibly, to drink responsibly and not to cause themselves longterm health harms.

Q161 Chair: It would not be unreasonable, would it, if you were having that kind of partnership in a particular locality, to look for a reduced incidence of alcoholrelated health effects as one of the definitions of success?

Henry Ashworth: In most of the effective crime and disorder reduction partnerships that you see, the local NHS is absolutely part of the partnership. In terms of the issues as to binge drinking that have been referred to, it tends to be the A and E departments, rather than the longer term chronic effects, that are affected.

Brigid Simmonds: I also think, under the new Alcohol Strategy, that the role of Health and Wellbeing Boards and their partnership and involvement are going to be key.

Q162 Andrew George: I want to move on to minimum pricing on which, Mrs Simmonds, you have views and, it seems, Mr Ashworth, you do not. In your evidence, Mrs Simmonds, you said that the heaviest drinkers are least responsive to changes in price. Do you believe that the heavy drinkers are born or do they become heavy drinkers?

Brigid Simmonds: I would not know the answer to that. There is some evidence that it can be genetic. There is lots of evidence that people become heavy drinkers because they drink too much and do not understand what they are drinking, which is the culture that we need to change.

Q163 Andrew George: So someone who is a heavy drinker would not have gone through any kind of progressive steps to become a heavy drinker.

Brigid Simmonds: I think they would have gone through progressive steps as their drinking has increased, and probably the variety of what they are drinking has increased. I am not an expert.

Q164 Andrew George: The reason I am asking the question is that you are saying that the heaviest drinkers are the least responsive to changes in price. On the assumption that heavy drinkers are light drinkers initially, one might then argue that it is at that stage you want to try and influence their drinking behaviour. Therefore, would you agree that your argument has no validity, in the sense that you are trying to influence people, to discourage them from becoming heavy drinkers in the first place?

Brigid Simmonds: It was the Sheffield study-which was in line with most international evidence-that found the heaviest drinkers are least responsive, but that does not mean that we do not want to encourage them to drink less over a period of time. The question is whether minimum pricing, as a whole population measure, is going to be the most effective. What we are interested in are targeted measures which deal with those heaviest drinkers.

Q165 Andrew George: You advance your case on that particular piece of rather inconclusive evidence. I was simply saying that if you are advancing your case primarily on that basis, your arguments have no validity.

Brigid Simmonds: I do not think we are advancing our arguments only on that piece of evidence. First of all, does any industry want the Government setting prices on what it sells? The answer has to be no. The second thing I would say very clearly is that minimum price affects everyone and I think it is unlikely, which is what I have said, to affect the behaviour of those who drink the most, which is where the problem lies. The real concern with beer is that because, in England, we have decided that the retailer will keep all the income it gets, there is a real danger the Treasury will suddenly have a black hole as people buy less alcohol and, therefore, will want to put beer duty up. Having seen a 42% increase in beer duty in four years-and where in community pubs 68% of what they sell is still beer-taxation is a huge issue for our industry, bearing in mind that 95% of the beer we drink in this country is produced here. It is a big manufacturing sector and supports almost 1 million jobs.

Q166 Andrew George: I want to come on to who would benefit from minimum price in a moment, but I wanted to establish-and you may accept-that the heaviest drinkers may not always in every circumstance have been pre-ordained to become heavy drinkers through some genetic abnormality.

Brigid Simmonds: No.

Q167 Andrew George: It might have been the result of progressive steps of which, perhaps, price might have discouraged them. That is a possibility.

Brigid Simmonds: That is a possibility.

Q168 Andrew George: Secondly, I wanted to ask what you thought about the Prime Minister’s comments on where the Government are going with this and that they will be consulting soon on a minimum price. The suggestion is 40p per unit. He has said that if the minimum price of 40p would mean 50,000 fewer crimes and 900 fewer alcoholrelated deaths each year by the end of the decade, it is something that we should all wish to achieve. Would you not wish to see those kinds of outcomes as well?

Brigid Simmonds: I would wish to see those outcomes, but those statistics are based on the Sheffield model, and it is a model. I do not think we have enough international evidence to suggest that those outcomes really will be the outcomes that-I agree with you-we desire to achieve because it is a whole population measure. I would rather see measures that tackle those people culturally in changing their behaviour from the earliest possible age, which is much of what we are doing with the Portman Group, with the Drinkaware Trust and with the amount of partnership into which the industry is entering.

Q169 Andrew George: So you are prepared to take the risk of allowing 50,000 crimes and 900 additional deaths per annum on the basis of your unwillingness to accept the case for a minimum unit price.

Brigid Simmonds: I have a number of members who have different views on minimum pricing. What I think we all absolutely accept is that the ban on belowcost selling without an element of production costs-so just doing duty plus VAT-is not going to make any difference. If you have an element of production cost, that would be a better measure for us and it would get rid of the irresponsible promotions, which do exist out there, rather than minimum pricing. Minimum pricing is giving the Government control of the pricing of alcohol and that is not something the industry welcomes.

Q170 Andrew George: Is it the 40p that worries you? Is there a minimum price below 40p that you think would be more acceptable to your members?

Brigid Simmonds: Take something like air passenger duty. When you introduce a tax like that, there is an irresistible decision that you will go on putting up that tax. So you start at 40p. By the time it becomes £1.80, in 10 years’ time, it is a different issue. It is the principle. The industry does not believe that the Government should be setting a minimum price, but there is also an acknowledgment that we want our products to be sold responsibly.

Q171 Andrew George: You say in your evidence that it would have an impact on pubs-on your members-but do you not think that a minimum unit price would have a more significant impact on retail sales in supermarkets than on sales within pubs? Can you not see circumstances in which it might drive trade towards your members and away from the supermarkets?

Brigid Simmonds: I can and the BBPA has spent a number of years complaining that one of the reasons people are not going to pubs is because it is so much cheaper to buy alcohol in the supermarket. But I do not think that this will make a significant difference to that and I do not have any members who really believe that this is the answer to the problems that pubs face. Far more of a problem for us is beer taxation, red tape, legislation and lots of other things that stop community pubs from functioning. This is not the answer and I think we have to be careful that it should not be perceived to be the answer. But, if that differential is lessened, there will be some help. One of the big problems for pubs is that, unlike a big business like a supermarket, they cannot absorb that taxation. When taxation goes up-as it did by 5.2% this year-they have to pass it on to the customer, whereas the supermarket can absorb it.

Q172 Andrew George: You also say that there should be a ban on belowcost selling. How do you know when belowcost selling occurs?

Brigid Simmonds: The ban that was proposed by the Government initially was a ban on belowcost selling, which was VAT plus duty. So you know what your price point is. Our argument is that it will not make much difference and there has to be an element of production. If you had an element of production which was an average you could introduce a ban on belowcost selling immediately because you can do it, as the Government have already proposed, under the Mandatory Code that exists in legislation. The minimum pricing will need completely new legislation, which was not, as far as I am aware, included in the recent Queen’s Speech.

Q173 Andrew George: That also presupposes that there might not be any collusion between the supplier and the retailer, nor even that the retailer is the producer.

Brigid Simmonds: Obviously the tax is paid by the producer, so it is paid at the brewery. It is not paid by the retailer. The concern of some of my members on invoice pricing-which is a system that is used in the rest of Europe-is that we would not wish that information to be made public. But as long as that information remained confidential and under the mandatory code, it would allow local authorities to take action just as they do when the on-trade perhaps is considered to have behaved irresponsibly.

Q174 Andrew George: You also say that minimum pricing may be a breach of European competition law. I am not suggesting that you give us a legal answer to that now, but would it be possible for you to provide a further briefing for us giving evidence as to why you believe there is a risk that that may be the case?

Brigid Simmonds: There are two Ministers who have already said in this House that they believe it may be a breach of European competition law. The number of cases that have been taken in Europe have related to tobacco. If tobacco is not considered a health harm, I find it difficult to believe, in that sense, that alcohol is going to be different. But I am afraid I do not have a legal opinion. It will have to be tested through the European Commission, which is likely to be in Scotland, I would have thought, before it is here.

Q175 Andrew George: But you do not favour the kind of practices that go on in the retail trade where multipacks and multideals are resulting in eyewateringly low prices, which must be a major cause of undermining your trade.

Brigid Simmonds: The issue is loss leading: "Come to my supermarket to buy cheap alcohol". I do not think the issue is multipacks. If we are not careful, any ban on multipacks will affect something that is low strength, which is beer.

Q176 Andrew George: Mr Ashworth, you and the Portman Group are caught on the horns of a dilemma. You have no view on it. How come?

Henry Ashworth: I have two roles with the Portman Group. One is that I regulate the products, packaging and promotion. I cannot regulate on price, because it would be illegal. The second role that I have is to try and lead social responsibility issues. I cannot lead on this because it is illegal for me to bring members together and discuss price. With either of the roles I have, I cannot affect this. Quite rightly it is for Government to make decisions in this area.

Q177 Andrew George: You can simply observe. You think your role does not entitle you to express an opinion on it.

Henry Ashworth: I can neither lead on it nor regulate it. As I cannot do either of those things, the role of the Portman Group is to lead on social responsibility issues and to regulate, where we can, as the watchdog of the industry.

Q178 Valerie Vaz: On the point about EU law, I do not know what your members think about what is going on in Scotland, or whether they or you have formed a view about what is happening in Scotland.

Brigid Simmonds: The view I have given you would also be our view in Scotland, but there are different members with different views in this area, and there are lots of different activities going on. We would say, in Scotland, that it is important that it is notified to the European Commission. I will be interested to see what the European Commission says. I do not think it is helpful to have price points that are different in Scotland from those in England. You have only to see what happened between Northern Ireland and the Republic to know that it will be unhelpful if that is the position we find ourselves in.

Q179 Valerie Vaz: Would you be surprised to hear that media reports in Ireland quote the EU Commissioner for health and social protection as saying that EU rules do not prohibit member states from setting minimum retail prices for alcohol?

Brigid Simmonds: To be honest, we have to wait and see what happens when it goes in front of the European Court. There is lots of activity that will go on; it is not activity that will be taken by the BBPA.

Q180 Valerie Vaz: But the EU Commissioner has actually said that. Have you had any discussions with the European Commission about this?

Brigid Simmonds: No, we have not.

Q181 Valerie Vaz: Is there any reason why not?

Brigid Simmonds: We had discussions recently about another issue for the industry, which is to do with tax stamps and duty fraud, but the EU is quite clear that it will not have a view until it is notified.

Q182 Valerie Vaz: But you could have an informal discussion. You can talk about it as you have done with other-

Brigid Simmonds: You could have an informal discussion. It is not something the BBPA is leading, but I know there are a number of members of the BBPA who may be having those discussions.

Q183 Valerie Vaz: What is your view on what the European Commissioner says, as quoted in The Irish Times?

Brigid Simmonds: I think it will be something that will go all the way to the European Court, and we have to wait and see what the European Court says about it.

Q184 Dr Wollaston: I want to pick up a couple of points. How would a ban on belowcost selling that includes production costs help when White Lightning cider costs so little to produce? Surely we need to address the alcohol content, not only the production costs, because it is the alcohol content itself that causes the harms.

Henry Ashworth: Could I make one comment? Heineken withdrew White Lightning cider from the market.

Q185 Dr Wollaston: Okay, but I am talking about white ciders in general.

Brigid Simmonds: Obviously, it is a decision by Parliament that they tax cider at a different rate to beer.

Q186 Dr Wollaston: I mean in general. That is not addressing the fundamental point that some alcohols-even vodka, for example-are significantly less expensive to produce than others.

Brigid Simmonds: Yes.

Q187 Dr Wollaston: And it is the actual alcohol content itself that does the harm. Further to that, is it not the case that when alcohol is too cheap it undermines any other public health measures or education measures simply because alcohol is a psychoactive drug, and that is fundamentally the problem?

Brigid Simmonds: I repeat what I said earlier. We do not believe that our products should be sold too cheaply. They need to be sold at a responsible price.

Q188 Dr Wollaston: But is that not the point about minimum pricing-that it is saying that there needs to be a responsible price that is linked to the health and social harms of alcohol?

Brigid Simmonds: A ban on belowcost selling with an element of production would bring the majority of those products that are sold irresponsibly to a much more responsible position. It would not end up with the Government having control over the overall pricing.

Q189 Dr Wollaston: You say "the majority", but is it not also the case that people who have a serious drink problem-an abnormal relationship with alcohol; drinking to get drunk-are very good at targeting the cheapest brands, and they would simply then target the next cheapest brand? It is only by setting a threshold that is linked to responsibility and the health and social harms that you can achieve that because production costs are so variable.

Brigid Simmonds: Production costs for cider, and indeed for beer, are much higher than they are for spirits. I could produce lots of information for you on that basis.

Q190 Dr Wollaston: Indeed, but that is what I am saying-that they are so variable. Therefore, the heaviest and problem drinkers-if you link it to production costs-are merely going to target the brand with the lowest production costs. You would also accept-and you quoted the Sheffield study, but again there may have been a misrepresentation there-that we know the heaviest drinkers in fact spend, on average, 40% less per unit on their alcohol, and although dependent drinkers may not modify their drinking because of a price elasticity, that is certainly not the case for the heaviest drinkers in general, which I think you might have been implying, without quoting. Would you not accept that heavy drinkers have any response to price at all?

Brigid Simmonds: Heavy drinkers may have a response to price, but I still believe that a ban on belowcost selling, which had a production cost that could be set either for different forms of alcohol, or at the highest common denominator-so the highest production costs, which is probably in beer-would have the same effect, because a lot of the products that are sold very cheaply are ownbrand products. It is those products that would have to be brought up to the same sort of costs. But it is not going to change the cost of alcohol in the supermarket to the same price that you will pay in a pub. In terms of beer, we pay 40% of the total beer tax in Europe and we consume only 13% of the product. So there has to be some question as to whether price is really the issue that we have in this country, or whether it is a cultural and behavioural change that we need to influence. Price in other parts of Europe, which is much cheaper, does not seem to have the same effect on the population as it does here.

Q191 Dr Wollaston: Yes, but would you accept that if alcohol is too cheap, it undermines other public health measures and education because of-

Brigid Simmonds: I would, and I would love to see, particularly, supermarkets to stop loss leading in terms of alcohol.

Q192 Dr Poulter: Picking up on that point, you have talked about pricing and duty. The British Beer and Pub Association says it is concerned that minimum price could ultimately be achieved through, or result in, higher beer taxation. Is there any evidence to support that? Do not the levels of alcohol duty and VAT on beer sold in pubs already equate to 40% per unit price?

Brigid Simmonds: No. Our concern is that-

Q193 Dr Poulter: I am reading your concerns on record. I am looking at consistency here in argument.

Brigid Simmonds: Our concern is that the Government continue to put up beer taxation by 2% plus inflation each year. They are not getting much more revenue from that beer taxation, but beer taxation is an important part of Government revenues. Our concern is that the Treasury will see a reduction in beer taxation because people are drinking less alcohol and will want to put up beer taxation as a result because, under the scheme that they are looking to introduce for minimum pricing, the retailer keeps the margin.

Q194 Dr Poulter: But you have said in answer to Dr Wollaston that you do not see a link necessarily between price and alcohol consumption, and now you are saying you are concerned that the Treasury may see a reduction in income if beer taxation goes up. I do not follow the consistency of your argument.

Brigid Simmonds: If a minimum price is introduced, there is no doubt that people will drink less alcohol. The question is: is it the people who drink to harmful levels that will drink less alcohol? This is going to affect the poorest in our population who then would not be able to afford it. So, without doubt, the Treasury’s income for beer taxation will reduce.

Q195 Dr Poulter: Hold on a second. Certainly from my frontline experience and from some of the evidence presented previously, if you deal with the most vulnerable street drinkers and the people who are binge drinking, there is evidence that increasing pricing among that group will mean they cannot afford to buy as much alcohol. I do not think there is anything controversial about saying, with vulnerable street drinkers and other people who are also, on the other end of things-looking at it from an economic point of view-of great financial concern to the NHS, that to protect that group from doing harm to themselves is probably a good thing. I think one would say it is definitely a good thing. I am struggling to follow the consistency in the argument here. On the one hand, from your earlier evidence, you are saying that having a per unit price does not affect behaviour, and now you are saying it would and it would reduce Treasury revenues. I am struggling to follow your logical thinking. You seem to tailor the argument depending on the question and who is asking it.

Brigid Simmonds: What I am saying is it will not affect dramatically the behaviour of those who we really must tackle in terms of alcohol abuse. It will affect the whole population because it will make something more expensive and, in this economic climate, people will drink less. Therefore, the Treasury will get less taxation out of it and there will be a tendency to put that taxation up. Their argument the other way is that they will get more income because fewer people will go to A and E and fewer people will be involved with the police.

Q196 Dr Poulter: You have just said that the people who are most vulnerable and who drink the most are the street drinkers. Why are you saying it will not affect their consumption of alcohol when it will affect the whole population’s consumption of alcohol? How do you make that distinction?

Brigid Simmonds: Because people who really do drink too much alcohol will stop spending on other things to fuel their particular wish to buy alcohol. I do not think that is true for the majority of us in the population who drink to sensible levels who, when it becomes very expensive, will drink less. So it will have less of an effect on those people.

Q197 Dr Poulter: But does not the evidence show that they do that already? People who have a very serious alcohol problem already forgo eating and paying their bills in order to support their alcohol problem.

Brigid Simmonds: Yes.

Q198 Dr Poulter: Again, that seems very contradictory.

Brigid Simmonds: I do not think it is contradictory. I do not think minimum pricing is the measure that will make the greatest difference to those people who drink too much alcohol. It will make a huge difference to the majority of people who drink alcohol responsibly. A ban on belowcost selling would be a better way of achieving what you are talking about.

Chair: Sarah Wollaston wants to ask some questions about advertising and marketing, moving it on.

Q199 Dr Wollaston: Both the Portman Group and the BBPA argue that the link between advertising and alcohol consumption is marginal at best. Is there a fundamental disagreement between the industry and Government on this issue? Of course, if advertising and marketing do not have an effect on consumption, why does the industry spend so much on them?

Henry Ashworth: I do not think there is a disagreement between the members of the Portman Group and the Government on this issue. The Government recognise that the Portman Group code, the Advertising Standards Authority code and obviously Ofcom’s involvement mean that we have some of the strictest regulations in Europe on this. They do not believe there is any evidence that has been presented to suggest that a ban on advertising is a proportionate response. They have absolutely challenged us and we have accepted that challenge through the Responsibility Deal to review our code of practice as the Portman Group, as we have with our sponsorship code of practice. We are absolutely tirelessly working to make sure that we are innovating, as industry regulators. The Government believe that we are effective as industry regulators and that that is the best way forward.

Q200 Dr Wollaston: If you are not wishing to target young people-children-with alcohol advertising, why do you have alcohol advertising at films which are for under-18s? If you go and see a 15 film, you will be bombarded with alcohol marketing.

Henry Ashworth: Obviously, advertising in cinemas is under the regulatory control of the Advertising Standards Authority, not myself, but the rules are very clear: to advertise alcohol 75% of the audience for a film must be over 18. Those are the rules. The Advertising Standards Authority strictly enforces those rules. I went to see "The Best Exotic Marigold Hotel" film. I was the youngest in the audience by quite a considerable margin, and it had a 12 certificate.

Q201 Dr Wollaston: But what if you went to see a "Harry Potter" film, for example? If you look at the proportion of the population who are under 18, having a cutoff at 75% surely is unreasonable.

Henry Ashworth: As I say, we have some of the strictest rules for advertising and marketing in Europe. The Advertising Standards Authority and ourselves are constantly reviewing those rules to make sure that we are effective as regulators and that we are absolutely committed. I absolutely reassure you that we are committed to ensure that marketing does not particularly appeal to under-18s. It is not in the interests of my member companies. They want to target their marketing at people who can legitimately buy their products. They invest heavily in supporting Challenge 25 and Challenge 21 schemes. The Portman Group rules are very clear that images of people who are or appear to be under 25 cannot be used. We operate very strict guidelines and we enforce them.

Q202 Dr Wollaston: Further to that, there is a code stating that you cannot claim that alcohol improves your sporting prowess, in which case why do we allow sponsorship of major sporting events, which not only create that link but also are widely viewed by young people? Why do we have alcohol sponsorship of the rugby world cup, for example, and the FA cup?

Henry Ashworth: The Portman Group code includes sponsorship. We are reviewing the code of practice at the moment, as we are committed to doing through the Responsibility Deal. The Scottish Government obviously have a sponsorship code. We are working very closely with them. We have looked at the review of the Scottish sponsorship code that Ipsos MORI has recently carried out and we are currently reviewing the situation. I believe that sponsorship is a positive form of marketing and that it supports grassroots development of the sport that it is sponsoring. If I could put it into context, the vast majority of people in this country drink responsibly and in a way that is sociable. We all enjoy sporting events.

Q203 Dr Wollaston: How does sponsorship of the rugby world cup support grassroots rugby?

Brigid Simmonds: I must declare an interest. I am a director of the Sport and Recreation Alliance. It was the previously named the CCPR and I was the chairman for six years until last year. I have been involved in promoting grassroots sports all my life. The RFU, along with every other national governing body of sport, uses those funds that it gets from its sponsorship to promote grassroots sports. The Sport and Recreation Alliance has given this Committee lots of evidence of grassroots sports that are supported by some of my members, from Shepherd Neame in Kent to Theakstons in Yorkshire. The average sports club makes a surplus of only £1,000 a year, yet we have a range of 30% of sports clubs that received £2,500 in sponsorship. It is hugely important to them. I have real doubts that there is a causal link between advertising and actual consumption, and if you look at the FA cup-

Q204 Dr Wollaston: Then why do you spend money on it?

Brigid Simmonds: Because it is about brand promotion. The FA cup also produced 50 million people who saw the responsibility messaging that went with AB InBev’s promotion of it. That would cost millions of pounds if you had to pay for it. If you watched on television or you watched it from the third round on you saw, around all those billboards, quite clear, responsible marketing about Drinkaware. That would be true of the Grand National and it would be true of the Heineken cup, which has just finished. So there is an advantage that people who go to those events are seeing a lot of responsible messaging on the product and around the stands.

Q205 Dr Wollaston: Surely you would accept there is a huge disproportion here if you are spending over £800 million a year on marketing that is telling people to drink and then you are spending a tiny fraction on responsibility marketing. I think even the WHO accepts that that is hardly responsible.

Brigid Simmonds: I do not think there is enough evidence-and there is not evidence from France or Norway, where there were bans-that it actually changed people’s consumption. The Joseph Rowntree Foundation and Demos have recently done quite a lot of work that indicated, particularly with young people, it is much more to do with parents and peers as to how much they drink, than it is about advertising.

Q206 Dr Wollaston: You would not accept that increased advertising exposure causes young people to start drinking earlier and to drink more when they do.

Brigid Simmonds: I would not. I would say that it is about the brand that they particularly drink. I do think that young people go through a phase where they possibly want to drink the brand of the team that they support, but it is a phase that you go through and I do not think that that increases the amount of alcohol that they consume.

Q207 Dr Wollaston: So you would not accept the findings at Stirling university that exposure to large volumes of alcohol marketing-saturation marketing, which is seen by young people, even if it is not deliberately being targeted at them-causes young people to start drinking sooner and to drink more when they do?

Henry Ashworth: I think the most recent findings from Stirling university say that that was inconclusive. I would say that the trend data-and this is the reason why trend data is so important to all of us-show that fewer young people are drinking now. As I say, 55% of young people have never had an alcoholic drink, with the percentage reporting drinking in the last week dropping by half, from 26% to 13%.

Q208 Dr Wollaston: The point being that those who do drink are drinking earlier and drinking more when they do.

Henry Ashworth: But sponsorship, as you have quite rightly pointed out, is a massmarketing tool. Sponsorship is about some very positive use of brands to get across responsibility messages and to ensure that Drinkaware is seen by everybody who watches those events. The trends are moving absolutely in the right direction. Do we need to do more? Of course we need to do more, and we need to target those young people who are still drinking. Only 17% of parents have a conversation with their children about alcohol specifically. We need to up that. Everybody needs to-

Q209 Dr Wollaston: Can I stop you there, Mr Ashworth? What proportion of young people own alcoholbranded merchandise?

Henry Ashworth: I have no idea.

Brigid Simmonds: I did quite a lot of work in relation to gambling on this subject and to do with young people wearing branded Tshirts where we agreed, as indeed the Portman code also specifies, that you cannot have Tshirts or other forms of merchandise for young people which have the brand of the sponsor on it. One of the difficulties with that is that when your child is 13, and possibly more vulnerable to that sort of messaging, they become big enough to wear an adult shirt. But I do not think there is any evidence-and there was no evidence when we introduced this for gambling that anyone could give me-that it was actually going to have that effect, but it is something that the Portman Group and the industry clearly support.

Q210 Valerie Vaz: I am confused. Are you saying that advertising does not make people want to buy the product?

Brigid Simmonds: It does make people want to buy specific products. The question is: does it make people buy more products and therefore drink irresponsibly?

Q211 Valerie Vaz: What does your research entail in terms of when you place an advert, say, on television or wherever? You must see an increase in sales. Do you keep those measures or do you not keep them?

Brigid Simmonds: It is not something the BBPA would do. That would be a particular brand. They would say that it is about increasing, yes, their brand but in a socially responsible manner. It is not about encouraging young people to drink more of a particular product.

Q212 Valerie Vaz: But it is encouraging people to buy, is it not? It must be. Advertising must have that effect otherwise people would not do it, would they?

Henry Ashworth: Brand marketing is all about encouraging people to buy a particular brand. The question was whether sponsorship encourages more young people to drink alcohol. The trends are all moving in the right direction. There are fewer young people drinking alcohol now than ever before.

Q213 Valerie Vaz: I understand that, but we used to be way down the bottom of the league and now we are third. You sniggered when I mentioned The Irish Times-I do not know why-but both Ireland and Britain have gone back up the league table of people who are drinking much more than they used to, and there could be all sorts of reasons like 24hour drinking and that sort of thing. Clearly, people have noticed that there is a problem. It may be coming down, quite rightly, because everybody is working together to do something, but I am surprised at some of your comments in terms of you advertise and it does not have an effect. Of course it does. It is there for people to buy the product. If you show some cool young people drinking, lots of other young people want to do that. It happens to me. If I see a Mars bar being advertised, I want to eat a Mars bar.

Henry Ashworth: Brand marketing is hugely important. It is important to any industry sector. It is about differentiating between one product and another. If I may say so, under the Responsibility Deal, the most recent pledge has been a significant unit reduction pledge. The way that will be delivered is using the power of brands to help people enjoy their drinks and to drink a little bit less alcohol at the same time. Brand marketing is a very important part of the partnership mix in changing the culture around drinking in this country. I am not sure if that answers your question.

Q214 Valerie Vaz: You have no specific measures of whether this Responsibility Deal is working or not. Do you have any specific indicators of performance?

Brigid Simmonds: The Responsibility Deal has a monitoring and evaluation group, which is looking at the change it is making. Henry was talking about our most recent pledge that came out on the same day as the Alcohol Strategy, which is that we would take 1 billion units of alcohol out of the system by 2015. That is being done in a number of ways. I have one major member of the BBPA who is reducing the strength of its three main premium lagers from 5% to 4.8%. That will take a million units from the market. We are obviously introducing newer, lowerstrength beers-you will be aware that the Government reduced taxation for 2.8% beers-and we have over 30 brands out there which will be creating that change over a period of time.

Henry Ashworth: If I could add to that, it is obviously very early days. The monitoring and evaluating group is chaired by Professor Mark Bellis from the northwest health observatory. This will be monitored using both CGA and Nielsen data at a national level. We are also going to be looking at some behavioural trials to see what happens when you change, for example, the alcohol strength of a bottle of wine from 14% to 12%, or if a beer product, for example, came down from 5% to 4.5%. The behavioural assumptions are that people will continue to drink the products that they enjoy because they enjoy the drink and are loyal to the brand. Brand marketing is going to be crucial in the delivery of this unit reduction pledge. It will take a significant number of units out of the market and enable the growth of a loweralcohol market. We may well be looking back in five years time and saying that this was a paradigm shift.

Q215 Barbara Keeley: I wanted to come back to what I think is one of the most important things we have touched on: changing norms and making cultural change. This is a comment really, but the major sporting events that I attend-I do not attend a lot of football matches, but certainly cricket events and test matches-are full of people who spend all day getting drunk. It is a useful thing to have an overall target of taking units of alcohol out of what is consumed but it would be useful, in terms of breaking this link between sport and drinking, to-

Brigid Simmonds: That is a cultural change, but if you have someone drinking three or four pints of 2.8% strength beer, that is considerably less alcohol than if they had had 5% beer.

Q216 Barbara Keeley: Indeed, but if you sit anywhere near the Barmy Army at an England test event, they get drunk and spoil the event for everybody else.

Henry Ashworth: Those grounds all have alcohol licences and those licences are all overseen by a local licensing authority. There is a very significant difference between the people who are vending at a particular event and the sponsorship of an event.

Q217 Barbara Keeley: What I have reflected to you happens at every different venue that I have been to. I think this link between alcohol and the sort of behaviour we see at sports is very important and I wanted to ask you about it, not only in terms of things like the police can do, and city councils and Health and Wellbeing Boards, because it is putting a lot of onus on them, but is there not a case, in terms of cultural change, of trying to get younger people in particular to understand the health impact of the level at which they are drinking? I do not think a lot of young people properly understand what it is doing to their bodies and what it might do by the time they are in their 30s and 40s. There is perhaps an opportunity to look at this over the next six months as we have sports elites performing-very many young athletes. I heard a young discus thrower in the House here yesterday who said that, in the end, he had to tackle in himself the fact that he was never going to become a champion or do well in his chosen sport of discus throwing when he spent some weekends partying. What is going to make young people understand the extent to which it probably does bring their physical wellbeing down if they do go out and have these binge nights on Fridays and Saturdays?

Brigid Simmonds: I was in Beijing for the last Olympics. I do not think there is a culture of drinking that goes with the Olympic games and a lot of good work has been done on the legacy of the Olympics, which is about getting people more interested in physical activity and sport. As you rightly say, you will not become a champion if you also are drinking too much while you are doing that.

Q218 Barbara Keeley: Or at all.

Brigid Simmonds: Or at all. That has to be part of that cultural change we are talking about and I would hope that the Olympics are part of it. On the 1 billion unit reduction, we have an issue that we cannot promote lower strength. Under the BCAP and CAP rules of the Advertising Standards Authority and the Portman Group, just as you cannot promote something that is high strength, you cannot promote something that is low strength. It would be helpful if this Committee was prepared to support our efforts to have that changed because the 1 billion unit reduction is going to be difficult to achieve if you cannot say, "In my pub or my supermarket, why don’t you buy that because it is lower strength?"

Q219 Chair: Do you want that promotion to be associated with a particular brand, or possibly as educating the public to look for lower-strength alcohol and then have labelling that supported the assertion?

Henry Ashworth: We are collectively committed to developing a market for lowerstrength products. That is what the unit reduction pledge is all about.

Q220 Chair: It sounds like good news for Kaliber.

Henry Ashworth: And many other brands. There are a number of different steps. One will be the reformulation of existing brands that people know, love and drink, and helping people to consume a little less. Another will be tremendous amounts of innovation. Over 30 new products-new beer brands-have taken advantage of the government’s new 2.8% reduced duty rate to launch. Of course, it is all good and well launching a product, but you then need to establish a market for it. Having all of the big supermarkets sign up to agree to support this unit reduction pledge will make all their retail practices available to support growing this market for loweralcohol products. That is the same in all different categories.

Brigid Simmonds: It will be combined with some of the unit awareness that we are doing, both in pubs and in supermarkets, which gives you an idea of how much you are drinking in terms of units, which I think is important to the point that you were making about people not understanding what they are drinking. On most cask beers you would have the ABV, but we now have this promotion of unit strength so it tells you how many units there are in a pint of beer, a glass of wine or a glass of spirits. That is an important part of the Responsibility Deal that the industry is offering.

Barbara Keeley: I think it needs to go a lot further than understanding units. It needs to make clear, "What am I doing to my body every time I go out and drink seven, eight, nine or 10 or more units?" I do not think people do understand that; what it does to your liver and what it does to your circulation. There was a good campaign on tar dripping into your lungs if you smoked, but I have not seen that with alcohol.

Q221 Dr Poulter: I want to come back to this point about taking units of alcohol out of the system. You gave an example there of saying, "We hear of one drinks company that is reducing the amount of alcohol from 5% to 4.8%" and then, at the same time, we hear that this is going to be a paradigm shift in the way that we are moving in alcohol policy and responsibility in the industry. But in reality, in terms of the percentage of alcohol drunk, it would be about 25 pints before that 0.2% reduction, from the example you gave, would be an effective reduction in alcohol. There is no realistic reduction at all.

Henry Ashworth: Can I give a slightly different example? If you were to go to a restaurant, for instance-

Q222 Dr Poulter: No. Let us deal with that example because that was the example given about the Responsibility Deal being put across. With a reduction from 5% to 4.8% you would have to be drinking something well over-from my very basic maths, and I may be wrong-20 pints before you see that it makes any difference, in real terms, to someone’s units and alcohol they are consuming.

Brigid Simmonds: Yes, but I do not think we assume that everyone drinks 20 pints. If you are drinking a couple of pints, you are obviously taking a reduced amount. Where this has worked best so far has been associated with sport. People who come off a golf course want to drink less alcohol, so they have something that is lower alcohol. In Spain, the market for no alcohol is 15% of the beer market. We want to move beer and part of our responsibility initiative is that we drink less alcohol. I agree, but I do not think, on average, that most people drink 25 pints of beer.

Q223 Dr Poulter: No, but I am saying that the net effect is that someone would have to drink, effectively, 25 pints before they saw a meaningful reduction in the number of units they are consuming in terms of the health effects of alcohol.

Brigid Simmonds: Yes.

Q224 Dr Poulter: If we are looking at this as an effective policy in having a Responsibility Deal and if we are tackling the underlying health care challenges, we may have taken, overall, some steps towards having a very slightly weaker beer on display, but if people have bad drinking habits and are already drinking far too much, effectively the difference between one of those people drinking 24 or 25 pints is pretty minimal in terms of the amount of damage it is going to do to their bodies.

Brigid Simmonds: The World Health Organisation was quite clear that we ought to be encouraging people to drink lower strength and the industry should be supported in exactly that. There is obviously a bigger difference if you then move to a 2.8% beer.

Q225 Dr Poulter: Indeed, and I think that is the point. If we are giving as an example of how we are trying to cut-how the industry is standing up to the challenge of reducing-alcohol consumption that we are reducing the percentage strength of beer by 0.2%, I do not think that is going to be effective in public health terms at all and it would be very misleading for you to say that it was.

Brigid Simmonds: You have to see it as a trend and look at it as a step in the right direction, because we have to take consumers with us on this journey. Making a jump between something that is 5% to 2.8% does indeed change the taste. Making a move between 5% and 4.8% is not so much of a change, and then you can be moved on to something different. We did a lot of research before we introduced the unit awareness in pubs and people were quite clear that they did not go to the pub to be told what to do, so we had to be careful in our messaging. But we do need to move consumers-and I think we need a tax system that helps to move consumers-towards drinking lower strength.

Q226 Dr Poulter: Sure, but on the 5%4.8% issue, my understanding, from speaking to a major and growing producer in my own constituency, is that to reduce the percentage of alcohol in a cider, in that case, or a beer by between 1% and 0.5% would not significantly change the taste, whereas the case for reducing alcohol significantly, or halving it, would-such as the example the Chairman gave of Kaliber as opposed to a premium strength lager. I fail to see, if you are taking this issue seriously, why a more meaningful increase cannot be pushed for in terms of the amount per pint, shall we say, and why 0.2% is going to make any difference. Practically, in terms of tackling binge drinking and the public health consequences, it is not going to make the blindest bit of difference.

Henry Ashworth: Could I come in? That was one example. It happens to be in the public domain as to what that company is doing. It is a 4% reduction in the amount of alcohol in that particular drink. There are many other examples as well. If you were to look, for example, at a bottle of house wine in a restaurant, at the moment most restaurants and consumers do not even consider the amount of alcohol in that bottle of wine, whether it is a 12% or a 14% bottle of wine. In fact, it is number 18 out of 25 considerations when buying a bottle of wine. We are trying to help people who want to enjoy a bottle of wine when they go out for a meal to do so, and if you reduce the alcohol content from 14% in your house wine to 12%, you would be taking 16% of the alcohol out of that particular product. People would still enjoy a bottle of wine and be able to drink more responsibly.

The whole purpose of this unit reduction pledge is to encourage more people to be drinking within Government guidelines, which is one of the Government’s stated aims. That was one example, and certainly a 4% reduction helps, but it is only part of the answer. We need to look at this across the piece and use the practices of the big retailers to encourage people to open up this market, looking at their ownbrand products as well. All the big producers are looking at their portfolio of brands to see what they can do. This is an absolutely innovative step taken by the industry to help more people drink within the Government guidelines.

Q227 Chair: We have more or less run out of time, but could I ask a last question on the 1 billion units out of the system by 2015? What proportion of the alcohol currently consumed is 1 billion units?

Henry Ashworth: It is about 2% of the total market–a significant amount in public health terms. That is what the collective group of companies have signed up to. We are at the very early days of this. Do we think it could be more? It could well be more. The most important thing is opening up the alcohol content of a product, in some cases, to the people who are shaping the choices. We were talking about nudge, social norms and helping people to make choices that mean that more people are drinking within Government guidelines, which is a shared objective.

Brigid Simmonds: Encouraging industry to do things that are voluntary are much more likely to be effective than lots of legislation.

Chair: There is likely to be an extensive discussion if we start off down that road, so at that point I will draw this part of the proceedings to a close. Thank you for coming to give evidence to us.

<?oasys [pg6,cwe1] ?>Examination of Witnesses

Witnesses: Barry Eveleigh, Lead Commissioner for Drug Treatment, Birmingham Drug & Alcohol Action Team, and Jacqui Kennedy, Director of Regulation and Enforcement, Birmingham City Council, gave evidence.

Q228 Chair: Thank you very much for waiting. You heard quite a lot of that evidence. Could I ask you, briefly, to introduce yourselves and tell us perhaps a little about the role that you have played on behalf of your organisation in the development of Birmingham’s local strategy?

Barry Eveleigh: I am Barry Eveleigh. I am acting strategic lead for the Birmingham Drug and Alcohol Action Team. My responsibility is for the oversight of both the drug and alcohol Government strategies and translating that into local practice. It is then making sure, once we have those strategies in place, that we deliver upon those.

Jacqui Kennedy: I am Jacqui Kennedy. My day job is Director of Regulation and Enforcement for the city council. I look after trading standards, environmental health, licensing, laboratories and other bits and pieces. I also have the strategic lead for the community safety partnership in Birmingham, so I work closely with the partners, be it through the DAAT, health or the police. I was the project sponsor for the development of the Birmingham Alcohol Strategy.

Q229 Chair: That is where I want to start-to understand how this strategy emerged and where the leadership function was located. Was it the city council that led the process with support from the health service and from the police, and so forth? How did it happen?

Jacqui Kennedy: We had a previous strategy that ran from 2007 to 2010. The local authority had led the development of that strategy. But we then worked closely as part of the community safety partnership. As our partnership matured, it was very clear that the replacement strategy could be a true partnership strategy and that is exactly how we have developed it. DAAT took the lead in terms of developing the strategy with colleagues and that was contributed to by all of the agencies.

Our strategy is very much an holistic approach to alcohol harm in Birmingham. We have based it on the framework that was the national strategy because we felt that that gave us the golden thread from neighbourhoods through to the national strategy. We have tried to consider the implications around health, crime and disorder, young people and antisocial behaviour. The strategy has tried systematically to structure a response to alcohol harm, and there are benefits associated with that. Birmingham is promoting itself as host to the American and Jamaican teams in terms of the Olympics, but also as a conference city. It is that balance of the tourism and the convention and conference offer, but also connected with the harm associated with alcohol in its neighbourhoods.

Q230 Chair: In terms of the history and where it came from, when was the first strategy and what have you learned, do you feel, along the way from your experience?

Jacqui Kennedy: Our first strategy was in 2007. It took us about a year to get to a public strategy. "Reducing Harm and Empowering Change" was the actual title of it. The key lessons learned were about how important it was not to have only one single agency approach to tackling alcohol. It was very much about understanding the impact of alcohol for the whole city but also within communities. Our key lesson learned, for when we were developing the new strategy, was that we needed to engage and consult more widely. The other thing that had been a little bit disappointing from the previous strategy was that it was underpinned by a strong delivery plan and some elements of that were not delivered. So the benefits that we could have got in that period had not emerged by 2010. It was very clear that we had not ensured that some of the partners were as included as they should be and the governance was not as strong as it needed to be.

The new strategy has very strict and strong governance around it. It is responsible and accountable through the Health and Wellbeing Board; it is accountable through the community safety partnership board; and it is also responsible through a corporate management team of the local authority. The city council is the sort of guardian for it, but all those partnerships are absolutely key to govern how we deliver because the strategy has been developed, again, with another strong delivery plan underpinning it and each of the partners is called to account as part of a scrutiny approach to make sure that we deliver against the plan. It is very much business as usual.

Barry Eveleigh: In terms of ontheground work, it has led to the expansion of a number of services that were piloted in the first strategy. For example, in the north of Birmingham, around Sutton, we piloted the notion of arrest referral schemes. That has now gone citywide and has led to further development on alcohol treatment requirements, which again is something that is mentioned in the strategy. They are proving very effective. To give you an example, last year the target for alcohol treatment requirements was 20. We exceeded that target and delivered 71 successful completions on that that have led-

Q231 Chair: I am sorry, 20 and 70; what was that?

Barry Eveleigh: It was for 20 successful completions of people being placed on that alcohol treatment requirement order. The target was exceeded and we hit 71.

Q232 Chair: Alcohol treatment order. How do you define "success"?

Barry Eveleigh: It is basically those people who attend the treatment requirement hours and who do not reoffend.

Q233 Valerie Vaz: How do you identify them in the first place?

Barry Eveleigh: They are identified through the court system. We have a dedicated number of individuals within the courts who look at what somebody’s alcohol use is and whether it is significantly related to their type of offending. Then a suggestion is made before the court and it is entirely the court’s decision as to whether that individual will go on an order or not.

Q234 Valerie Vaz: The court makes the order.

Barry Eveleigh: Yes.

Q235 Dr Wollaston: But success is judged not only on if they attend the course, but of they then do not reoffend.

Barry Eveleigh: No. It is by the behaviour change.

Q236 Rosie Cooper: Is everybody who requires that treatment, or is to be referred, taken on? Do you have enough provision and facilities?

Barry Eveleigh: Yes. That is one thing we have managed, which is looking at the overall capacity issues to make sure that we take that on board. The one thing that was interesting as to the development of alcohol treatment requirements is that we did it without additional funding. It was based on a partnership arrangement that could work within existing resources. That is the idea and what this strategy is about, how we can work together to achieve more with the same, if not fewer resources.

Q237 Rosie Cooper: That deals with the ones the courts referred. How many people who need an intervention because of their drinking in Birmingham do you actually deal with? What is the percentage of the overall figure? It is all right telling us how successful little pockets are, but the reality is that it is part of a much bigger thing that Birmingham has had.

Barry Eveleigh: Absolutely.

Q238 Rosie Cooper: Are you able to meet the requirements of the people of Birmingham?

Barry Eveleigh: Yes. I think it is fair to say that we are still in the early stages of developing the alcohol treatment system. It is only in the last three years that we have taken this on board and extended it out to what it needs to do to match the treatment system.

Q239 Rosie Cooper: So when I walk out of here, I know that you are able to help everybody who needs an intervention of whatever sort in Birmingham because of their alcohol dependency.

Barry Eveleigh: With the demand at the moment, yes, we can. There is no evidence of waiting lists for people to access treatment. In terms of the wider population, last year we delivered over 22,000 brief interventions within custody suites, GP practices and for students in colleges.

Q240 Valerie Vaz: What about people in their homes, if they are victims of domestic violence or if they are perpetrators of domestic violence? Are you picking up people inside as well as those who are creating public disorder?

Barry Eveleigh: Yes. That is through the alcohol arrest referral scheme. Those people who are arrested and go into the custody suites are seen by an arrest referral worker who is trained in brief interventions. Whether the individual is then further charged or not, they get that provision in the cells. There is also the issue of fixed penalty notices. With somebody whose alcohol consumption is such that they do not want to put them through the courts, and in order maybe to encourage people into treatment, they are given the option of seeing a treatment worker for two onehour sessions to get brief interventions. If they attend that, they are not charged.

Q241 Rosie Cooper: Brief interventions, I hear, are quite successful. Are you saying that if we could get twohour interventions throughout the country, our alcohol problem would disappear?

Barry Eveleigh: I am not saying it is going to disappear, because the evidence is that it is only effective in one out of eight individuals, but at least it is a start, and it is a costeffective method.

Q242 Rosie Cooper: Of those people in Birmingham you are able to help, only one in eight are able to be helped in the brief intervention. Are you able to financially meet all the requirements of the other seven?

Barry Eveleigh: Those individuals get an intervention. At the moment, the numbers that we deliver on are above the recommendations that the Department of Health sets-around 15%.

Q243 Rosie Cooper: I am not bothered about the Department of Health. I am asking you the question. You told me you were able to help everybody who needs it, and now only one in eight are helped with the brief intervention. Are you able to fund whatever intervention or help those people need to get off alcohol? Are you able to fund it? You said you could before and now I am not sure you can.

Barry Eveleigh: No. As to the one in eight of those people who get a brief intervention, that is the evidence of the success of that brief intervention. We do not have any waiting times and there are certainly no capacity issues in terms of delivering brief interventions.

Q244 Rosie Cooper: After that what happens?

Barry Eveleigh: After that, in terms of those people who are dependent and have hazardous, harmful dependency issues, they get into treatment systems without any waiting lists.

Q245 Rosie Cooper: All of them?

Barry Eveleigh: Yes.

Q246 Rosie Cooper: How many of them would you-

Barry Eveleigh: Last year we treated over 2,000 individuals.

Jacqui Kennedy: That is about 10% of our dependent drinkers.

Q247 Rosie Cooper: Okay. Birmingham does not have a problem, then, because you are able to deal with it.

Barry Eveleigh: It has a problem. It is how we deal with it. As I say, the treatment system was in its early stages and we looked at how we could work with individuals and develop our treatment systems so that we had the capacity-

Q248 Rosie Cooper: I am only interested in outcomes. This is all it is for me-outcomes. How many people did you get off alcohol in Birmingham last year?

Barry Eveleigh: It was 575 individuals.

Q249 Rosie Cooper: How many people do you think are alcohol dependent-or more than that-in Birmingham?

Barry Eveleigh: As to alcohol dependents, we have 22,000 individuals.

Jacqui Kennedy: As to harmful and high risk, it is 39,000. We know exactly what our numbers are and we have an incremental plan through some community alcohol partnerships in the local areas, but also some panBirmingham approaches. We are trying to address it neighbourhood upwards and through panBirmingham approaches plus, obviously, we have a whole strategy around domestic violence where alcohol is a big issue for us. We have a whole strategy around the nighttime economy where alcohol is also a big issue. It is pulling all those strands together and this Alcohol Strategy has tried to pull those strands together.

Q250 Chair: Are the 39,000 all named individuals referred into your services? Where does that number come from?

Barry Eveleigh: No. That is using the Department of Health’s alcohol calculator in terms of the numbers we have per head of population within Birmingham.

To come back to your point, the problem we have-and it is outlined in your strategy-is getting people to recognise that they have a problem and want to change their behaviour. That is the issue that we face. As you touched upon earlier, there are issues about the advertising. Whether or not that encourages young people, I think it does act as a trigger for those people who are dependent on alcohol, who have maybe come off alcohol but are exposed to these triggers of alcohol consumption through advertising. That is something we need to look at.

Q251 Barbara Keeley: You have answered some of the points I wanted to make. I do not know how much you heard of the previous panel’s session, but there was a lot said about cultural change, although not many ways offered to achieve it and I think it is very difficult. Could you predict how far down the drinking scale you think you will be able to go? Our brief says that there are 28% of men who drink more than 21 units and 19% of women who drink more than 14, which is the norms, is it not? Do you see the brief intervention strategy being able to get into that? Also, could you touch on-whether it is working through licensing authorities or behavioural aspects-how you are dealing with the problem that we did touch on quite a lot in our session of young people going out and having a massive amount to drink on one night? It is clear to me-and I mentioned it in the last session-that both sporting venues, and clubs and pubs in city centres, go along with this and carry on selling alcohol to people, including young people, who have already had too much. Is that an aspect of what you are doing or do you think the right way to deal with that oneoff or maybe a couple of nights a week of drinking a lot is something you could do through interventions? Or is it both, I suppose, is what I am asking?

Jacqui Kennedy: I will take the licensing bit first. I think it is a whole combination of the toolkit that we use. For instance, as to the nighttime economy in Birmingham, in 2004 Birmingham got a really bad reputation for high crime and high levels of antisocial behaviour, all associated with Broad Street. We put in place-working with the licensing authority, the council and the police-a business improvement district. That has had a massive positive impact, with the venues themselves realising that they can make more money if they do not have 18 to 24yearolds throwing up in the street. That has had a massive impact. We have a business improvement district there for Broad Street, and that gave us a sustainable solution. We now have one for Southside, which is our other main nighttime economy area, and that has had a positive impact.

We also introduced the no-drinking-on-the-streets policy-alcoholrestricted areas-for the whole of the inner ring road for the city of Birmingham. You cannot walk up and down the street carrying or consuming any alcohol. That had an impact as well. We also introduced-although we did get challenged by the Office of Fair Trading on this-"no irresponsible pricing promotions on a Friday and Saturday night". There were venues previously that would offer five double vodkas and a Red Bull for a fiver. We stopped all of that. That was done through a voluntary agreement with the venues in Broad Street and in Southside. We have had some challenges from the Office of Fair Trading that that is anti-competitive but, while it is a voluntary agreement and code, that has really worked for us. It has reduced antisocial behaviour significantly as well as crime and disorder.

In terms of young people pre-loading and coming into the city, that is still an issue for Birmingham as it is elsewhere. I was in Bristol last week and it was exactly the same sort of situation. What we are trying to do there is work with the licensed premises and with the police, and say that if they continue to serve people who are drunk-and it is really difficult because there is no objective definition of "drunk", but if there is drunkenness in the venue-the police or the licensing authority will actually suspend or revoke their licence or limit their times. The problem with that, though, is you now have venues not allowing youngsters to go into their venue at night. They are trailing up and down the street but, because they cannot drink on the street, they are having to go somewhere else. It is a combination of all these things. There is not one silver bullet for the problem of alcohol in Birmingham anyway, so it is the combination.

The other thing we did was a communications campaign about people understanding the potential impact of drinking too much, such as having a pint at 9 pm and then having a pint of blood at 2 am-that sort of thing. We have tried to use the nudge campaigns and the communications campaigns. At the moment we are looking at playing on the vanity-though vanity might be the wrong word-or selfimage of people. There are a lot of calories in alcohol and we do not tell people how many there are. But we have to balance that. You do not want to make people become anorexic, so it is about getting that balance. We are looking at that as well.

We have tried to combine all the tools that are made available to the local authority and to the police. The police use a campaign where they do an early intervention if there is any sort of rowdiness, lairyness or antisocial behaviour. A yellow card is issued, using the football term, and then people get banned from the area if they continue to behave badly. That early intervention has improved the general offer. The other thing about the business improvement district is that we have now changed the age profile by promoting the ICC. I think that there is something about people from the age of youngsters right the way through to older people mixing together in the street which dilutes some of that bad behaviour as well. So, again, we have looked at the marketing mix, particularly in the city centre, but also in some of the suburbs that are growing now into nighttime economy areas.

Q252 Barbara Keeley: Does it cover your major sporting venues, football grounds and cricket grounds?

Jacqui Kennedy: Yes.

Q253 Barbara Keeley: There is a huge amount of drunkenness at football grounds.

Jacqui Kennedy: Yes. In the football grounds, and certainly Villa Park, which is my team-not that I am biased in any way, and we are still looking for a manager if anybody is interested-I know, because I am a season ticket holder, that there is occasional drunkenness but the stewards are brilliant and we work, as a licensing authority, tightly with them. I was interested to hear the comments about the cricket. I do not know what it is like at Warwickshire, so I am going to have a little visit and see how it is there. But we are very strict as a licensing authority. We have a group of elected members responsible for each of the sports grounds to make sure they comply with licensing.

Q254 Barbara Keeley: It tends to be test matches, in my experience.

Valerie Vaz: In which case you want to go to Edgbaston.

Jacqui Kennedy: I need to go to Edgbaston, yes. That was my bit.

Barry Eveleigh: From the health aspect, we are looking at various ways to try to communicate messages to individuals because not everybody wants to go to a treatment service where they are seen as perhaps being alcoholics or alcohol dependent. There is a variety of different initiatives. Sporting venues is one, in terms of putting messages out-advertising drug and alcohol services-that people can just see. Something printed on the back of a ticket is an idea of some of the campaigns that we have had. We have recently launched, in conjunction with the city council, a website called "MyLife4Me" where people can access a range of health information. In addition to that, they can also undertake their own health assessment to see whether they have some form of alcohol and drug dependency. Then there is a further IT package where they can start to undertake their own recovery, to try and cut down on their drinking or drug taking behaviour through a package that is called "Breaking Free Online".

Jacqui Kennedy: One of the other points is, obviously, with the demographic of Birmingham there are a lot of people who do not want to go for a night out clubbing, or where there is alcohol anyway. So Barry and I have recently met to talk about the possibility of trying to get somebody from the trade to open up an alcoholfree venue in the city. We think in Birmingham there would be quite a lot of demand for that because not everybody wants alcohol. We are looking at seeing how we can court our trade representative colleagues to see if somebody would like to try investing in that. I know there is such a venue in Merseyside.

Q255 Chair: You referred to a yellow and red card system and said that a particular individual with a bad behaviour record would be excluded from a part of the city. I think that is what you said.

Jacqui Kennedy: Yes.

Q256 Chair: What is the legal basis of that? That must be quite difficult to enforce.

Jacqui Kennedy: No. It is really straightforward. It is basically a dispersal order that is already a tool in the police’s toolkit if somebody is causing a problem. They are only sent away for 24 hours. It is not something like a drink banning order. It is only if they go a bit too far in terms of the night out. I do not think we have had to issue any for quite a long time. There is a whole selfregulation aspect to the nighttime economy as well in terms of if it is feeling nice it dilutes that behaviour. So we have had some positive moves, although recently there has been a creeping in, because of the financial situation, of some venues dropping their alcohol prices. We want to nip that in the bud quickly. We will use all our powers as a licensing authority to challenge that because that does undermine the licensing objective.

Q257 Chair: Are you acting within your powers to enforce what is effectively a minimum pricing policy through the licensing system?

Jacqui Kennedy: We have not been legally challenged on it yet, but I have been threatened with it several times. I am anticipating that and then we will have to revisit it, but at the moment it is a voluntary code among the businesses. For the businesses-certainly in Broad Street and Southside-commercially it is more beneficial to them to have people paying full price rather than "buy one get seven free".

Q258 Chair: But presumably, in dealing with the business community, you will get many who will buy into your responsibility message and then you will get the maverick that sees an opportunity in not buying into it.

Jacqui Kennedy: Most of them are in the business improvement district and there is an element of peer and selfregulation. If you are a member of the business improvement district, there is a duty to the board.

Q259 Chair: It becomes part of the contract between the operator and the business improvement district programme.

Jacqui Kennedy: Yes.

Q260 Chair: What incentives can you offer through the business improvement district programme?

Jacqui Kennedy: Being a member of the BID in terms of the communications is one thing. Our BID in Broad Street, for instance, offers things like environmental improvement and street cleaning-all the environmental factors to make the area a nice place to be. Those would be the sorts of things that the BID might withdraw. The other issue is that we are very hot on any data associated with any spikes in crime, disorder or antisocial behaviour, which then would potentially, if that was allocated to that venue, take them straight in for a licensing review anyway.

Q261 Dr Poulter: In terms of working with many of the bars in the city centre, as well as dealing with irresponsible behaviour towards the sale of alcohol, there is an issue about encouraging people in some cases to choose soft drinks or incentivising those people perhaps who drive or who use their car. In parts of America it does quite well, I understand. They incentivise people to have soft drinks in restaurants and bars. Have you looked into this? If you have, have you found any appetite for that from the bars and clubs in the town centre?

Jacqui Kennedy: We operate Best Bar None. You get extra points if you have a policy as to the Best Bar None scheme, so they get accredited and potentially appear high up the scoring level. We do that. We do encourage designated driver status. That has been piloted-we have tested that-but we have not evaluated any outcomes yet. I think that is exactly what we should be doing because, at the moment, being nearly always the designated driver when I go out with my husband, it costs nearly as much to buy me an orange juice and bitter lemon as it would cost to buy me a pint of lager. It is something that we have not sorted yet in Birmingham, but we are looking at it.

Q262 Dr Poulter: That is good because it is not just orange juice but other soft drinks, for example, which I know have a huge markup in many bars. Nevertheless, young people-who we are aware we are dealing with here-sometimes, to make the alcohol palatable, will have Coke or something else in their drink. But this is something you think can be positively looked into, can be further developed and would be a good thing to do, not only in Birmingham but elsewhere.

Jacqui Kennedy: I think it would be a very good thing to do. The other thing we need to do is enforce more licensed venues to offer tap water. That was a big issue for us as to the nightclubs where they turned off the tap water. We used our health and safety powers and closed them down, or threatened them with closure, because they were saying that you had to buy your drink and you could not drink out of the tap. Our water is from Severn Trent and it is fantastic. It is better than some bottled water. It was a whole issue, but that is the sort of thing that needs to be dealt with. There are lots of tools and powers available to local authorities and to the police that need to be used efficiently. I think we are moving in the right direction in Birmingham.

Q263 Chair: You have obviously been working on this for some years in Birmingham and you would have been aware that the Government was developing its own Alcohol Strategy and Responsibility Deal and so forth. Were there things that you were looking for in that Strategy before it came out that were not there when it did come out?

Jacqui Kennedy: No, because we have fed in on every stage of the consultation. We were quite pleased with the content of the strategy when it came out and we have tried to take it to a local level. We have followed the national strategy rather than trying to create something different.

Q264 Chair: In terms of the role of the pubs and the clubs and the private sector in supporting your strategy, are you asking them to do things that they demur from?

Jacqui Kennedy: We have-and I do not know if we are just really lucky-a very responsive licensed trade in Birmingham. They have been very responsive and have worked collaboratively with us on most things. But the business improvement district is the model, I think, that has delivered on that because the businesses themselves can see the commercial benefit, plus the conversations that we have. Public health moving to the local authority is going to be a positive thing. In Birmingham we have worked very much as, "It is business as usual", but working even more closely with public health colleagues will be very positive.

Barry Eveleigh: To expand on that one, we are about to launch a scheme called Community Health Champions, which is basically recruiting individuals from their local communities and training them up on various public health messages, not only alcohol but smoking and sexual health. They will be going into bars and clubs to give people the sort of information that they need. You talked about the idea of soft drinks. What we will be doing within this is trying to get through the message that if people drink water regularly throughout their evening’s entertainment, they probably will not wake up with a headache in the morning. It might possibly have an impact on crime reduction, in terms of people going a bit over the top, ending up in a fight and then in the cells.

Q265 Chair: We finished up in the discussion with the last panel talking about the target of reduced sale of units of alcohol over a period and it appeared that the national target was a 2% reduction in units of alcohol sold between now and 2015. How do you react to that?

Barry Eveleigh: I think it is a good start. The figure of 2% sounds small, but the impact of 1 billion units on somebody’s liver across the nation is going to have some impact-

Q266 Chair: On one person’s liver it would have quite a significant impact.

Barry Eveleigh: Yes, it would have a huge impact. It is about how we get that message across. The previous speakers talked about low alcohol and how that is advertised. If it is done effectively, you can achieve great success. For example, in Coventry, in a pub that I drink in, which is a bikers’ pub, they have a lowalcohol real ale. For bikers to drink lowalcohol real ale is quite an interesting idea. With this product that is a real ale that has bike promotions behind it, rather than if you were to have Kaliber on the shelf, people do not lose their cool. It is about how you sell those products to enable people to reduce their alcohol consumption.

Jacqui Kennedy: One of the things that somebody suggested there, which I have written down to take back-because we do environmental health as well-is the idea that the house wine should be a lower percentage. I tend to order a bottle of house wine and it would not occur to me to check the percentage. If we can encourage some of our restaurants to offer that, it would be a positive thing, so I have learned something.

Q267 Chair: I know you will not have had that conversation yet, but what do you anticipate will be the reaction?

Jacqui Kennedy: I think it will be positive. Again, a lot of our restaurants are looking at the health, nutrition and obesity agenda. We are working on healthy offers in takeaways. That sounds like a contradiction, but we are looking at how we can do that. I am thinking of a whole batch of restaurants that we are working with at the moment as to the nutrition, health and obesity agenda that I am confident would sign up for that virtually straightaway.

Q268 Valerie Vaz: I want to follow up on that. Is your strategy primarily a health one as opposed to a crime and disorder one?

Barry Eveleigh: No. Our strategy, as we alluded to earlier, is a holistic approach that covers all areas that, basically, is a replication of the national strategy. There is no one approach to this. We are dealing with complex human behaviour and, therefore, you need a range of interventions from an enforcement level to a public health message.

Q269 Valerie Vaz: Which Department would you think it should sit in?

Jacqui Kennedy: We think we should sit in partnership and it should-

Q270 Valerie Vaz: I mean a national Department. Should it be the Home Office, the Department of Health, or-

Jacqui Kennedy: With all due respect, it has to be everybody. If I look at my day job, I have licensing, which sits with the DCMS; crime and disorder which sits with the Home Office; health which sits with the Department of Health; and I am tackling underage drinkers which sits with the young people’s Department. I cannot compartmentalise my job into Government Departments and my service is not broken up into services. You have to take it as holistic. You might have a lead, so in our partnership, the local authority is the accountable body for the community safety partnership and Health and Wellbeing Board, but you need to have all partners. Even DEFRA has a role because of rubbish, recycling and litter-alcohol litter. I think it has to be across all-

Q271 Valerie Vaz: It is a Cabinet Office-type role.

Jacqui Kennedy: I think so, yes.

Q272 Valerie Vaz: I was not quite clear.

Can you quickly-and we might be changing tack slightly-tell us what your view is on a minimum alcohol pricing level?

Barry Eveleigh: It is something that we support. The early indications from Scotland are that it is starting to have an impact in terms of the sales of alcohol. I think we have to be cautious in light of recent reports that have shown an increase in counterfeit alcohol being sold. In the past two years there has been a fivefold increase. We have to be very careful if you push the price of alcohol up that there is not a shift-especially when we are talking about young people-and you do not move then to consumption of drugs, especially with the advent of legal highs. It is a good idea, but we need to keep our ears to the ground in case something happens.

Jacqui Kennedy: Certainly, with my trading standards hat on, we have seized a lot of counterfeit spirits, but we have also seized a lot of lowstandard noncounterfeit spirits. They have just used a different name, so it is not Vladivar but it is called Vladi or something like that. It is not counterfeit, but it is pure, badlyconstructed vodka.

Chair: There is historical precedent for that.

Q273 Barbara Keeley: I have to say that it sounds as if you are doing a really good job. At a time of council budget cuts, are you having to justify the funding of your posts, if you like, and whoever else works with you on the things you have talked about? Is it financially costeffective or is there some goal, over a number of years, that it will become so? What sort of measures are you looking at, in health or police and antisocial behaviour, to assess the outcomes of the work you are doing?

Jacqui Kennedy: In terms of funding for the local authority, this is our day job. It is linked into licensing, trading standards and environmental health. It is the day job. It is not a speciallyfunded activity.

Q274 Barbara Keeley: But other authorities are not doing what you are doing. That is all I am thinking. There must be some extra expenditure on it because other authorities are not doing it. Setting up a business improvement district must take some doing.

Jacqui Kennedy: That was pump-primed by our city centre partnership, and as part of the development offer-so building employment and jobs-they funded the ballot for the business improvement districts. They now have not only those in the city centre; I think we have 11 in different parts of the city. They are sustainable and are all funded through the BID levy. My job is the day job and I happen to have the council lead on alcohol, so there are no issues about savings there in terms of the DAAT.

Barry Eveleigh: In terms of the DAAT business, at the end of the day this is public money. What we have to do is to demonstrate that we are using that money effectively and that it is achieving something in terms of what is actually happening. We have been working over the last number of years to look at it not only in terms of the number of people that we see, but what we do with those individuals. We have been working in terms of outcome measurements, looking at where it goes with the drugs PbR and trying to continue that justification of what it actually achieves.

Jacqui Kennedy: In terms of what we set ourselves in our strategy, we are looking to stabilise the rate of alcoholrelated hospital admissions by reducing the rate of increase by 2% year on year. We have said we are going to reduce alcoholrelated crime and disorder by 10% by the end of the strategy period, and we are looking at reducing the months of life lost due to alcohol by 10% by the end of the strategy period.

Q275 Barbara Keeley: Are you trending okay on that? Are you starting to meet that?

Jacqui Kennedy: We are just kicking off. This is a new strategy, but the trajectory is positive so far. We still have increases. Our old strategy had measurements as to A and E admissions. We think that these indicators and outcome measures are far more outcomefocused and holistic than output statistics.

Q276 Chair: You plan on monitoring them realtime, not waiting till 2015 to see if you have it right.

Jacqui Kennedy: No. We are monitoring in realtime through the Health and Wellbeing Board and through the community safety partnership.

Barry Eveleigh: We are looking at sixmonthly reviews from creation of the strategy, and then a lower level with the providers, on a monthly and quarterly basis.

Q277 Valerie Vaz: Can I quickly ask about A and E? Do you have anybody from your strategy team there, like alcoholic nurses or-

Barry Eveleigh: Yes. What we actually have within the city-

Chair: Alcohol service nurses, I think, was what you meant.

Valerie Vaz: That was what I meant.

Barry Eveleigh: This is where, to an extent, we were some way ahead of the game. We developed a service called RAID-Rapid Assessment Intervention Discharge services. They are based across the four PCTs within the city so that anybody admitted with some sort of alcoholrelated illness is seen, assessed and referred to appropriate treatment teams. If their alcohol dependency is quite severe and they are going into withdrawal in hospital, that team then automatically works with the consultants to start the detox within the hospital. But then, to prevent bed blocking, they are transferred back into the community where the detox is continued and then there is an aftercare package in place.

Q278 Dr Wollaston: Can I clarify a point that Rosie made earlier? If you are a GP in Birmingham and you refer somebody for alcohol treatment-not brief intervention, but for alcohol treatment-there is no waiting list in Birmingham.

Barry Eveleigh: No.

Q279 Dr Wollaston: What about for selfreferrals, though? Would that be the same?

Barry Eveleigh: There are no waiting times at the moment.

Q280 Dr Wollaston: That is quite remarkable. Also, touching on health, the Government are consulting on allowing licensing authorities to take healthrelated harms into account when making decisions on licences. Do you support that move? Secondly, what effect do you feel the number or density of licensed premises in an area has on healthrelated harms within Birmingham?

Barry Eveleigh: Okay.

Jacqui Kennedy: I will help.

Barry Eveleigh: In terms of bringing in health for this, it is a good move because it has been sliced out of the equation in terms of a valuable input that can say, "We think there should be some restriction in terms of what is going on in these areas because we are constantly getting people brought through who have been assaulted. They are coming through with various alcohol problems and they are creating a nuisance." I think it takes it back to that. In terms of density, it is an interesting one, and I am not quite sure how that one plays out. I would look to Jacqui on that one.

Q281 Dr Wollaston: Alcohol Concern has produced a paper on this and I wondered if that is your experience, and whether you would agree with its work on this.

Jacqui Kennedy: In terms of the paper you are referring to, I do not know exactly what it contains, but, as a licensing authority, we need to be clear. It is easy for the police to bring up a review of the licence because they can say they have had 10 assaults or drunkenness or whatever. It is more difficult than that. There will be parts of the city where we have community alcohol partnerships in place and where I think health representations around more venues or more licensed premises in those areas may have an impact. One of the areas we talked about was Moseley, which has a street-drinking issue, and it has recently been awarded some funding from Baroness Newlove’s pot to tackle that issue. There is a whole question mark there, from the health impact view, about opening another licensed venue in that area and would that have a disproportionate impact or tip it over the edge. We are not absolutely sure how it is going to play out yet. I need to acquaint myself with the Alcohol Concern document.

Q282 Dr Wollaston: Finally, returning to the issue of minimum pricing, the Birmingham strategy is supporting minimum pricing, as you pointed out, and the Core Cities Health Improvement Collaborative has called for a 50p minimum price. Are you going to be lobbying now for the minimum price to be set at 50p or, referring back to the evidence you gave earlier, do you think that is going to be too high? What would be your view?

Jacqui Kennedy: We have recently changed the city council so we have to get a political mandate for how much further we take it in terms of lobbying. But any issue as to minimum pricing, we think, is a positive thing. As to what the level should be, we are not sure.

Q283 Rosie Cooper: Are alcoholrelated deaths in Birmingham going up or down?

Barry Eveleigh: For males it is not as high as females.

Jacqui Kennedy: Is it increasing or decreasing is the question, I think.

Q284 Rosie Cooper: Is it increasing or decreasing?

Jacqui Kennedy: We have it here, I think.

Barry Eveleigh: It is still on the increase.

Q285 Rosie Cooper: It is still on the increase.

Barry Eveleigh: Yes.

Q286 Rosie Cooper: You do not have a waiting list for treatment.

Barry Eveleigh: No.

Q287 Rosie Cooper: So is the increase in deaths due to the failure of that which you say is your treatment?

Barry Eveleigh: No.

Jacqui Kennedy: No. We think it is because people do not realise that they have an alcohol problem and that is resulting in them dying.

Q288 Rosie Cooper: People do not realise they have an alcohol problem. So should you be concentrating more on making them aware than on treatment, because you have no waiting lists? What can you do? What intervention will stop alcoholrelated deaths increasing? That is what you are about.

Barry Eveleigh: Sure.

Q289 Rosie Cooper: So if you have no waiting list and no obvious problem with time, money, facilities, capabilities or volume-however you want to describe it, you have no problems with any of those-but deaths are still increasing, where are you targeting?

Barry Eveleigh: We are pretty much targeting everywhere. It comes back to the old-

Q290 Rosie Cooper: You are targeting everywhere. That is a misnomer, is it not?

Barry Eveleigh: We are trying to target everywhere-GP practices, colleges and universities where there is that problematic drinking in freshers’ week. The first thing people want to do when they go into university is make sure that they go out and party. We are trying to work within the local delivery groups and to work with communities-anywhere that we can get out that message-whether that is through treatment services or-

Q291 Rosie Cooper: But that is my point. You obviously cannot be reaching the parts that you say you need to reach because, if you were, alcoholrelated deaths and illnesses would not be increasing.

Barry Eveleigh: The phrase is that you can take a horse to water but you cannot make it drink. It is about getting the message through to individuals that they are causing damage to their bodies. Whether they decide to act upon that information is their own choice at the end of the day. That is why the Government strategy is quite important. For some individuals, we need to coerce them into treatment, as has happened within the drugs criminal justice service. Some people do not consider themselves to have an offending problem-a drug problem-but once they go through that legal system and they have to go to treatment, the penny sooner or later drops.

Q292 Rosie Cooper: But a lot of people are escaping all of you because they are dying.

Jacqui Kennedy: Yes, but there is a whole intergenerational step change that we are trying to make. We have an increase in young people not drinking, which is positive, but we cannot pull back from what has gone 20 years ahead of us. A lot of our people who are dying are dying not at 20, 21 or 30, but they are older people dying as a result of a lifetime of hazardous drinking. We are making that change, but it is an intergenerational thing and it is not something that we are going to be able to do in three years.

Q293 Rosie Cooper: So you are concentrating on young people and the older ones are just going to die off.

Barry Eveleigh: No. We try to go right the way across the board. It is the prevention of young people from going on to develop liver disease and working with those people who are also on the verge of liver disease and doing something with them. What we have to accept is the reality for some individuals who have chronic liver disease and are going to die; it is not going to change their drinking behaviours.

Rosie Cooper: Fine. Thank you.

Q294 Barbara Keeley: Could I ask a point of information? Is it like smoking? If people stop or really cut back, do things return to normal, or is there likely to be a lag in the results in that if you have done the damage you have done the damage?

Jacqui Kennedy: I am not a medic. If Jim McManus-our public health man-was here he would say there is a point where the damage is already so far-

Barbara Keeley: It is understandable that there is a substantial lag in figures, but I do not even know if-

Rosie Cooper: Professor Gilmore said that you cannot predict who will recover and those who will go on to suffer irreparable harm.

Q295 Barbara Keeley: But there are some points where, if people stop now, they can-

Jacqui Kennedy: Yes.

Barry Eveleigh: Yes.

Jacqui Kennedy: Our hospitals put interventions in place. Ward D15-I do not know what it is called-in the city hospital put an intervention in place if somebody is admitted with chronic liver disease.

Chair: That probably takes it about as far as it can. Thank you very much for coming to give evidence. I have been enjoying the irony, during the course of this morning’s session about the problems of alcoholrelated disease, that we sit taking this evidence under a portrait of Pitt the Younger who died of an alcoholrelated disease at the age of 46.