Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd
Health, Social Care and Sport Committee - Fifth Senedd13/12/2017
Aelodau'r Pwyllgor a oedd yn bresennol
Committee Members in Attendance
|Angela Burns AC|
|Caroline Jones AC|
|Dai Lloyd AC|
|Dawn Bowden AC|
|Jayne Bryant AC|
|Julie Morgan AC|
|Rhun ap Iorwerth AC|
Y rhai eraill a oedd yn bresennol
Others in Attendance
|Andrew Misell||Alcohol Concern Cymru|
|Alcohol Concern Cymru|
|David Emery||Byddin yr Iachawdwriaeth|
|Dr Richard Piper||Alcohol Research UK|
|Alcohol Research UK|
|Lynden Gibbs||Byddin yr Iachawdwriaeth|
|Tim Ruscoe||Barnardo’s Cymru|
Swyddogion y Senedd a oedd yn bresennol
Senedd Officials in Attendance
|Sian Giddins||Dirprwy Glerc|
Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle y mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.
The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.
Dechreuodd y cyfarfod am 09:30.
The meeting began at 09:30.
Bore da i chi gyd a chroeso i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yng Nghynulliad Cenedlaethol Cymru. Fe wnaf i estyn y croeso, yn y lle cyntaf, i fy nghyd-Aelodau, a datgan ein bod ni wedi derbyn ymddiheuriadau oddi wrth Lynne Neagle y bore yma ac nid oes neb yn dirprwyo yn ei lle.
Fe allaf bellach egluro bod y cyfarfod yma’n ddwyieithog; gellid defnyddio’r clustffonau i glywed cyfieithu ar y pryd o’r Gymraeg i’r Saesneg ar sianel 1 neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. A allaf atgoffa pobl naill ai i ddiffodd eu ffonau symudol ac unrhyw gyfarpar electronig arall neu eu rhoi ar y dewis tawel, a hysbysu pobl y dylid dilyn cyfarwyddiadau’r tywyswyr os bydd larwm tân yn canu? Bydd y meicroffonau’n gweithio, hefyd, yn awtomatig pan fyddwch chi’n siarad; nid oes angen cyffwrdd ag unrhyw fotwm.
Good morning and a warm welcome to this latest meeting of the Health, Social Care and Sport Committee here at the National Assembly for Wales. I'll first of all welcome my fellow Members, and explain that we've received apologies from Lynne Neagle this morning and that we have no substitute for her.
May I further explain that this meeting will be held bilingually? Headphones are available for simultaneous interpretation from Welsh to English on channel 1 or for amplification on channel 2. May I remind everyone to either switch off their mobile phones or any other electronic equipment they may have or to turn them to silent, and also tell you that, in the event of a fire alarm, you should follow the directions of the ushers? The microphones will work automatically when you speak, so you won't need to touch any of the buttons.
Felly, symudwn ymlaen i eitem 2 ar agenda'r bore yma, a pharhau â'r craffu ar Fil Iechyd y Cyhoedd (Isafbris am Alcohol) (Cymru). Dyma ydy sesiwn dystiolaeth Rhif 6, ac o'n blaenau, am y sesiwn gyntaf y bore yma, mae cynrychiolwyr o Alcohol Concern Cymru. Yn benodol, felly, mae'n bleser croesawu Dr Richard Piper, prif weithredwr Alcohol Research UK, a hefyd Andrew Misell, cyfarwyddwr Alcohol Concern Cymru. Croeso i chi'ch dau.
Rydym wedi derbyn eich tystiolaeth ysgrifenedig ymlaen llaw ac, yn naturiol, mae Aelodau wedi ei darllen mewn manylder. Felly, gyda’ch caniatâd, fel sydd yn draddodiadol, awn ni’n syth i mewn i gwestiynau, ac mae’r cwestiynau cyntaf o dan ofal Caroline Jones.
So, moving on to item 2 on this morning's agenda, which is the ongoing scrutiny of the Public Health (Minimum Price for Alcohol) (Wales) Bill. This is evidence session No. 6, and joining us for this morning's first session are representatives of Alcohol Concern Cymru. It's a pleasure to welcome Dr Richard Piper, chief executive of Alcohol Research UK, and also Andrew Misell, director of Alcohol Concern Cymru. A very warm welcome to you both.
We have received your written evidence, and, naturally, Members will have read that in detail. So, with your permission, as is our habit, we will move immediately to questions, and the first questions are from Caroline Jones.
Diolch, Cadeirydd. Good morning. Bore da.
Minimum unit pricing aims to reduce alcohol consumption among hazardous and harmful drinkers. What do we mean by 'a hazardous and harmful drinker', and is it clear who the Bill is targeted at?
I think there's been quite a lot of ambiguity about who this measure is targeted at over a number of years. I think there are some quite distinct groups of drinkers that we can roughly divide the drinking population up into. If we start at the very sharp end, we have the dependent drinkers—what some people would call alcoholics, so people who are physiologically dependent on alcohol: they need to drink every day. Now, they have a certain amount of flexibility in how much they can drink, but only up to a point. So, this measure is likely to reduce their consumption, but it will not halt their consumption, and so we would certainly make the case for services to help them to exit that drinking life.
But there is this big group in the middle of people who are drinking either too much or far too much but who are not physiologically dependent on alcohol and who are in a position to moderate their consumption. I think that's where we're going to see the big impact.
Okay, thank you. I'll go on to my next question, then. We've heard, in the committee, that overall alcohol consumption has reduced in recent years, but not among hazardous and harmful drinkers. So, what do we understand about heavy drinkers' purchasing and consumption behaviour? How significant a factor is the price of alcohol? Is it likely that these drinkers will reduce consumption if minimum pricing is introduced, as predicted by the Sheffield model?
I think we've seen parts of the world—Russia and Canada—where wherever price goes up, consumption goes down. So, like any other commodity, alcohol is price sensitive. So, I think the first thing to say is that we do expect minimum unit pricing to lead to a reduction in drinking levels, and, in particular, in drinking the number of units. So, somebody might be drinking the same quantity of liquid, but what they're ingesting is less alcohol. It's really, really important to think of this measure as a population-wide measure. There are a certain amount of alcohol units awash in people's bodies and this will reduce that amount of alcohol in people's bodies, over the long term, and that will lead to significant health benefits.
We're saying about reducing the alcohol consumption, but will it reduce the alcohol consumption in the people it is aimed at?
Yes, it will.
You think so. Okay, thank you. And my next question is: what health and other outcomes do you believe will result from the introduction of the minimum price policy proposed in the Bill? And do you agree with the estimated impacts set out in the explanatory memorandum?
Yes, we'd agree with those, and I think the Sheffield model's relatively clear. This is absolutely a health measure. Alcohol is a wide-ranging issue that affects community life, social life, violence et cetera, but this is really about health. What we know is that alcohol units over time massively increase the risk factors in relation to cancer and in relation to a range of liver diseases. So, this measure will, for those drinkers who are drinking the cheapest, strongest alcohol and are choosing that because that's the situation they're in—it will lead to health benefits for them, and we have no doubts that those models make sense.
Okay, thank you. Diolch.
Caroline, there's a supplementary to question 1, which we'd like to pursue, if you—
Yes, if nobody else wants to ask that. Alcohol Concern Cymru's paper states that 'there is little or no demand' for the drinks that will be most affected by minimum unit pricing, apart from among dependent drinkers. So, does this suggest that the Bill may have a greater impact on people who are dependent on alcohol? Can you comment further on this question, please?
I think it will at the very cheapest end. The particular drinks we're talking about there are the white ciders. For historic reasons, ciders are the cheapest form of alcohol. There have been two studies done, one in Scotland, one in London, showing that there is next to no market outside of the alcohol-dependent drinkers for these ciders. There's going to be a very definite impact on dependent drinkers.
If you think about a cider like Frosty Jack's, the price would, in theory, go up from something like £4 for 3 litres to over £11. I think we—and I'm sure other people have said this in this committee—need to be certain that there are very robust arrangements in place to help people who are in a very difficult situation to exit that drinking life. It's not a life they've particularly chosen. Certainly, in my experience, it's not a life they enjoy. There is a willingness, a determination on some parts, to really get out of that life, and so when it comes to your white cider drinkers, the people who are drinking the very cheap stuff, this minimum price measure is only half of the equation.
Can I just make one brief further point on that? So, our point there specifically is about that particular type of drink. There are other drinks that will be affected that aren't those chosen by dependent drinkers. So, I wouldn't want our paper to lead to the wrong impression. But that specific type of drink is primarily drunk by dependent drinkers. Other drinks, vodka particularly, are drunk by many harmful, hazardous drinkers who wouldn't see themselves as dependent. Both groups will benefit from this Bill.
Angela, did you want come in here?
Well, actually, you've just mentioned something I was going to touch on. If you were to, for example, buy two—I don't know, is it bottles or cans of Frosty Jack's?
Three-litre bottles, unfortunately.
All right. So, that would then be £22. If a bottle of vodka then became £20 because of the MUP. Would you get more bang for your money if you were to have the bottle of vodka or the bottle of cider, because what I wonder is if they'll just say, 'Oh well, instead of buying the two, we'll buy that one' but, actually, it's going to be more harmful because of the strength of the vodka. I don't know. Is vodka stronger, for example, than a white cider? So, are we then pushing them, because of economics, onto stronger drinks?
Well, I think we're saying it's stronger because it's got more units of alcohol in it. This measure is absolutely about making drinks priced per unit. Therefore, the Frosty Jack's will now be 22 units and the vodka will be 20 units—yes, the vodka would have more alcohol in it, but it may be slightly more expensive. That's up to the manufacturers. 'Reformulation' is a word that comes around a lot. Reformulation is where manufacturers decide to change their products. So, it may well be that Frosty Jack's decide, 'No, we like that £3.50 price point', and what they may well do is reduce the amount of alcohol in the product. And that is one of the likely and intended, hoped-for, consequences of this Bill—to reduce the strength. People will be drinking the same quantity of liquid but doing less harm to themselves.
Yes. Thank you.
Okay. Moving on—Julie.
On the same sort of theme about substitution, do you think there is any chance that people will go on to illegal drugs?
My understanding from the field is that there is a danger, there's always a danger at the periphery of any measure that all sorts of things will happen, but this has been overplayed. There's nothing that necessarily drives a drinker towards another drink. They're in a drinking habit. Alcohol has been their substance. Other substances don't necessarily give you the same effect, it doesn't last for the same time, the price is different, and the social structures around use are different. And I think one of the very interesting things that came up in the research that's been done in Edinburgh is that we're talking about drinkers' self-concept—the way they think about themselves—and in order to move to another substance, be it, say, industrial alcohol or another drug, you have to start thinking about yourself differently and be willing to do that. And also, you have to be willing, in most cases, to enter the illegal market, which is a bold move that not everyone's willing to take. Similarly, a lot of drinkers, although they might tell you that they would start stealing, they don't actually have the drive to steal because it's so different from what they do at the moment, which is a harmful but entirely legal lifestyle.
The other point, I suppose, is about longevity. This is a measure that has long-term effects. Someone who is drinking five, 10 fewer units a week because of this measure may well be seeing those effects over 20 years. For someone to counteract that benefit, they're going to have to be stealing successfully for 20 years. We think that's very unlikely. So, although a few people may decide to seek out illicit drugs, and a few people may choose to try and find a way round the measure, the vast majority of people will benefit. We would argue strongly that denying the benefits to the majority because of loopholes that minorities may find ways round this would be a mistaken route to go down.
Thank you. And you've already mentioned the importance of other services—support services and treatment services. How adequate are those services now and do you think more should be put in jointly with this being introduced?
Everyone wants more money, don't they? Everyone wants more money for their field, but then we also know that the Welsh Government is short of money. You would have to ask alcohol services on the ground and they'd probably tell you that they'd like more investment. I think there's always room to do more. There is room for new approaches as well. We've been running our own assertive outreach project for a while to do with engaging with drinkers who are drinking very heavily, but are not engaged in alcohol services, and trying to bring them into alcohol services more systematically, rather than them simply accessing care on a rather chaotic basis, generally via the emergency services. So, there's always more that can be done, I think.
My understanding is that the situation in Wales is better than UK-wide. UK-wide, one in six people who require treatment get it, the other five in six don't. The situation in Wales is better than that, so well done.
Are there any figures for Wales?
I don't have the figures.
I don't have the figures either.
But we'll get them.
If you do them, it would be useful. If we know that it's one in six in England, it would be good to know what the actual—
It's one in six UK-wide, but, yes—.
The other thing to say is that we have innovated quite successfully in relation to a project known as Blue Light, which involves the most chaotic, the most difficult drinkers—those who are involved in emergency services consistently are very, very costly drinkers. What we've learnt from that is that nobody is beyond help. Everybody can be supported and helped, and I think it's a really important social concept, really, that we can't and we don't need to write anybody off, and I think that's an important point to make.
Ocê, symudwn ymlaen ac mae amser yn pwyso. Rhun.
Okay, moving on and time is against us. Rhun.
I aros yn yr un maes, mewn difrif, a oes angen camau i gyd-fynd â'r Bil yma er mwyn cydnabod y newid, o bosib, sydd ei angen mewn gwasanaethau—cynnig rhagor o fynediad i bobl i wasanaethau alcohol ac ati—neu rywbeth ar wyneb y Bil hyd yn oed?
Staying in the same area, if truth be told, do we need to take steps to run in parallel with this Bill in order to recognise the changes, perhaps, that may be required in services—providing greater access to alcohol services and so on—or something on the face of the Bill even?
Nid wyf yn siŵr a ydy e'n rhywbeth y buaswn ni eisiau ei gynnwys o fewn y Bil; dim deddfwriaeth yw'r ffordd orau i wneud popeth. Ond yn sicr, i gyd-fynd â'r Mesur yma, mae eisiau, fel rwyf wedi dweud, cydnabyddiaeth bod angen rhyw allanfa i bobl. Maen nhw'n byw bywyd nad ydyn nhw'n ei fwynhau, nad ydyn nhw, fel arfer, wedi ei ddewis, ac mae eisiau inni wneud yn siŵr bod y gwasanaethau yna ar gael, fel mae Richard wedi dweud, hyd yn oed ar gyfer y bobl sy'n amharod iawn i geisio cymorth. Mae eisiau inni fynd â'r cymorth atyn nhw.
I'm not sure whether it's something that we would want to include within the Bill; legislation isn't the best way to achieve everything. But certainly, in parallel with this Bill, as I've said, we need some acknowledgement that we need some kind of way out for people. They're living lifestyles that they don't enjoy and that they haven't usually opted for, and we have to make sure that those services are available, as Richard has said, even for those people who are most unwilling to seek help and support. We have to take the support to them.
A oes yna ddigon o asesu wedi ei wneud o beth fydd effaith cyflwyno deddfwriaeth fel hyn ar bobl sy'n yfed yn beryglus neu bobl sy'n ddibynnol, a'r angen wedyn i gyflwyno camau gan Lywodraeth er mwyn helpu'r rheini?
Has there been sufficient assessment carried out of the impact of introducing legislation such as this on those who are drinking at dangerous or hazardous levels or are even dependent, and the need then to introduce steps by Government to assist those people?
Gan fod hwn yn fesur newydd—nid oes un wlad ar wahân i Gymru a'r Alban wedi gwneud yr union un peth yma—mae wastad rhyw elfen o ddyfalu o ran beth ddigwyddiff. Mae yna ychydig o astudiaethaethau wedi bod o ran beth sy'n digwydd i ymddygiad pobl sy'n ddibynnol ar alcohol pan fo rhywbeth yn digwydd i leihau faint maen nhw'n gallu ei gael, ond, yn sicr, mae angen mwy. Bydd eisiau i ni ddysgu, ac rydw i'n meddwl y bydd eisiau i ni ddysgu'n gyflym. Bydd eisiau i ni baratoi, ac wedyn, wrth i'r Mesur fynd ymlaen—a dyma lle yr ydym yn gweld ein lle ni fel sefydliad, fel elsuen—mynd allan i'r maes a gweld beth sy'n digwydd ar lawr gwlad a sut mae angen i bethau newid.
As this is a new Bill—no other country apart from Scotland and Wales have done this exact same thing—there's always an element of guesswork as regards the outcome. There are a few studies that have been undertaken as regards alcohol-dependent people's behaviour when something happens that reduces the amount of alcohol they have access to, but, certainly, more are needed. We need to learn, and I think we have to learn fast. We'll have to prepare and then, as the Bill goes on its journey—and this is where we see our role as a charity—go out into the field and see what's actually happening at the grass roots and how things need to change.
Ar ba ffurf ddylai'r ymateb yna fod: strategaeth alcohol, strategaeth lleihau defnydd alcohol gan Lywodraeth Cymru i gyd-fynd â hwn, fel mae nid dim ond y ffon sydd yna, ond bod yn foronen hefyd?
And what form should that response take: should it be an alcohol strategy, a strategy for alcohol reduction, or usage reduction, by the Welsh Government, so that it's not just the stick, but you also have the carrot too?
Yn sicr. Wel, mae—. Nid ydw i'n siŵr os bydd e'n strategaeth—maen nhw'n sôn am gael llai o strategaethau dyddiau hyn, ond bydd yna ryw fath o ddogfen, rhyw gynllun, i gyd-fynd â'r Mesur yma. Fel y dywedais i, bydd angen gwaith ar lawr gwlad i estyn allan i'r yfwyr trymaf, y rhai sydd fwyaf dibynnol ar alcohol, ac, wrth gwrs, bydd eisiau i hynny gael ei gydlynu yn genedlaethol, a dyna'r pwynt y byddwn i yn ei wneud yn gyson. Fel mae Richard wedi'i ddweud, nid oes neb sydd y tu hwnt i gymorth; nid oes neb sydd y tu hwnt i wella.
Yes, certainly. I don't know whether it will be a strategy—they're talking about having fewer strategies these days, but there will be some kind of document, or some kind of plan, to go hand in hand with this Bill. As I said, we will need to do work at grass-roots level, outreach work with the heaviest and most dependent drinkers, but, of course, that will have to be co-ordinated on a national level, and that's the point that I would make consistently. As Richard has said, there is nobody beyond help; nobody beyond getting better.
Ac, yn fyr iawn, mae yna gwmnïau yn mynd i wneud arian allan o hwn. Mae'n bosib bod archfarchnadoedd yn mynd i godi rhagor am alcohol. Ai fanna y mae'r ffynhonnell o arian i dalu am y gwasanaethau alcohol newydd yma?
And, briefly, there are companies that are going to profit from this. Supermarkets may charge more for alcohol. Now, is that the source of funding to pay for these services?
The first thing to say is that we're not the Occupy movement. [Laughter.] Whatever our personal politics, we're not anti-profit. We're not even anti-alcohol. We're anti-alcohol harm. So, if it so happens that some supermarkets, or, indeed, retailers, do increase their sales, which may be possible, we're neutral on that. But the model is designed in order that people will buy less actual alcohol. Now, if they're buying Frosty Jack's, £3.59 for three litres, and now it's only got five units of alcohol in it—or seven I guess you could get away with—instead of 22, is it any cheaper to produce? Not necessarily. It may have to be de-alcoholised, which is an extra process. So, there may not be any benefit there. Secondly, we would expect that there may well be a reduction in actual sales, and that's part of the plan. So, either reformulation or a reduction in sales—both of those are likely to lead to a marginal effect on profit. If there were significant profits, then, after a year, we may all want to have the discussion about the H word, hypothecation. And we're aware that, with the sugar levy, for example, at the moment, there are moves for that to be hypothecated. So, we think there is a new move in UK Government towards hypothecation for that. So, that would be worth keeping an eye on, but I wouldn't build it into the Bill at this stage because I think it's unlikely.
Iawn. Dawn nesaf.
Okay. Dawn next.
Thank you. I just want to ask you a little bit about the alcohol consumption of children and young people and the behaviour and whether the behaviour of children and young people drinking—whether the rise in price is likely to have a greater impact on that group. Just your thoughts on that, really.
I don't think it's been studied in enough depth, but, intuitively, yes, the behaviour of teenagers over the past few decades, since I was a teenager, does not appear to have changed enormously. Young people tend to be lower income because their employment opportunities are limited, and they are still in the habit of clubbing together to buy large quantities of cheap alcohol. As I was saying to Richard last night, if you visit Wales's many historic monuments, you will often find cans and bottles of cider because that's where kids go, like they've always gone, to drink cider out of the way, because it's cheap. So, it is going to have a definite impact on that drinking population because it's very much about making alcohol less affordable, relative to what you've got to spend. So, kids who've only got the money from their Saturday job are going to feel that pinch.
And, presumably, it will also impact on this preloading culture as well, wouldn't it, you would assume.
I think that's—
The slightly older younger people.
Yes. I was asked this morning on the radio about the effect on pubs, and this is another one of these big unknowns. You might think that this would make drinking in the pub more attractive, because there's less of a price differential. The pub has other advantages: it might be a pleasant environment, there might be food, it's much more sociable. And one of the other potential benefits to pubs and the night-time economy in general is that people will be less drunk when they arrive. Certainly, one of the complaints you'll hear from city centre and town centre publicans is they'll say, 'Why am I having to put up with all this mess? Why am I getting the blame for all this trouble at the end of the night, when these customers were drunk when they got to my premises?' So, that is a potential benefit.
Yes, and it's also going to impact presumably on happy hours and the two-for-ones in the pubs, which tend to be attracting younger people into that.
It's a very simple measure, based purely on the volume of ethanol in the drink. Certainly, we haven't looked at discounts in pubs, but we've looked at discounts in supermarkets and what tends to happen with the supermarket discounts is the discount pushes the price of the drink below the minimum unit price. So, although the measure doesn't ban the discount itself, it makes the discount impossible and that may well happen in the pubs as well.
The other point, actually—I think you may be underselling yourself. Andrew has done extensive fieldwork in pubs—[Laughter.]—and not, I hasten to add, actually drinking all his fieldwork, but photographing, and he's done some great work on that. The cheapest drink found in a pub was 98p a unit. So, if that was at a happy hour, it would be 49p a unit—we're talking, potentially, 50p a unit, so there would be no change. Even discounted alcohol consumption in pubs would be unaffected by this measure at the 50p level. Now, it's up to you to decide if that's a good or a bad thing, but that would be the fact as we would see it.
The other thing that has been flagged up with us as an area of concern is the potential impact on people with low incomes, and people on low incomes—I don't want to generalise too much—tend to be those that are drinking the higher strength alcohol, the more hazardous drinkers and so on. Do you have any particular concerns about that?
I think part of it is how we think about this. If we think about this as a measure that is essentially a hammer and we're asking the question, 'Who is it going to hammer the most?', I think we're misunderstanding it. I think if we see this as a measure that's a benefit, it is the state making some decisions that make it more difficult to drink large quantities of ethanol for the same amount of money. That is a benefit to the population and it's a benefit to people. Those benefits will accrue more in poorer communities. So, I think, if we understand it in that way—. That is how we understand it. Those communities are less resilient to alcohol problems. They tend to be more affected by a greater density of alcohol drinkers in that community and the families and communities around those drinkers also find it difficult to seek support or access support. So, this measure should benefit those groups more.
Just to be clear, I guess what you're saying is that this would be a potential health benefit for people that are in that harmful and possibly hazardous area but not alcohol dependant.
Because our concern was amongst that first group they could potentially start spending their money on alcohol rather than on other things for the family. You don't see that as such a danger.
No. We think that group will be spending either less money on alcohol—. It depends how they are running their budgets, but those drinkers, if they're harmful or hazardous drinkers, can, and will often, be employed or may well be engaged in other ways and will be living in accommodation with families. We're not all talking here about street drinkers, absolutely not. We're talking about a large bulk of the population who will be drinking too much. Those groups will be budgeting. The cost increase here may—. I think this is the reformulation issue; they may well be drinking similar quantities of liquid but with less alcohol in them. That is going to be a huge benefit to them and their families over the long term and that's why we support this measure. I think it's also important to say that the measure will—. Price sensitivity actually affects everybody in the population. So, even the so-called wealthier or middle-class harmful/hazardous drinkers—people drinking at that level—still, whether it's consciously or sub-consciously, choose the strongest, cheapest drinks and not just the strongest drinks, but the strongest, cheapest drinks. This measure will also influence them. So, the benefits apply to all this group. The benefits will be even greater in those poorer communities.
So, do you think, from what you're saying, that actually this would have a beneficial impact on what we see around some of the health inequalities that we currently—
Yes. I think this a progressive and not a regressive measure for that very reason.
Thank you, Chair. You've mentioned the importance of having robust arrangements in place and room for new approaches and you've also said that nobody is beyond help. What additional measures do you think could maximise the effectiveness of the minimum pricing? Are there any additional things, particularly, that you would like to see, for example, greater education, awareness, on heavy drinking?
Education is an interesting one. Alcohol education feels like a good idea. Unfortunately, all the evidence from around the world shows that it doesn't really make an enormous amount of difference. Richard, I think you were making the point the other day that there are a certain number of people in the country who are overweight—including myself to some extent—and we all know how to become less overweight but we don't do it. There is a role for education but it doesn't achieve a great deal. I think there is still work to be done in explaining this very measure. We understand it quite well. I don't think the general public, still, know how it will work, what it will do, what it won't do.
And we need to work on that.
We're taking some responsibility in relation to developing some very simple visuals that will explain—. For example, this isn't adding 50p to a drink, which I think is a very intuitive way of misunderstanding this. You're asking about additional measures—now, I'm no expert in the Welsh Assembly's powers and non-powers, so Andrew will have to jump in here, but we've got a package of things that we think British society needs to introduce. Drink-driving, I know, is not in your jurisdiction, but the 80 mg limit is well out of date in our view—absolutely, 50 mg is where we should be, if not lower; 20 mg, or a minimum nominal level of around 10 mg—so, we'd like to see that change. Marketing and also promotion—. So, there's advertising, particularly advertising that we believe—we don't know, but we believe—is deliberately targeting young people. It's an, 'Oh, we didn't mean to—sorry', but we suspect that's not the case. We suspect they're a deliberate action to target young people with marketing advertising, particularly on social media, which is very, very poorly regulated as a marketing form. The provision of calories, ingredients and unit information on packaging and promotions in stores, particularly supermarkets and corner shops—. The availability of alcohol, the mixing of alcohol in terms of its physical placement in stores next to the chocolates, next to the chickens or whatever, but making it a lifestyle product as opposed to what it is, which is a very special product—. It's the same as every product on price and sensitivity, it's not the same as every other commodity in many other ways. It's a non-essential, luxury item that causes harm to people. We're not against it but we are against its over-promotion. I was in a hotel last night in Cardiff—I won't name the hotel—and there was a sign above the bar that said, 'Make it large every time'. That's the sort of thing that I think, if I was in your position, I would want to have a look at.
Thank you for that. That's really helpful. Do you think the Bill should make more specific provision about any additional measures needed?
I don't know if legislation is always the best place to put things like this. I think there's a temptation, isn't there, to want to legislate on everything and various politicians over the years have come unstuck by saying that they're going to produce a measure or an Act of Parliament that will commit them, forevermore, to doing something. I think policy changes over time and legislation is for some things, like this price measure. To my mind, it's probably not for the peripherals, which will need to change over time.
Rhun, you've got a supplementary here.
Not a supplementary as such, just one last question if everybody else is done.
Well, Angela's coming in too.
Yes. One of the things that hits me and will hit a lot of people is that it's a big change, it's a piece of legislation, that would have a relatively small effect. When you look at the numbers that we have, maybe a hazardous drinker drinking 3 per cent less—so, that's somebody who goes through a 12-pack of cans at home every week only drinking 11 and two thirds cans. Is that really making a massive difference to somebody's health? That might be left as dregs because they didn't quite finish off the can, you know.
I've been surprised at how small some of the estimated reductions from Sheffield are, and we need to remember this is a mathematical model—
But this is the stuff we're relying on: a 3 per cent decrease—is that really, really a big enough difference to be going through this?
It's not the only thing we're relying on.
No. My view on this is it's a bit like the question on the other measures; there's politics around this now, which you know better than I do. Bringing in MUP at 50p a unit, I think, would allow us to look at that effect and to go, 'Okay, what was that effect? Was it 3 per cent? Was it 2 per cent? Was it 6 per cent? And how does that affect different groups of the population?', and then to look at that pricing level, and then you have it within your gift, in the legislation, to look at that pricing level over time. Nobody knows, when they introduce legislation, exactly what the effects will be, but putting in a minimum unit price for alcohol will lead to lives saved over the long term. It's also—
We keep on being told that, but it's just that people need to understand why it is, and understand that this is going to make a difference. Even though I get this, and I see this is a positive thing—anything that makes people behave in a healthier way, and the same with putting the prices of cigarettes up over the years, is a good thing—but we need to be sure that this is the way to do it.
One thing I would say, on a very practical level, is that Sheffield are working with numbers, but alcohol is not sold in thirds of cans. You're potentially talking about the difference between someone buying three litres and not buying it. These strong drinks don't tend to come in sizes of less than half a litre; you can't break them down. So, although the numbers may suggest two thirds or a third of a can, the everyday business of sourcing this stuff operates in litres and half litres, and that's a much bigger change.
And human behaviour is such that it doesn't matter how much you say, 'Right, I'm going to buy those three bottles of wine for £10; I'm definitely only going to drink half a bottle tonight,' many people in this room or listening to this will understand that, actually, for many people that's challenging. Alcohol is a commodity such that it affects people's decisions. The decisions we make before and the decisions we make during drinking change, even when we don't want them to, and that affects a large group of people. If anyone in the room is thinking, 'Oh, that's me,' don't worry; you're not alone. That is the effect that alcohol has on huge numbers of people. Over time, that accretes up—over five years, 10 years, 15 or 20 years—and leads to you being on the mortuary slab or leads to you having an operation for liver disease. Bring that number down a bit with a 50p MUP, assess what that bit is, and then we can look at what the right level should be, going forwards. So, I would encourage you to press ahead with this.
Okay. The last question is from Angela.
I've got two questions, actually. I'll ask my last one first, because it bounces off Rhun's questions. What data do you think, if we went ahead with this, we should be collecting? What should we look to monitor? Because, as you say, this is not in common currency anywhere else. The Scots have just started it. There's no empirical evidence. What do we need to see? Because, like Rhun, I'm quite unimpressed by saving five lives over the five-year period, and I think they talked about a 20-year period where the savings for the NHS were something like £80 million. Well, over 20 years, that's not going to float anyone's boat either. So, what do you think we need to measure?
So, at No. 1, I would look at what's happening to the market. I would look at unit prices and the consumption levels and sales on that—particularly what's for sale. So, 'Is reformulation happening?' is the first question. Secondly, what are consumption levels? That stuff is available. That information is available, so we'd be looking at consumption levels. Those early indicators are the key ones, because as you said, in three, five, 15, or 20 years' time, we would see the benefits, but we can't wait that long. So, we want to have a look at those things. We know that reduced consumption levels of units of alcohol—not of liquid or money—lead to health benefits, and I think we can take that as read. Therefore, we need to look at consumption levels. So, I think we know the link between alcohol and harm. Therefore, we need to look at consumption and alcohol, and those early indicators would be the ones that we would be looking at. My colleague James Nicholls is on the evaluation team for the Scottish evaluation of MUP. We will be absolutely very closely monitoring that, and we'd be very happy to work with you to look at that evaluation process.
Okay. Well, my second question, which actually comes back to the measuring slightly as well—. I'm slightly concerned that nobody wants to talk very much about the linking between drugs and alcohol. I know that you touched on it briefly with Dawn, but we've got a paper here that has a horribly long list of papers that I've not read. There's a study that finds that cannabis is a substitute for alcohol, with alcohol consumption declining when cannabis is legalised. There's study after study after study after study. And I know that we can also find studies that are the other way. I'm really worried about an addiction trail, and I'm worried about these young kids who think, 'Oh God, I can't afford my Frosty Jack's, so I'm going to go and buy a bit of weed instead, a bit of pot'—or whatever. Do you have any information at all about that, any knowledge or information from any of the monitoring or research that you've ever done about the addiction trail, about the links between drugs and alcohol? I have to say, Chair, that if we are ever going to make recommendations on measuring outcomes, one of the measurements I would absolutely want to see is that we measure whether or not we're pushing people just from one harm to another harm.
This is certainly something that the Scottish Government say they're going to look at. It's a danger we can't ignore. I think, sometimes, it's overstated. I take your point, actually, about someone who's perhaps not had a lengthy drinking career. They may feel they have more options in terms of the substances they wish to use or misuse. As I said earlier, there's a certain amount of evidence that people who are in a drinking pattern and may be in a drinking group are not necessarily going to move to a group that misuses another substance, because it's a different substance, different behaviour, different group. But, no, we can't ignore it. Certainly, I know from my own contact with the street drinkers in Cardiff that there's a certain amount of what services call 'poly-use'. People are using other things. You get some people who are very definite that, 'I only drink' or 'I only use cannabis' or whatever it is. They'll often have some disdain for people who use other substances, and they're much less inclined to move between substances. But there are people who use more than one and move between them, and we can't ignore that. We definitely need to be on the ball with that as this measure goes forward.
Is there a particular age group that might be more susceptible to poly-use?
I don't know, but I can certainly find out.
Okay. Dawn—final question.
It's just a quick point, picking up Andrew's point from earlier on, actually, in response to Jayne about education. You were saying that you didn't think it particularly works. But the evidence around smoking shows that education did work around that, didn't it? Did you see it as very different then? The message about the harmful effects of smoking did get through, coupled with the prices, I guess. So, I'm just wondering whether there is a correlation, and also whether you see employers having a role to play in this. We've talked about—. Certainly, I've spoken with Andrew in a previous life about workplace policies for dealing with alcohol abuse and so on. So, just your thoughts on that.
On the business of alcohol education, I suppose we are only going on what the evidence says. Various studies around the world across the years have shown that informing people about alcohol often leaves them better informed but seems to have minimal effect on their behaviour. I mean, that goes for all sorts of things that we do in life. It is perhaps because the message is more complex. The message around smoking was very simple: it was just, 'Don't do it.' Tobacco is a different substance as well. It's used in different ways. That said, ultimately, there has probably always been a certain element of coercion around smoking. There have always been places where you can't smoke, which always created an idea that it was a bit unacceptable.
Sorry, what was the second half of your question? Oh, employers.
Workplace education or policies.
Certainly we do quite a lot of work with employers, and we've always been very keen to emphasise that alcohol is not, in the first instance, a disciplinary issue, which is how some employers have tended to see it. It's a health-of-the-workforce issue. It may become a disciplinary issue, particularly if you're dealing with safety-critical work. The workplace is certainly one place where people can be assisted to reduce their drinking or manage their drinking, but I certainly wouldn't put all the pressure on employers. There's a tendency, sometimes, I think, to think that, say, the workplace, or schools—. People always think schools can solve all our problems—if only we could get the schools to teach the kids, all the problems would go away.
Or parents, yes. So, you certainly can't put all your eggs in one basket and say, 'If only we could get the workplace sorted'. But yes, definitely. And that's part of a wider agenda—that we have to really remove the stigma around putting your hand up and saying, 'Do you know what? Actually, I think I've got a problem with this'.
One final brief point on that, if I may. Workplaces can also be counterproductive; they can be cultures of drinking.
And I don't think it's just employers as, if you like, the first person to see if someone needs help, which I think is right, but there's also a broader model here about what message we send. They're mini societies, they're mini cultures, and they are places where our global societal culture can be shifted. You know, if 50 out of 100 workplaces take a less positive approach to drinking in and during work, broader society changes too. That's definitely not something we'd legislate for, but it is—going back to your point about other measures—something we're working on quite strongly with employers to help them do that.
Grêt. Diolch yn fawr. Rydym ni wedi gor-redeg ychydig bach, ond rwy'n credu roedd yn sesiwn hynod ddiddorol a bendigedig. Diolch yn fawr iawn i chi am eich cyfraniad y bore yma, y ddau ohonoch chi. Fe allaf ymhellach gyhoeddi y byddwch chi'n derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi gallu gwirio eu bod nhw'n ffeithiol gywir. Ni fedrwch newid eich agwedd ynglŷn ag unrhyw beth, ond fe fedrwch chi o leiaf gwirio eu bod nhw'n ffeithiol gywir. Diolch yn fawr iawn i chi.
Great. Thank you very much. We have slightly overrun, but I think it was a very interesting and wonderful session, so thank you very much for your contributions this morning. May I further announce that you will receive a transcript of these proceedings so that you can check them for factual accuracy? You can't change your views on anything, but at least you can check them for factual accuracy. So, thank you very much.
Gallaf gyhoeddi i fy nghyd-Aelodau y cawn ni doriad rŵan am ryw 10 munud am egwyl a dod yn ôl erbyn 10:20. Diolch yn fawr.
May I inform fellow Members that we will now take a break for some 10 minutes? Then we will return at 10:20. Thank you.
Gohiriwyd y cyfarfod rhwng 10:11 a 10:22.
The meeting adjourned between 10:11 and 10:22.
Croeso nôl i sesiwn ddiweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Cynulliad. Rydym ni wedi cyrraedd rŵan eitem 3, sef rhagor o graffu ar Fil Iechyd y Cyhoedd (Isafbris am Alcohol) (Cymru). Hwn ydy sesiwn tystiolaeth rhif 7, ac o'n blaenau ni rŵan mae cynrychiolwyr o Fyddin yr Iachawdwriaeth a Barnardo's. Mae'n bleser, felly, i groesawu Lynden Gibbs a David Emery o Fyddin yr Iachawdwriaeth—croeso i'r ddau ohonoch chi—a hefyd Tim Ruscoe, swyddog materion cyhoeddus Barnardo’s Cymru. Nawr, rydym ni wedi derbyn papurau ysgrifenedig yn naturiol ymlaen llaw, wedi derbyn y dystiolaeth ymlaen llaw, ac felly, gyda'ch caniatâd, fel sydd yn draddodiadol rŵan yn y pwyllgor yma, awn ni'n syth i mewn i gwestiynau. Mae'r cwestiwn cyntaf gan Caroline Jones.
Welcome back to this latest session of the Health, Social Care and Sport Committee meeting here at the National Assembly for Wales. That brings us to item 3, which is further scrutiny on the Public Health (Minimum Price for Alcohol) (Wales) Bill. This is evidence session No. 7, and joining us now are representatives of the Salvation Army and Barnardo's. It's a pleasure, therefore, to welcome Lynden Gibbs and David Emery from the Salvation Army—a warm welcome to both of you—and also to Tim Ruscoe, public affairs officer for Barnardo's Cymru. We've received your written evidence and, with your permission, as is something of a tradition at this committee, we will move immediately to questions. The first question is from Caroline Jones.
Diolch, Cadeirydd. Good morning, everyone. My question is: could I ask what your understanding is about the target group at which this legislation is targeted? Who are the hazardous and harmful drinkers, and are we confident that alcohol consumption will be reduced in this group if minimum pricing is introduced?
For me, in terms of the people that I work with, most of them—I was speaking to somebody yesterday in our services—most of those guys would be, basically, drinking the stuff that we're talking about. So, most of the problematic drinking that we see would be affected, in that what they do is: they've got a certain amount of money, and they will drink that money. What we're looking at is increasing the price, therefore the maths say that they will drink less. That will be helpful over the long run, certainly. Hopefully what it will do is pass them over to something even a little bit healthier, because I don't know any of the guys that I work with that actually enjoy what they're drinking. They just drink for the effect, and so hopefully, if it measures up, the tables—. We were doing some work with some people in a different area, and we were hoping to maybe work with the GPs and that sort of thing to get people to drink more healthily, because most of the people are not going to stop drinking, but hopefully what we can do is move them over from the stuff that they're drinking to a healthier option, which will then help them to engage better with our services.
So, that's for the guys that we're working with—not just people off the street, but also people that are really struggling with their health. Then it goes down to people from all of those more deprived areas. Those are the people who are drinking a lot of those things. The Sheffield—when you've read—
Yes, there'll be questions about that. We'll be drilling down in detail.
With the Sheffield stuff, the outcomes are looking really, really good, and ideal.
Harmful and hazardous drinkers exist across all income groups, socioeconomic groups, whatever—however you identify. This particular piece of legislation is to address the access to cheap, strong alcohol that is available through licensed or retail shops. So, it's the legal access, and regulated access. It's not able to address any other forms of access. Having said that, families who live on lower incomes tend to be affected by a wider range of health issues generally, and if you then compound that with harmful and hazardous drinking, the effects that are seen—the statistics that have been put before the committee throughout this investigation are compounded, as they say. So, low-income families, who are more likely to access cheap and strong alcohol, are more likely to suffer serious, life threatening or mortal health issues.
Diolch. Talking about the substitution issue, do you think there is a danger that people will move on to illegal drugs, for example, if it's more expensive to get alcohol? I was thinking particularly of the group that you work with.
In the group that I work with, there's a cohort that will just drink and there's a cohort that also do both. So, the way things are at the moment, it's not stopping people from accessing those sorts of drugs and everything else. It will just purely, in my view, tackle the drinking. Because there is a separate cohort, but mostly it's comorbidity. They're doing both anyway.
I was in a sudden deaths group this last week, and the majority of those were related to both alcohol and drugs, and one of the problems that you've got is that, if you're doing both, then it's much easier to go over. So, they drink a lot of very cheap alcohol and then use on top, and that then becomes an issue. So, hopefully that will also help in that regard as well.
So, you don't see that as a danger.
I don't think so.
What about you, Tim? Have you got any views on this?
Yes. Before I answer that, I have to say that we generally support the principle of the Bill and think that it should be a measure that's taken—before I say what I'm going to say.
You've asked this question of a few witnesses in previous sessions, and I note that some of the health professionals were saying that there was no research to evidence substantially that there is substitution taking place. I asked this question of our service managers and out service team leaders, so what I have is anecdotal. One quite glibly said, 'Oh, it doesn't matter what they do about the price of alcohol; it's already too expensive. All the young people we're working with are using spice'. When we actually dug down into it a little bit more, that substitution has already taken place and it is that they have a large service user group that have very few alcohol issues, but they do have a lot of issues around spice. It is cheaper, it's strong and it's available. There are elements of additional safety concerns around people who choose to substitute with a substance that is illegal. It has to be illegally bought. There might be increased possibility of exploitation and other safety issues around the individual, who are generally young and generally vulnerable. So, there are those additional safety and health issues around substitution.
I would suggest that we don't have the substantive research to say that it happens, but that needs to be done, I would suggest. There is enough anecdotal evidence to suggest it needs to be done.
In a similar service user group in a different geographical area, again, the service leaders are saying it's not going to affect this service group; their drug of choice is cannabis. Alcohol is a drug of convenience. And they were actually reporting that they've seen a decline in young people in their service group who are going through alcohol-related court cases. They've seen a decline in that, and they've actually suggested that there is an improvement, for example, in the care system. So, the ability to stay longer in settled placements means that there's greater parental instruction over safe alcohol use, but the choice for intoxication tends to be cannabis.
Right. Thank you for that very informative answer. I was going to go on to ask about services, and obviously you've mentioned the improvements in the care service. Do you think that there need to be more services to support people with drink problems, and how adequate do you think they are at the moment? Do you think that if this becomes the law, there would be a need for increased services?
I think there's always a need for an increase in services, particularly in this time of austerity when everything is getting cut back. It's really about having the opportunity to go into treatment. I know the treatment that we've got within Cardiff is always full and there's always a waiting list. There are always people ready. And the problem is that, with a lot of things like this, you've got a window of opportunity where somebody is ready to make a move, and often you haven't got the place to give to them at that particular time. If you miss the window of opportunity, then unfortunately you're not necessarily—
That is the motivation to move to give—
Yes. You can get somebody to a point where they really want to do something about it, and then trying to marry the motivation with the place isn't always that easy. We're getting some community detox situations, which is really helpful in moving those forward and working with people in that way, but actually getting there for those that are not particularly suited to community detox and need a little bit more than that, that's quite tricky.
I think I would make the point that there's a difference between dependence and reliance as well. Very few, as we know—a small percentage—of drinkers are dependent drinkers, but an awful lot are reliant drinkers. They're reliant on drinking to manage maybe their mental health, or it might be a cause of mental ill health; it may be a dual diagnosis. There is also peer pressure, there's habit, there's a social acceptance around drinking and, therefore, some of the effects of drinking. So, I think we need to make the distinction between dependence and reliance. I think there are a lot of well-established paths for treatment for dependence. I think there are less established paths of treatment for reliance. And a lot of that is to do with aspiration, seeing a future. When you ask an awful lot of children and young people, 'What colour do you see your future?' and they say, 'It's like an untuned television', what is it I can do to actually help tune that television? We don't have an awful lot of reliance-based services, I don't think.
Thank you. Is—?
I was just going to add, very, very briefly, that there are an awful lot of people who find themselves in situations where they are motivated, or they are fed up with their current situation, who will possibly even commit a crime so that they can enter into the criminal justice system, so that, hopefully, they will be able to get some form of treatment through that route, rather than the availability of services that are within everyday life. So, you are compounding already a very difficult situation for individuals and their families by the fact that they feel very desperate in their plight to address some of the issues that perhaps they are facing up to, with respect to their—
So, you do know of people who do actually commit crimes in order to get help?
Yes. It's a complex issue. Some people will commit crime because it's cold outside, but there are those aspects that you need to also take on board with respect to people who have a significant alcohol concern for themselves. And perhaps we'd want to do something to reiterate the fact about whether we need to increase treatment—well, we can always do with more because it is an issue that people do find themselves in. So, I just wanted to add the criminal justice aspect.
I think that's a real key issue, in that what we do as a nation, we spend an awful lot of money on the prison service, and a lot of people that I work with go into the prison service, become clean, and it's a really good place to become clean, whatever the stuff that you hear about—. It is a good place to become clean, and what we then do is—. So, we've spent an awful lot of money getting this person clean in that system, and then, what we do is, as soon as they come out, we don't support them and they go back to where they were, as opposed to keeping them clean. Investing in that point there is a really, really useful way of dealing with that issue because it makes perfect economic sense.
Moving on. Rhun.
Jest yn adeiladu ar beth glywsom ni gan Julie Morgan, mae'n amlwg mai capasiti rydych chi'n meddwl yw'r rhwystr mwyaf i drin pobl sydd â dibyniaeth alcohol, neu sydd eisiau mynd i'r afael â phroblem alcohol. A oes angen, felly, ochr yn ochr â'r Mesur yma, gyhoeddiad o gamau gan y Llywodraeth ynglŷn â mesurau pendant y byddan nhw'n eu gwneud i gynyddu capasiti, i dynnu rhwystrau i bobl rhag cael mynediad at wasanaethau triniaeth alcohol ac yn y blaen?
Just building on what we heard from Julie Morgan, it's clear that you believe that capacity is the greatest barrier to treating people who are either dependent on alcohol, or want to tackle an alcohol problem. So, along with this Bill, do we need an announcement of Government steps on specific measures that they will put in place to increase capacity, to remove barriers to people accessing services in terms of alcohol treatment and so on?
The ideal would be that, yes. The more the merrier, I think, is the phrase. What's affordable is the issue, I would suggest. But, yes, certainly, that would be—. If you're looking at a complete package, that would be great.
So, rather than seeing this Bill in isolation, it would certainly be useful to have a signal from Government about the kinds of measures that they would be willing, or that they would be wanting to put in place, not to just have a stick, but to have the carrot as well, and to have all those measures in place that could help.
Certainly, and I think there's quite a wide thing with the community detoxes, but also, for those who need more than that, in terms of having those facilities available as well and the support within, because I know we're getting a lot of support from the services whereby they're coming in to places like Tŷ Gobaith and doing a really good job and we're working together in partnership. It's about forging those partnerships to ensure that the support that's already there is getting to the right places, I suppose.
What about measures also to raise awareness amongst those professional workers and those working with people affected by alcohol of what minimum unit pricing will mean—what effect it's likely to have on the people that they work with and on their needs?
The Bill in itself is a good step, but it's a step that needs to be taken with a whole suite of other measures and areas of challenge. The minimum unit price, we think, is the right way to do it. Taxation has proved to fail and if you rely on taxation, the commercial imperative is to sell, so they will find ways of providing a cheaper product that fits within a tax regime. So, the minimum unit price is something that you can't avoid. So, we believe that that's correct.
On the things that need to happen around it, if we look at other public health initiatives, like smoking, tobacco is not a grocery; it's separate to the groceries on the supermarket shelves. It doesn't have attractive packaging; it has nasty pictures on it. Alcohol is on the shelves, when you walk into the shop, it's Christmas time, it's all about brightly coloured packaging and multiple-buy offers—all those sorts of things. It's a grocery and it goes into the basket. There's a whole acceptance around usage. If you listen to commercial radio, you will hear an item about the harm of alcohol, followed by the advert for somebody selling alcohol. So, there are some measures that are beyond the Assembly in terms of commercial control, I would suggest—advertising and those sorts of things—that have to dull the bright and shiny, trendy and nice elements about alcohol. It is, after all, a drug, and it is a harmful drug. So, we do have to place some responsibility on retail to make it less attractive.
On education, some of our workers and leaders have suggested that we need education around the issue in primary schools. It goes all the way through schools into the community education programmes. So, we are talking about addressing the issues within communities and within families. And it's about whole communities—not an element of the community, but whole communities. We have to accept that change is going to be gradual and we're not going to see any results very quickly. We might see a decline in the retail purchase, but we might not see a decline in the consumption. But we will see a decline in retail sales quite quickly. But the positive effects will be really quite gradual. But we need education, awareness-raising and we need to change the culture, and that's quite a slow process, as happened with tobacco.
Thank you, Chair. I just wanted to focus a little bit on children and young people. Inevitably, the Barnardo's evidence covers that in some detail. So, two things really: can you talk a little bit about the purchasing and consumption behaviour of children and young people and what impact you think this Bill might have on them? Can I ask Barnardo's in particular about the suggestion that there should be a stronger focus on children's rights and safeguarding issues around this? It's not included in the Bill, so I'd just like to explore that a little bit further with you, but first of all, just the impact of the Bill on children and young people drinking alcohol.
I'll kick off as it's on children. Worryingly, around the purchase and consumption question, an awful lot of our services are telling us that this isn't going to make a difference in the purchase and consumption, particularly the purchase around children and young people. The vast majority of children will access alcohol through the family, through the home, and most of that is responsibly. So, the parent is controlling, is sharing good information about responsible use, pointing out strengths, talking about safe limits and those sorts of things, so it's a responsible and progressive step.
However, children and young people, some of whom have worrying consumptions, are also gaining alcohol through family or parents. The two examples I used in the written evidence are anecdotal and not widespread, but concerning nonetheless, because both the children and the parents believed they were doing something right. They were providing a safe space for their child, even though it involved a bottle of vodka. It was a safe space to consume; they weren't putting their children and young people into worrying spaces to purchase or to obtain. So, that really is quite a worry, if that's seen as okay by the adult who is responsible.
In particular, we would like to see a greater aspect in terms of children's rights. The Bill talks to reducing the instances of serious health and death through alcohol. It doesn't necessarily relate directly—it does through the explanatory memorandum to an extent—to the effects of other people's consumption. So, for example, this will have no effect whatsoever on the lives of children and young people who are exploited where alcohol is a tool for exploitation. No difference at all. Some of those victims of that exploitation might be using alcohol to manage really difficult feelings or manage the experiences of previous abuse and they might be 11, 12 or 13. That alcohol is supplied for them. If there is an increase in alcohol price, for the exploiter, it's a small hit on their profit, and it is profit, so there is no recognition necessarily that alcohol isn't just about those elements of health.
The adverse childhood experiences that we're all talking about more and more frequently, they are about even small amounts of alcohol being consumed in front of a child, or behaviours that become inappropriate because of alcohol. Domestic violence doesn't require alcohol to be present. Most domestic violence has alcohol or other substances as a contributing factor. It's not a requirement. We don't necessarily see this Bill addressing that particularly. Domestic violence, again, goes across all groups, all income groups.
But, to be fair, that's not the stated intention of the Bill, is it?
To be fair, that's not the stated intention of the Bill.
To be fair, it's not. However, it is a public health Bill.
There are other pieces of legislation that deal with that.
I'm not entirely sure they deal with—. This is about addressing alcohol consumption and access to it. Access to alcohol and the consumption of it adversely affects children. So, is there enough in here that takes account of the wider effect on public health issues and the public health purse, not just on hospital admissions and serious illness? That's why we're saying we're not entirely sure—
I understand what you're saying.
—it has a children's rights effect, certainly as widely as it could do.
Okay, so we could look at that in safeguarding terms. It might be in a different area of legislation, but it's something that this needs to take account of.
In fairness, it might be through regulation. Because this is limited as it is, but we don't think it shouldn't happen. It might be through regulation, or it might be through something else. As I say, this will not be as effective as it could be if it's in isolation.
Sure, okay. Do colleagues from the Salvation Army want to say—?
Well, the only thing that I would say is obviously we're very concerned about the impact that excessive alcohol consumption is having on children full stop. We also recognise that this is only one aspect of a huge complex picture. We seem to be saying this time and time again but, nonetheless, it is one aspect that is important and vital that needs to be addressed. We've already talked about who are the hazardous groups—well, children who grow up in homes that have parents who drink alcohol excessively, that's a hazardous group. We've talked about education. Again, you mentioned about teaching children in school about this. That is an aspect. So, we recognise that it's a huge area and some of the most distressing work—and, again, this is anecdotal but it's true—that I've encountered in dealing with people who have an alcohol problem is where the children are involved. It is heartbreaking. And so we recognise that this Bill is not the panacea for everything but it certainly is one step on that long road that all aspects of—
So, you're talking specifically about the impact on a child of living perhaps with alcohol-dependant or hazardous drinkers, yes.
There is that one aspect.
There is that one aspect. But they're not drinking, but they're impacted—it's impacting on them.
There is that one aspect. However, in other situations, when you're perhaps dealing with somebody and you say to them, 'Tell me your story', we find that—'When did they start drinking?', and it could have been the sherry in granny's cupboard or whatever and that has been an aspect of their involvement in their own journey that—
It is learned behaviour, these things, as well, isn't it? That's what they grow up—
And there's lots of evidence and lots of stories that we all know about those things.
I think it's interesting that you're saying that you're not observing the kids drinking at that level. Certainly, my observations have been that they have been drinking to that level and it's not just at the lower ends of the spectrum. I live in the Heath, which is—you wouldn't say that was an area of deprivation. I take my dogs for a walk every day and certainly during the summer time I'm picking up the sorts of bottles that we're talking about every day and, when I go around in the evening, I'm not seeing adults in the park, I'm seeing 13-year-olds, 14-year-olds, 15-year-olds in the park. So, they're the people that are leaving them behind in those sorts of areas and obviously drinking to excess in terms of the behaviours. So, that's all the way across the board. That's not just in the Elys and the other areas, who are also behaving in the same sort of way. But, at the end of the day, they've got a limited purse and the less that they can buy the better.
So, that's the kind of inevitable experimentation from young people trying alcohol and—.
Sure. But, for me, in terms of—
Would it stop that, that's the thing, isn't it?
It's not going to stop it, but it will slow it down. Instead of having 20 units they might have 15 between them. Well, that's a better outcome, from where I'm sat. Yes, they're still going to experiment, but in actual fact if they can buy less then they're going to consume less—that's basic maths—and that will happen in those situations and that's got to be a good thing.
In general terms, children that we're aware of where harmful and hazardous drinking exists in their families, take two journeys: one is abstinence and the other is they drink, but the drink is at home, it's available and it's taken at home, it's the learnt culture—but generalisations.
But they're not buying it.
They're not buying it. I think you were right to point out that it is a normal process for children and young people to experiment. We all did, with whatever it was we were experimenting with. It might have been, in my case, girls. [Laughter.] Sorry.
We're drifting off the point there, I've got to say, and Angela is raising her eyebrows at me. Time to move on to Jayne's questioning.
I'm not going to ask you any further about that, Tim—[Laughter.]—but I am going to ask you about your paper. It's just in response to what you said to Dawn, really, about the relationship between alcohol and domestic violence. In your paper, you said one of the areas where the weakness of the legislation is most stark was around alcohol and domestic violence. You've covered quite a bit in your response to Dawn, but I was just wondering about your statement, which implies that there are other areas of the Bill that are weak. Do you want to expand on that part?
It does imply that. The weakness around domestic violence is that domestic violence, categorically, is not a low-income issue and this Bill does nothing to address the effect of alcohol in domestic violence in families who can afford alcohol. It exists in almost all instances of domestic violence. Some geographical areas are reporting a significant reduction in the age of victims and perpetrators of domestic violence, all of which is substance or alcohol related. That was the weakness I was referring to, that it doesn't address other income groups' consumption and purchase. As Dawn said, that isn't the purpose of this particular Bill, but we have to do something around that.
Other weaknesses we've talked about are around whether it fully associates with the safety issues, the public health issues, that are on the downside. Substitution—actually, is it safer for children and young people to have regulated access to alcohol than unregulated access to other substances? We don't know. We don't have that evidence to say, 'Actually, alcohol is the safer alternative'. We don't have that evidence. So, that might be something that is required in terms of a suite of interventions that are going to help deliver the purpose of the Bill.
Okay, thank you. The Salvation Army: would you like to comment on any weaknesses that you see within the Bill or would you agree with Tim?
I think the comment that's just come to my mind, not so much on the Bill, is this idea of domestic violence, because, obviously, from a Salvation Army perspective, we seem to be dealing with people who are really on the extreme of alcohol misuse. Very often, they form relationships within the same group and there is, very often, a huge amount of domestic violence within that group, within those partnerships. Because, really, at the end of the day, that is the only peer group that will really accept them. So, it is—I hate to use this concept—like a social leveller. You know, the alcohol has taken hold of people so that they're attracted to each other for whatever reasons and there is an element of domestic violence there, sometimes very tragically, as we probably know from news reports, et cetera. So, I would just emphasise that aspect. As far as the Bill is concerned, I'll perhaps—
I think, whatever you're going to do, there are going to be weaknesses. For me, it's got to be part of a package. It's a great starting point. It hits a cohort that really needs input, and the Sheffield figures make no bones about the impact that that's going to have, which has got to be a positive impact.
In terms of children's rights, alcohol and domestic violence and stuff like that, what we're seeing at the moment is that the research is about the trauma-informed care—basically, the number of different levels of trauma that a young person goes through actually is affecting their journey. So, when we're working with them, actually, you go back and it's the impact of the traumas in those early days.196
If the Bill does what the research says it's going to do, it will cut out not all of that trauma, but it will cut out the trauma for a number of those people, and those young people, who otherwise would go through it. Now, if it cuts out that trauma for just one, it's worth it for me, but it will cut out a lot for a cohort where there is a lot of trauma and a lot of problems that are going to come, going forward. So, actually, if we can do that, it's worth it for me. Never mind all of the weaknesses—you could go through weaknesses forever and a day, but just by getting that done it will make a massive impact, and that's why we're backing it all the way, really.
Great. Angela with the last questions.
To be honest with you, I think that my questions have been asked, in terms of what other—. I think you've been very clear, actually—very clear—in saying that not only should we look at the Bill, and not only should we look at minimum unit pricing, but we probably need to make some commentary in our report about the fact that there have to be clear, concise support services for those who are in the midst of it and those who are trying to come out of it as a result of the changes. I think we've heard your message loud and clear. I just want to say that you do great work, guys—thank you.
Grêt. Wel, dyna ddiwedd y sesiwn. Diolch yn fawr iawn i chi am eich presenoldeb; diolch yn fawr iawn am y papurau ysgrifenedig y gwnaethoch chi eu cyflwyno ymlaen llaw, a diolch yn fawr am ateb y cwestiynau yn fendigedig. Mae hon wedi bod yn sesiwn arbennig o dda—diolch yn fawr iawn i chi. A allaf i bellach ddweud y byddwch chi'n derbyn trawsgrifiad o'r cyfarfod yma i'w wirio i wneud yn siŵr ei fod yn ffeithiol gywir o'ch ochr chi? Gyda hynny, diolch yn fawr iawn i chi am eich presenoldeb y bore yma—diolch.
Great. Well, that concludes the session. Thank you very much for your attendance; thank you very much for the written evidence that you presented, and thank you for responding to our questions so wonderfully. It's been a wonderful session. May I just inform you that you will receive a transcript of this meeting so that you can check it for factual accuracy? With those few words, thank you very much for your attendance this morning.
I weddill y pwyllgor, rŷm ni'n symud ymlaen at eitem 4, a phapurau i'w nodi. Bydd Aelodau wedi gweld y llythyrau sydd yn eich pecyn chi: tystiolaeth atodol gan Christopher Snowdon am isafbris am alcohol, a hefyd llythyr gan Ysgrifennydd y Cabinet ynghylch cyllideb ddrafft Llywodraeth Cymru. Mae yna lythyr hefyd gan Dr Tim Stockwell o Ganada ynglŷn ag isafbris am alcohol, a hefyd crynodeb o'r gwaith a wnaed gan dîm allgymorth y Cynulliad mewn perthynas â Bil Iechyd y Cyhoedd (Isafbris am Alcohol) (Cymru).
We move on now to item 4, papers to note. Members will have seen the correspondence in your packs: supplementary evidence from Christopher Snowdon on a minimum price for alcohol, and also a letter from the Cabinet Secretary for Finance on the draft budget. There's also a letter from Dr Tim Stockwell from Canada on a minimum price for alcohol, and also a summary of the work undertaken by the Assembly's outreach team in relation to the Public Health (Minimum Price for Alcohol) (Wales) Bill too.
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).
that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).
Cynigiwyd y cynnig.
Mae hynny'n dod â ni at eitem 5, a chynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o weddill y cyfarfod. A yw pawb yn cytuno? Grêt.
That brings us to item 5, a motion under Standing Order 17.42 to resolve to exclude the public from the remainder of the meeting. Is everyone agreed? Great.
Derbyniwyd y cynnig.
Daeth rhan gyhoeddus y cyfarfod i ben am 11:03.
The public part of the meeting ended at 11:03.