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Minimum unit alcohol pricing scuppered by Cabinet revolt?

The Coalition Government’s Alcohol Strategy was dealt a severe blow when a Cabinet revolt seemingly forced Prime Minister David Cameron to abandon its key element, the minimum unit pricing of alcohol (MUP). While the decision has still to be formally confirmed, all the indications are that MUP has been abandoned, especially as the news that MUP would not, after all, be implemented in England appeared to be leaked by the Home Office.  

The U-turn was seen as a personal rebuff for the Prime Minister, who, in May 2012, declared: “We are going to introduce a new minimum unit price - so for the first time it will be illegal for shops to sell alcohol for less than this set price per unit. Of course, I know this won’t be universally popular. But the responsibility of being in government isn’t always about doing the popular thing. It’s about doing the right thing.” 

The public health community, which has been virtually unanimous in support of MUP, urged Mr Cameron to continue doing the right thing. In the almost certainly forlorn hope that the policy may yet be saved, the Alcohol Health Alliance, representing the major part of the medical and allied professions, sent a personal letter to the Prime Minister urging him to stand firm. Other bodies, including the British Medical Association, organised pro-MUP petitions. Speaking on the BBC Radio 4 Today Programme, Conservative MP and member of the Health Select Committee, Dr Sarah Wollaston, said she felt devastated that the plans to introduce MUP had been dropped. She said that when alcohol was too cheap, people died.  On the same programme, Dr Vivienne Nathanson, Director of Professional Activities at the BMA, said that her message to Mr Cameron was “Be courageous: this is a once-in-a-lifetime opportunity to save lives, to save the country money.” 

Speaking for the IAS, Katherine Brown said: 

“Since the Government announced its proposals in March, the evidence for MUP has strengthened and the support-base for this crucial policy has widened.  We have now seen real-life results from Canada that indicate a 10% increase in the minimum price of some drinks led to a 33% decrease in wholly alcohol related deaths. Doctors, the police, emergency services and leading children’s charities all publically endorse MUP, and recent public opinion polls show the majority of people support tough action on alcohol too. 

“We urge the Government to stand firm on MUP, as a U-turn on this crucial policy would effectively be turning its back on the most vulnerable groups in society.” 

Industry reactions 

Predictably, the news of the U-turn was applauded by those elements of the alcohol industry, particularly the global producers and the wine and spirits sectors, that had been engaged in a vigorous lobbying campaign against MUP,  However, the industry is divided on the issue, and other sectors, essentially those connected with the on-trade, joined forces with the public health lobby in urging Mr Cameron to stand firm. In a letter to the Daily Telegraph, some leading lights from the beer, pub and club sectors warned that the important role of pubs in communities across the country was under threat from the easy availability of excessively cheap packaged alcohol, and the authors entreated the Government to stick to its plans to introduce MUP “ to address the costs to society of irresponsible alcohol sale and consumption, and to encourage drinkers back into pubs and clubs.”  The letter continued: 

“The Government has public support. In a recent YouGov survey the majority said the Government was right to try to reduce the amount of cheap alcohol sold in shops. 

“Yet at the same time, the Government’s plans are being undermined by some who seek to distort the public’s understanding of how MUP would work. For example, 46 per cent wrongly believe MUP would increase the price of alcohol in pubs. 

“MUP will not solve all alcohol-related ills, but it will encourage responsible drinking……. By introducing MUP, the Prime Minister has a great opportunity to save lives, to save money and to protect British pubs.” 

Coalition politics 

Almost until the week of the annual Budget, it looked as though MUP was still on course to be introduced, an announcement to that effect possibly expected in the Chancellor’s Budget statement. The Home Office was considering the results of a public consultation on MUP in which the questions posed concerned not whether MUP should be introduced, the principle already seemingly having been accepted, but at what level the price should be set. 

Then it emerged that the policy was to be abandoned, with, ironically, Theresa May, the Home Secretary, being named as one of its leading opponents in Cabinet. Other senior Conservative opponents included Eric Pickles, Michael Gove, Andrew Lansley, and the Mayor of London, Boris Johnson. Previous reports had suggested that there was even more opposition among Liberal Democrat ministers, and in the end, Prime Minister Cameron presumably found himself out-numbered and unable to push the policy through. 

Most political commentators suggested that the real cause of the Prime Minister’s embarrassing climb-down had more to do with the internal politics of the Conservative Party than the merits of the issue itself.  However, it is understood that the Treasury also opposed MUP. 

The politicians’ ostensible reasons for opposing MUP centered around the twin concerns that it would not have the beneficial effects claimed but that it would be politically suicidal by increasing the cost of living for ordinary people at a time of austerity, with the biggest burden falling on the less well off.  There was also the consideration that MUP was subject to legal challenge. The former Labour Home Secretary, Alan Johnson, was quoted as saying that he had explored the possibility of introducing MUP but had been advised that it was contrary to both national and EU law. 

For the public health community, these objections to MUP were without merit.  They pointed out that the main evidence base for MUP had been gathered at the request of the Government itself by the team at Sheffield University, and, it was argued, they had demonstrated that MUP would have beneficial effects in relation to reduced ill-health and crime, and that it would not place an undue burden on either moderate drinkers or the poor.  The claim that, as leading Conservative back-bencher David Davies put it, MUP would not work because “alcoholics are not sensitive to the pennies” was flatly contradicted by, among much other evidence, new research on the effectiveness of minimum pricing in Canada. This showed that the beneficial effects of MUP in relation to alcohol deaths were, if anything, being underestimated, and alcohol deaths would not fall unless ‘alcoholics’ were also affected by the price of alcohol.

 

Text of the letter to the Prime Minister from members of the Alcohol Health Alliance on 13 March 2013: 

Minimum unit pricing for alcohol 

The Alcohol Health Alliance UK, representing all major medical and nursing organisations, is concerned by numerous media reports that the Government has decided to drop its plans to introduce a minimum unit price (MUP) for alcohol.  We urge that you do not falter at this late stage in the process of introducing this critical policy. 

The cost burden on the NHS caused by alcohol related problems was more than £3.5billion three years ago, with these problems attributable for 1.2million hospital admissions per year.  The Government cannot fail to act on this, especially in light of the increasing burdens on the NHS.  We would urge the Government to introduce a MUP of 50p in England, in line with Scotland.  A recent report by more than 70 multidisciplinary organisations has called for a 50p MUP to be prioritised.  This policy is a targeted approach that will have the greatest impact on the heaviest drinkers and families devastated by alcoholism, but with minimal impact on moderate drinkers. 

We have now seen concrete results from Canada, who have led the way in successfully introducing a MUP.  Evaluation there indicates a 10% increase in the minimum price of some drinks has led to a 33% decrease in wholly alcohol related deaths.  With death rates in the UK from liver disease rising by 65% over the past 20 years, the Government cannot afford to do nothing. 

Setting a MUP targets the price of the cheapest alcohol at point-of-sale.  Prices in pubs are likely to be unaffected as most drinks sold in the on-trade are above a 50p MUP already.  Even some sections of the drinks industry have come out in favour of MUP, as major brewers agree with the majority of pub landlords, that MUP will help local pubs that are being undercut by cheap drink sold in supermarkets. 

Approximately half of all crime in Britain is alcohol related and alcohol is linked to 40% of all domestic violence cases.  It is estimated that at full effect a MUP of 50p would prevent 40,000 alcohol related crimes per year.  The Association of Chief Police Officers has also been supportive of MUP. 

We would be happy to arrange for clinicians to demonstrate to you and other cabinet members the reality of the health costs associated with alcohol misuse, and how the introduction of a MUP will have significant positive impact on health and lives. 

The only opposing force has been a high profile, well funded campaign led by the global alcohol producers.  This is a group with a clear interest in prioritising profits over public health.  We urge you to be courageous and to put health and lives first by introducing minimum price of 50p for a unit of alcohol. 

Yours sincerely

Professor Sir Ian Gilmore, Chair of Alcohol Health Alliance UK

Dr Mark Porter, Chair of Council, British Medical Association

Dr Peter Carter, President and General Secretary, Royal College of Nursing

Professor Lindsey Davies. President of the Faculty of Public Health

Dr Clare Gerada, President, Royal College of General Practitioners

Sir Richard Thompson, President, Royal College of Physicians

Dr Francis Keaney, Vice Chair, Faculty of Addictions, Royal College of Psychiatrists

Professor Colin Drummond, Medical Council on Alcohol and National Addiction Centre, Kings College, London

Dr Zulfiquar Mirza, College of Emergency Medicine

Eric Appleby, Chief Executive, Alcohol Concern

Dr John Wilson, Vice President, Royal College of Physicians of Edinburgh

Dr Evelyn Gillan, Chief Executive, Alcohol Focus Scotland

Dr Kieran Moriarty, British Society of Gastroenterology

Dr Dominique Florin, Medical Director, Medical Council on Alcohol

Miss Kathryn Harley, Dean, Faculty of Dental Surgery, Royal College of Surgeons of England

Andrew Langford, Chief Executive, British Liver Trust

Ali Wheeler, Director, Drinkwise

Katherine Brown, Director of Policy, Institute of Alcohol Studies

Colin Shevills, Director, Balance North East