 Welcome everyone to the 16th meeting of the Health, Social Care and Sport Committee in 2022. I've received no apologies for today's meeting. We have some members joining us remotely, though, so it's a hybrid meeting. The first item on our agenda is to decide whether to take items five and six and private. Our members agreed. Our second item today is an evidence session with the Minister for Public Health, Women's Health and Sport on tackling alcohol harms in Scotland. This follows a session on Tuesday 1 March 2022, where the committee took evidence on the same topic from Alcohol Focus Scotland, Public Health Scotland and Scottish Health Action on Alcohol Problems. The minister is joined by her supporting officials. I welcome to the committee Milly Todd, Minister for Public Health, Women's Health and Sport. Good morning, minister. Amy Kirkpatrick, the head of alcohol harm prevention and Maggie Page, the unit head of the drug strategy unit for the Scottish Government, is joining us online. I invite the minister to make a brief opening statement. Thank you, convener. Our chief medical officer has said that a healthier population could be one of our nation's most important assets and must be our ambition. To achieve that, we must focus on addressing health inequalities and their detrimental effects. The negative effects of poverty, trauma and discrimination on an individual's mental and physical health cannot be ignored. It is for all the reasons that we have increased funding in tackling problematic alcohol and drug use. It is also why we need to consult on potential restrictions on alcohol advertising and review the level of minimum unit price. Minimum unit price was introduced in 2018, and we are in the final year of our five-year evaluation period. Twelve months after minimum unit price was introduced, we saw a decrease of 2 per cent in alcohol sales in the off-trade. We also saw a decrease in alcohol-specific deaths of 10 per cent, the largest decrease since 2012. Then the pandemic hit, and there is evidence to show that some groups who were already drinking at dangerous levels were drinking more despite alcohol sales falling overall. We do not yet know if the increased deaths reported in 2020 will be echoed in 2021. We cannot prejudge what the evaluation of minimum unit price will say. We are not yet in a position to indicate whether the current level of 50 pence per unit should be changed and, if it does, what that change would be. Any price must be supported by robust evidence. It is important that we review the attractiveness of alcohol. Attractiveness is one of the world health organisations three best buys for countries to prevent and reduce alcohol-related harms. We know that children and young people in Scotland are seeing a staggering amount of alcohol advertising and promotion in a variety of ways. A survey in 2018 of over 3,000 young people aged 11 to 19 found that half of those surveyed had seen at least 32 instances of alcohol marketing within a month. That is at least one instance a day, and I am sure that we would all agree that that is simply too high. Seeing alcohol advertising and promotion can influence the attitudes that children and young people have towards alcohol, especially when that is cast as fun, sociable or cool. We know that there is a direct link between exposure to alcohol marketing and children and young people starting to drink alcohol, and that can increase the likelihood that they will drink in ways that can be risky or harmful in later life. I personally find this deeply troubling, and I am determined to cut down on the volume of alcohol advertising and promotion that young people see and to reduce the appeal that alcohol has to them. That is why we are planning on consulting on a range of new measures to restrict alcohol advertising and promotion in Scotland in the autumn. That consultation will be vital in helping us to consider whether new legislation is needed. We know that alcohol-related harms are an important issue as drug-related harms. Both are significant public health emergencies. That is why we have set our national mission to improve lives and save lives at the core of which is ensuring that every individual is able to access the treatment and recovery that they choose. Increased investment from the national mission on tackling drug-related deaths has been used by alcohol and drug partnerships across Scotland to support people facing problems because of alcohol and drug use. However, more can still be done to get people into appropriate treatment quicker in order to reduce harms and to help our recovery. There should be no shame in reaching out for support, and the voices of those with lived and living experience are critical to this process. We are working with the UK Government and the other devolved administrations on reviewing and updating clinical guidelines for alcohol treatment. The guidance will look to introduce new approaches to treatment and support the development of alcohol-specific treatment targets. We are working with Public Health Scotland on reviewing the evidence on current delivery of alcohol brief interventions. That work is in the early stages, but it is critical to ensuring that alcohol brief interventions are as effective as possible. We are exploring the evidence around managed alcohol programmes and are delighted to be able to contribute to the running of the model being piloted in Glasgow by the Simon community Scotland and its evaluation. I am under no illusions that there is still a lot to be done, but I am determined with your help to improve the nation's health, to tackle health inequalities by implementing those bold approaches to reduce the significant harms of alcohol. I also hope that I can count on support from across Parliament in tackling the harmful impact of alcohol marketing when the consultation launches. Thank you minister. You have gone through quite a wide range of measures that you are implementing. I want to take us back to the trends. You mentioned the trends before the pandemic, and quite a lot of measures could be said to have been working. We have reduction in alcohol deaths and things seem to be moving in the right direction. The pandemic comes along and, with everything else, some things happen as a result of that. You said that there has been less consumption of alcohol, but the type of alcohol consumption that has been happening has probably been of the less social side and more at home. It is affecting particular demographics from what we hear. I really want to ask you what things you have perhaps been doing up until the pandemic you are continuing on with, but how are you prioritising an order to deal with the trends that have occurred since the pandemic and the potential alcohol harms that have happened since the pandemic to those particular demographics? You are absolutely correct, convener, that there has been quite a disruption caused by the pandemic in this area and in many other areas. What we have seen is a steadily reducing amount of alcohol consumed. We saw in the first year of after introduction of minimum unit pricing of alcohol a huge decrease in the number of deaths, 10 per cent. It is the second largest decrease in a year since records began. In 2020, that is the first year of the pandemic, adults drank an average of 9.4 litres of alcohol per head, which is 18 units per adult per week. That is the lowest level of average alcohol consumption in Scotland for 26 years, but it is still an early 30 per cent more than the recommended limits. What that does not tell us is who was drinking and how they were drinking. There is a real suspicion that what happened was that people who were drinking heavily before the pandemic consumed more during the pandemic and those who were drinking less drank less. There was also a big shift in where we drank, because of lockdown. There was a lot less drinking alcohol in bars and a lot more consumption of alcohol at home. There were also changes in the level of admissions to hospital and an increase in the number of deaths. You would think that if there was an increasing number of deaths there would be an increasing number of admissions to hospital, but we saw the opposite. That may be about the level of strain that was being experienced across the healthcare system at that time. We have a lot to disentangle and understand about what happened during the pandemic. We also do not know whether that is a one-off or whether that is going to alter the trend going forward. What we did see—there is one crumb of comfort in all of this and it is not comfortable, I have to say, at all each of these deaths. It is an absolute tragedy. The 23 deaths per week is only the tip of the iceberg. Those are the deaths that are directly attributable to alcohol. There is also a large number of deaths related to heart disease and cancer, of which alcohol is a contributory factor. It is an absolutely tragic situation, but the one crumb of comfort is that we did see, although Scotland has a long-standing, recognised harmful relationship with alcohol, that more Scottish people died of alcohol during the pandemic. We also saw that increase happen right across the UK, so it was not something that was unique to Scotland. Our rise of 17 per cent was slightly lower than the rest of the UK country, so that gives me a hope that perhaps some of the work and strategies that we have in place were protective during that difficult time. Minimum unit of pricing of alcohol might have meant that, although we had a devastating increase in the number of deaths that year, we did not have quite the same level as they had in the rest of the UK. Minimum unit of pricing of alcohol is not the only string in feather in our cap, though we have done a lot of work over a number of years. When you have a nation with such a harmful relationship with a substance like alcohol, you have to do more than one thing to try to tackle it. We have taken a whole range of actions to reduce the availability, attractiveness and affordability of alcohol in line with the World Health Organization's recommended approach. We are going to continue that on, taking that whole population approach, which aims to reduce alcohol consumption. It aims to reduce the risk of alcohol-related harms right across the population. We have two consistent threads running through our work, though, and two target areas that we are really keen to be focused on. That is one that our actions have to reduce health inequalities and protect children and young people. We are consulting on potential restrictions on alcohol advertising, as I said, and promotion, particularly to protect children and young people. We are keen to give consumers information on labels and health information, such as the placing of the 14 units recommendation on cans. We are also discussing on a foreign nations basis putting calorie labelling on to alcohol. We think that that will be helpful. We have twice, over the course of the pandemic, run our Count 14 campaign, worked to raise awareness of all four of the United Kingdom's CMOs, lower risk drinking guidelines of 14 units per week, for the four weeks in March 2019, and we did it for six weeks in January to March 2020. My colleagues are going to pick up on quite a lot of the things that you have mentioned. I am interested to hear about the measurement, which could be a false measurement, about the hospital admissions during the pandemic, because, of course, we cannot make any assumptions on that basis. The work that is going forward to identify people who, perhaps, have got into problem areas in terms of their drinking is one thing. You also mentioned young people and the next generation coming through. I do not want to go into some of my colleagues' areas on the kind of advertising aspect of things. In terms of that relationship, we have been really trying for many, many years to tackle the causes of that relationship and how that relationship with alcohol that Scotland seems to have continues. The best way of doing that is to change that relationship at the point where people are starting to drink. In that area, what is the Scottish Government doing to assist changing that relationship that young people have towards drinking, which could lead to problem drinking in later adulthood? I think that all the work that we have done so far—if you think about minimum unit pricing, reducing affordability—will help to see less drinking in society. One of the main areas that we need to go into is our alcohol advertising and promotion. Young Scot, the children's Parliament and the youth Parliament did this amazing report a couple of years ago, which really made very shocking reading. They came to the Parliament and presented it. From the mouth of babes, you heard directly how much alcohol they were exposed to. Alcohol is ubiquitous in our children's lives. It is not just the advertising, but the advertising is a big part of it. They talk very clearly about when they open the fridge door in the morning to get their milk out. There is a stack of wine in the fridge. If you think about how our drinking has changed as a nation since the 1970s, when I grew up, when it was not very common to drink at home when people did not really drink wine with dinner, children nowadays are seeing a great deal more alcohol being consumed at home. They see alcohol advertising on transport and on billboards on the way into school. That is a point that I have made here at the committee before. You cannot just protect children from alcohol advertising by throwing a ring around where children are. You cannot just prevent alcohol advertising around a school. Children are in our society and they see billboards and adverts as they navigate their way to school. The other thing is that they see advertising in the cinema and on the television. There was a shocking study that was done on the amount of adverts that children were exposed to in sports promotions. I will find the statistic and make sure that I get it correct. When children are watching sports, again, a couple of times a minute, they are seeing alcohol advertising. That is particularly harmful because they are heroes to children. I am not sure what the noise is. It is a noise that is said to happen in a lot of broadcasting picks that I think it is to do with the central heating, so I apologise for that. It is a we now. I thank the minister for managing to make your way through that noise. I will pass it on to the deputy convener, Paul Cain. Thank you, convener, and good morning to the minister. I wonder if I could just ask a wee bit more in terms of the Government's 2018 alcohol framework. There is a lot in there. The committee is keen to hear about progress. I am particularly interested in looking at action points 9 and 15 about the requirement for close working with the UK Government and the acknowledgement that we obviously have to have collaboration there. I am keen to understand from the minister what interactions meetings have taken place since 2018. Obviously, we appreciate that there has been two years of pandemic, but it would be good to get a sense of what progress the minister feels has been made. I will potentially bring Amy in to give a bit more detail, because a lot of those meetings are happening at official level. However, there are two areas that bring to mind that we are working on together. One is developing clinical guidelines for the treatment of alcohol misuse, and the other area is labelling. We are very keen to get a foreignation approach to labelling, including health messages such as the CMO's recommendation for 14 units per week, but also in terms of calorie labelling for alcohol products. I will ask Amy to tell you a little bit more about the way in which that interaction between the Governments occurs. I will bring in Amy. We regularly meet on a foreignations approach to discuss alcohol harm reduction. We also meet Wales quite regularly, as you may know. We have just recently brought in minimum unit pricing, so we have talked quite a lot about that. However, as the minister said, we are quite focused on the calorie labelling. On the treatment side, not my area, but on the treatment side, we have brought in your key treatment guidelines. I suppose that I can perhaps expand on the calorie labelling guidelines. That is a key ask of many of the third sector and the wider organisations that we have taken evidence from in the past. I wonder whether the minister might want to say anything about what progress he feels is being made. Perhaps there is a sense that progress has been too slow to try and get that consensus, if you like. The minister alluded to it in opening remarks about how ubiquitous alcohol is. Part of that is through not just advertising, but what information is out there in terms of labelling and standards. I wonder whether you can comment on that progress. I agree with our stakeholders that progress has been disappointing. I am not entirely sure why. The consultation has been delayed by the UK Government. We do not know when the UK plans to run that consultation. We are very keen to work on a four-nation basis and we are very keen for the consultation to be across the UK. We think that that is the most effective way. We have learned a lot about public health over the course of the pandemic. We have learned that it is where possible that working on a four-nation basis is absolutely the best way forward. We are also very disappointed that the UK Government has stalled on that consultation. Despite attempts to get clarity on the timetable, we have not got it. I am disappointed to report that. I cannot tell you when that is likely to happen. We now want to dig in a little bit deeper into minimum unit pricing. The Scottish Government was committed to a review of a minute unit pricing after two years, but it was delayed by a pandemic. In the opening statement, you said that there was a five-year review and we are now in four years. Can you update the committee on how it is progressing? We are working on reviewing the level of minimum unit prices under way. It is really important work and we need to carry it out thoroughly to ensure that any change to the level has a robust evidence base. Just as important as the review of the level of minimum unit pricing is, the need to ensure that minimum unit pricing continues as a policy. That is the sunset clause, if you remember, when the legislation was passed, a sunset clause was built in. The act requires that the Scottish ministers lay a report before the Scottish Parliament, as soon as practical, after five years. That is the 30th of April next year. We have just passed the four-year anniversary in the first of May since the introduction of the minimum unit price. We are doing both of those reviews simultaneously, but the focus has to be on the five-year review because there is legislation in place that is strict around that timetable. There are also other things when we know that the pandemic has changed our behaviour. We have changed the way that we drink and we need to better understand that. When we are thinking about minimum unit price, we also know that the cost of living crisis, so we are very keen that the minimum unit price should reflect affordability, as the World Health Organization is clear, rather than simply cost or price. The fact that people's household costs have increased so substantially will have an impact on how we interpret it and how we review the minimum unit price. The final change that has happened is the internal market act, which has changed the landscape and how there was a lot of discussion as that legislation went through Parliament. The Scottish Parliament did not consent to it, but that may well have changed our ability to take public health measures in Scotland that are different from the rest of the UK. Minister, it is 10 years since 50 pence was the first proposed as a minimum unit price. In evidence to committee, it was argued that it should be automatically upgraded with inflation rather than having to go to review or to legislation. What is your feelings on that? I have alluded to the level of complexity this time. We need to have a robust evidence base as we review it. I am not going to automatically assume that we uplift it, but as we review the minimum unit price, there needs to be a robust approach and a solid evidence base in forming that decision. A lot more than we anticipated has changed. However, I think that it is attractive for us to consider some sort of automatic uplift, so I am not convinced. I talked about the challenge with linking to inflation. I do not think that that would capture the issue of affordability because inflation is going up, but so is cost of living. People have a lot less money in their pockets to spend on alcohol right at this moment in time. We are spending a great deal more on energy and we are spending the highest taxes since the 1950s. We need to look at affordability. I think that it is perfectly possible for us to find a way to do that automatically. I think that, to be effective, it probably needs to be reviewed on a more regular basis than it has been. Thank you, minister. Brexit, when you mentioned the internal UK market earlier on in your statement, how could that affect Scotland and the Scottish Government in trying to implement health measures against alcohol? I guess that one of the obvious areas would be labelling, for example. We are very keen in Scotland to have both the 14-week recommendation and calorie labelling on alcohol. Should we choose not to proceed with that on a foreign nations basis, should England choose to do things differently, if a product was passed as suitable for sale in England, it could be sold in Scotland as well? That would really weaken my ability or our ability as a Government and our ability as a Parliament to take public health decisions for Scotland, which is one of the very well-rehearsed arguments that we had at the time of that bill passing. There is an obvious example. I have a few members who want to ask some questions on minimum year pricing. I want to ask you about the industry itself. Previously, there were some arguments about them being concerned about the industry going to the wall, about people heading down to England to fill their boots up with lots of alcohol, people turning to other drugs as well. None of those things seem to have happened, which is really good and really positive. Has there been any indication from industry that there would be a challenge to any further increase in minimum unit pricing? In fact, I will leave it at that one and then I will come back in with another question. I have not had a direct indication from industry, but I suppose that one of the things that I regularly say in life is the biggest predictor, the most solid predictor of the future is the past. If we look at what happened in the past, I think that that will give us a reasonably solid idea of potentially what could happen going forward. This is a multimillion-pound global industry that will want to protect its interests. We know that it is an incredibly powerful industry. Are you preempting any new arguments? Or are you just expecting it to be very similar to last time? Really, the evidence is saying that what was predicted to happen did not happen. I am just wondering if there has been anything else or any new ideas that have been brought to the table about additional concerns that they have now moving forward and any evidence that there might be a line on for that? I have not heard any particularly new arguments. As you say, some of the evidence has been quite comforting for the industry, so it showed that there has not been displacement into more harmful drugs. People are still buying alcohol, although less, but that is one of the really sophisticated aspects of the policy, which is that profits do not go down. Industries are not harmed by it, so that is one of the things to admire about it. We are looking very carefully at all the evidence, and Public Health Scotland is publishing evidence as we go along, but it will not be until the end that we have the full data and analysis from the four or five years that we are really able to draw conclusions about the solid, and it will be a solid and robust body of evidence that is built up. For those of us who were convinced about it, if I think back to the introduction of this policy, I was a health professional when this policy was introduced. I was working in a psychiatric hospital, and I was excited at the idea of a sophisticated, clever public health policy that would target in such a specific way harmful drinking. I expected it to work, and clearly this Parliament expected it to work, but we would not have passed it. The evidence is reasonably robust and solid, and certainly pre-pandemic was pointing in the right direction, but we need the full evaluation to make decisions going forward. The alcohol industry is not going to shape public health policy, but I am more than happy to hear any concerns that it might have. A report from the Institute of Economic Affairs has suggested that minimum unit pricing is responsible for a certain amount of displacement to higher value categories. MUPs resulted in an extra 8.2 million litres of pure alcohol being sold in the 50 to 64 pence per unit categories and a further 400 litres being sold above the 70 pence per unit category. What investigatory work has the Scottish Government commissioned into that level of displacement? Do you recognise the argument that MUP has pushed consumers towards the mid-range rather than away from alcohol in its entirety? If you think about it, that is what the policy was intended to do. It was intended to make alcohol more expensive. What we found was, when we looked at things that we could buy, we could exceed the 14 unit per week recommendation for £2.50 before the introduction of minimum unit pricing. That was the intention of the policy. That is not a downside of the policy. The intention was that people would have to spend more in order to buy each unit of alcohol. I may be oversimplifying that or not quite understanding your point, but isn't that what was made to happen? One of the points was to reduce the amount of alcohol that people were drinking. It was also an intention from the policy. All I am suggesting is that they are still drinking the same, if not more, just of those with a higher unit. The study that you have quoted shows that people are buying more expensive alcohol. What other studies show is that, at a population level, we are consuming less alcohol and the lowest level of alcohol consumed by people in Scotland for 26 years. Per head of population, we are only consuming 18 units of alcohol per week. That is still in excess of the recommended 14 units, and it does not quite explain the whole picture. Within that, there are some people who are abstinent or drink very little, and there are some people who are drinking very heavily. At a population level, both of those things are true. We have reduced, as a population, the amount of alcohol that we drink and the alcohol that we are buying to drink is costing us more. That is what the World Health Organization said that we had to do in order to tackle alcohol harm, which was to make alcohol less affordable. You talked about other studies on the population level, but is it not true to say that those studies show that problem drinkers are actually drinking more through the pandemic? Is it also not true to say that those people without a problem drinking, those who are drinking more moderately, have significantly decreased? Is that not what those studies are showing? So what Sue was asking and what the population answer you gave, I do not think that they quite match up. What I have said is that we need to drill further into the statistics that we have from the first year of the pandemic. We need to understand—the big picture is that the population drank less, and yet we know that we had the highest level of alcohol deaths, a 17 per cent increase on the year before, which is absolutely tragic. Some people must have been drinking more, and we think that that is a pandemic impact. We think that that is largely explained by the people who were drinking heavily before the pandemic, who drank more during the pandemic. We need to understand that better. We need to understand whether it has persisted, so whether that was a one-off change in response to an emergency situation, or whether that has persisted. However, we do not quite have the understanding of what happened yet. I think that we will need—certainly I will be keen to see this year's data to see whether it is a trained one-off that has stuck, or whether it is just a one-off related to, particularly, the initial lockdown in which healthcare services were so seriously impacted by the pandemic. No, no, absolutely. Minimalcal pricing was brought in to address problem drinkers, because, as you said, you could go over 14 years at £2.50. So, it is the problem drinkers that we are really trying to target with minimalcal pricing, because those who are spending significantly more on that alcohol are affected by minimalcal pricing, whether they have a problem with drinking or not. It is that group that is drinking very cheaply that minimalcal pricing was trying to target, but it does seem that they have drunk more. I will bring Amy in to see if she can add a little more detail or clarity to this. My understanding is that minimalcal pricing was on a whole population. It was not just targeted at people who were drinking heavily. It was targeted at people who were drinking heavily. It was targeted at particularly young children and young people who were buying very cheap alcohol. And what we expected was this world health organisation, which talked about the three best buys, one of which is affordability, was that if we made alcohol less affordable, there would be a shift, a general shift across the population. My understanding, and this is from my time working in mental health, is that a heavy alcohol drinking is a spectrum. There are some people who are completely abstinent, some people who drink very little, and there are people who drink more and more heavily until you get to problem drinking. What the policy of minimum unit pricing did was shift our drinking to a safer point on that spectrum. I firmly believe that there will be fewer people who run into the problem of alcohol dependency in future because we introduced minimum unit pricing in the past. We are seeing, and I do not think that it is entirely down to minimum unit pricing. I think that this is the challenge when you look back. There have been a number of changes, but children nowadays drink less. Children and young people are less likely to drink and drink in fewer units of alcohol than they did even in our quite recent history. Our policies are having an impact both on the population and on the problem drinkers. I will ask Amy to come in and see if there is any more clarity that she can add to it. One of the things that I was slightly skeptical about when I first came across this policy was whether people who are seriously addicted to alcohol and for whom their life revolves around alcohol would minimum unit pricing reduce the amount that they drink. The evidence does suggest that, as we brought the policy in, even those people who were most seriously addicted to alcohol would reduce the amount that they were drinking. We are talking about 23 deaths a week and over 600 admissions to hospital every single week in Scotland last year. We have to tackle that. As the minister said, minimum unit pricing was introduced. It was to aim population-wide and to tackle a hazard in harmful drinkers. I think that the evidence before the pandemic was that there was a decrease and there was some evidence to show that it was helping. Obviously, as the minister already said, it did not continue during the first year of the pandemic, but we still need to understand that in more detail. There were other factors in that, as the minister already indicated with regard to the hospital admissions. Obviously, access to services was impacted by the pandemic as well, so there were a number of factors involved in that increase in alcohol-related deaths that we do not fully understand yet. Public Health Scotland will be publishing a harmful drinkers study in the coming weeks, in which we hope to see and gain a better understanding of what actually happened and what has happened so far, since the minimum unit price has been introduced. Any changes to do with the minimum unit price will be in front of the committee anyway, so we will have ample opportunity in the future to drill in a lot deeper. We have to move on, because there are a number of other things that members want to ask questions on. In terms of reducing attractiveness, Gillian Mackay, you have some questions. I have spoken to football teams who have adopted a social responsibility approach to sponsorship and are moving away from associations with alcohol and gambling brands. That is obviously laudable, but they are in the minority and teams that are facing difficult financial circumstances will probably be less likely to take this step. What are your thoughts with regard to encouraging supporting teams to gradually move away from alcohol sponsorship versus an overall ban? Do you recognise that a ban is probably the best and fastest way of ensuring the end of alcohol sponsorship? Is there a possibility of providing financial support to clubs, either in the event of a ban or to those who do end alcohol sponsorship? Women's football is a shining light in this area, and they have a very responsible policy. They are sponsored by SHAP, and they do not accept alcohol sponsoring. That is a great thing. It would be great if all sports were like that. I think that the World Health Organization is reasonably clear that voluntary codes do not work and that legislation is needed. Other countries in the world have brought in legislation, and I think that France certainly has. Although we have seen quite clever examples of how the industry gets around the measures in France, we are very mindful of that when we are considering legislation. Ireland has either done it or is in the process of doing it. I think that we have spoken about that before—that study where we looked at the six nations. The level of alcohol advertising and promotion that children were most exposed to was in the Scotland-England match, rather than in any of the other matches, because many of the other countries—both France and Ireland—already have measures in place to protect children from advertising during sporting events. Carol, you wanted to ask some questions about this. If you want to start again, we missed the start of your question. No bother. Apologies for that. Good morning to people. I am very interested in the theme of reduced visibility. I wondered whether the Government or any research had been done around reducing visibility in places in which people who perhaps have problems impulse buy such as supermarkets and the notion that reduced visibility for children and young people in other countries has gone down the route of not having alcohol in the doors so that people nip in and out so that they go for milk so that they do not necessarily see alcohol. I wondered whether you have thought about that or whether there is any research that you are looking at on that. I am open to any approach that I think will work, but there are not currently any plans in place to adjust the licensing laws. I do not think that this will do this and the problem will go away. We are all accepting that the level of problem that we have in Scotland and the harmful relationship that we have with alcohol is probably going to take multiple measures over a good period of time to shift the culture so that we have a significantly healthier relationship with alcohol. You are right to talk about it not being just children and young people and impulse buying. In fact, the evidence would suggest that people who are in recovery struggle to see adverts for alcohol and take steps to avoid seeing adverts for alcohol. There is another group in our society, in our community, who find it very hard to resist the lure, the attractiveness of alcohol as it is presented to us today. It is not just children and young people. Have you any other questions? No, I just want to thank the minister for that question. I am hoping that we could possibly come back on it. I think that it is a mission that we should perhaps explode in Scotland, so thanks very much for that. Absolutely, always happy to work with you. Minister, for me, there is only certain things that the Scottish Government can do in relation to alcohol advertising, but some of it is also at UK level, particularly around the broadcast media. Are you aware of anything that has been done in the UK wide in terms of television advertising? Amy, do you want to confirm that? No, I am not aware of anything about television advertising, I cannot think. Amy, do you want to say what is happening in a foreign agency system? No, we are not aware either. Mr Todd did write to the UK Government in December, pushing for to look at advertising on TV, streaming and in the cinemas, but we are not aware of any action that has been taken in that area as of yet, but through that development, we will update the committee. I am going to move on to questions around reducing availability and alcohol licensing and questions from Sundesh. Minister, earlier you spoke about the WHO recommendations and price and availability is another key part of it. We have heard and some of us have experienced the problems when it comes to granting licences. A lot of councils feel that when they are presented with alcohol licensing they cannot say no to it because of worry of going to court and losing. I know that Glasgow is doing particularly well when it comes to trying to look at this, but is there anything that the Scottish Government can do to strengthen the hand of councils around the country so that they can say no to people who present with licences? Certainly, as I said, I am more than willing to hear from councils or stakeholders or cross-party politicians if there are things that they think that we could do to support local authorities. Much of the licensing, as you know, is in the hands of our local authorities, and that is in many ways so that they can make decisions that are appropriate for their own communities, which is absolutely the right thing to do. However, if there are any suggestions on what we could do to strengthen their ability to make decisions, I am more than happy to consider that. My concern—it is very important that we let councils make those decisions, but my real concern is the fact that they cannot say no. That is not a position that I think we should be in. The council should be able to make a decision and not worry that they are going to go to court and lose and end up spending a vast amount of money trying to defend their decision. I suppose that there is always a challenge. We are asking councils to make a decision based on balancing the rights of people who drink responsibly versus balancing the need to protect people who might be harmed by more ubiquitous availability. There are five high-level licensing objectives, preventing climate and disorder, securing public safety, preventing public nuisance, protecting and improving public health, protecting children and young people from harm. Those licensing objectives are ranked equally. I think that councils already have the powers and guidance on what they need to be considering as they make those decisions. Public health should be part of that consideration. If there is a particular suggestion that you have that you want me to consider in terms of strengthening the hand of local licensing boards, I am more than happy to hear it. We need to be in a position—with everything that you have said, Minister, it seems reasonable that a council should be able to say no and justify it. However, if we look up and down the country, that is not happening because councillors are worried that they are going to be taken to court and they are going to lose that court case and cost the council a lot of money. That cannot be the position that we are in. We need to be in a position where councillors can say no. I think that we are in a position where councillors can say no. They have considerable discretion to determine appropriate licensing arrangements according to their local priorities and circumstances and their legal advice. I do not think that it is appropriate for Scottish Government to intervene in those matters, certainly not in individual cases. As I have said repeatedly, if there is something that you think I need to do, at Scottish Government level, to strengthen their hand. However, we have seen our own experience, and it has certainly been that alcohol industry is very well funded and it is global. It is quite likely that they will use the law to challenge anything that impacts on their business, so that really is a reality. However, local authorities have responsibility to balance the needs of all the people living in their local area and to come to the right decisions that are best for them. I think that they are best placed to do it. I do not think that central government is best placed to do it. In terms of specific measures, I think that overprovision is one of those areas where we could do a wee bit more. Obviously, that falls under some of the areas that you just mentioned within the licensing arrangements. Do you believe that there is a place to be able to strengthen overprovision as a reason for refusing licences under one of those current areas that you outlined in your answer to Sandesh Galhany? Overprovision is a tool by which licensing boards can prevent new licence premises openings in the areas where they consider that there are too many licence premises already in operation. I think that it is a valuable tool. I am not sure if what you are asking is for me to support local authorities to use it more or encourage them. I think that that is absolutely the way to consider those issues going forward. I will speak to officials. I do not know if either of my officials would have anything to say on that. I will see if there is anything that we can consider within government already. We are not planning to change the licensing laws, but if there is anything that I can do to support local authorities to be more confident in applying them and achieving the balance that we all seek to achieve, I am more than happy to consider that. I am not sure whether the officials want to come in, if Amy Kirkpatrick wants to come in. We work very closely with our colleagues in licensing, and we are more than happy to work with them on anything that we suggest, but, as the minister said, work is not ongoing currently on that. I am aware that licensing colleagues are working on updated guidance for the licensing boards, which I think will hopefully alleviate some of their concerns. That is very helpful. Thank you. Very much, convener. My question is focused on the online purchases of alcohol. How do we further regulate that? It is something that became more and more prevalent during pandemic and lockdown periods. People can buy alcohol from Amazon and online sites. We saw the relaxation of licensing rules to allow clubs and venues to deliver to people's homes. I just wanted to get a sense from the minister of perhaps where, if there is any work that is going to be done to, I suppose, review the impact of online sales and what they contribute in terms of overall percentage. I think that you are absolutely right. It is an area of growth. The pandemic has shifted our behaviour at a population level in a way that we would not quite have imagined. That has happened with food as well, so we are consuming in a different way to the way that we consumed before. Premises such as pubs and things that are selling alcohol online have to have a licence, and they have to get a premises licence through the licensing board within the area where the premises are located. They still have a licensing process to go through. I agree that we need to consider how much alcohol is being bought from large national retailers such as Amazon. Much of the online world regulation is reserved to Westminster. We went over during the passage of the recent bill through Parliament, and I will ask Amy to come in on that. We went over whether online sales could be considered a public health issue rather than an online sales issue. The UK Government was quite keen to consider it as online sales rather than as a public health issue. We will continue to look at that. If I think about what has happened over the course of certainly the first year of the pandemic, we need a little bit more understanding of just exactly how consumer habits changed and what happened in order to ensure that that particular strategy of reduced availability is not completely undone by online sales. Ordering from Amazon in the morning and getting it delivered to your house in the evening. I am not sure whether Amy has anything more to say on that. I think that most of the discussion on that particular bill was about food online sales rather than alcohol online sales, but it is a growing trend across the board. It is a complicated area, especially since a lot of it is reserved to the UK Government. Our ability to make impact there is limited. It is one of the areas that we are considering as part of the consultation that is due to be published later this year. We are trying to work through what could be done and what that would look like. That will be out later in the year. I will bring in Emma Harper. There is another issue with online sales. If you sign up to a regular wine club or whatever, you will never stop getting promotions. For people who are having a problem with their drinking and want to move on from their drinking and stop drinking altogether, the constant marketing will never take you off a list. That must be really difficult for a lot of people. I accept that that is not perhaps in the powers of the Scottish Government. You are absolutely right to think of it that way. The World Health Organization talks about the three best buys being availability, affordability and attractiveness. Those wine clubs or cider clubs or whisky clubs or gin clubs, we have seen many different versions of the same thing. They absolutely target both the availability and attractiveness, so you get a great deal of marketing around them. Of course, it is there in your house without any effort, delivered to your home every month, every six weeks, however the frequency is. That encourages more drinking and more alcohol, and we definitely need to think about things like that. We are not going to shift our relationship with alcohol and suddenly overnight by pulling one lever. There are also things that come along that change our habits. The pandemic was one thing that completely changed almost everyone's behaviour overnight. We do not know whether those changes are going to stick or not. Other things that happen, such as wine clubs and things, I do not recall anyone when I was growing up being a member of a wine club, but it is not uncommon. We are going to need to keep looking at how our behaviour has changed and ensuring that the measures that we are using are keeping us in the healthy zone. We are not aiming for abstinence, we are not aiming for zero alcohol in Scotland, we are aiming for healthy drinking and a healthy relationship with alcohol. We just need to keep an eye on how behaviour change is going forward. Emma, I am going to bring you in. Thanks, convener. It is just a quick sub to what Paul's original question was. Other countries in Europe have gone through the pandemic as well, and we obviously need to look at what other countries are doing and learn from them as well about whether they have changed alcohol consumption habits during the pandemic and then what they are doing as well. I am interested to hear from the minister how we are learning from the other countries, how we are working with them, because in the world health organisations global challenges for alcohol harms and prevention, we need to learn from other countries. I will be interested to hear a wee bit of feedback about that. Absolutely. I will perhaps bring Amy in here again to supplement what I say, but we are always looking around the world to get ideas and to think how to solve problems. Things that happen in Scotland are rarely unique to Scotland. What is clear, though, is that Scotland does have a really troubled relationship with alcohol and we have had it for some time. If you remember back to the discussion around introduction of minimum unit pricing, one of the reasons that we were able to safely chart our way through the various legal challenges of that was that it was clear that we had more of a problem than most people and most other countries. We have to understand that. We probably need to do more to get our relationship on a healthy footing than most other countries in the world. Alcohol consumption is really cultural and it is really interesting when you look at different countries. Alcohol is much more available in Italy, for example. It is much more common to drink along with food, but it is often smaller quantities and it is almost always with food. The way in which we drink in Scotland is quite different. If you look at the Scandinavian countries, they equally had a difficult relationship with alcohol and brought in quite serious legislation around licensing and availability, so you have to go to a specific shop to buy alcohol. Of course, we have all heard stories about just how expensive a pint of beer is in Norway, although they all get paid very well, so that shows you the issue around affordability. We are absolutely happy to look at other countries, but it is quite a complex picture and we have to be careful not to just think, coo, that is an easy solution or an easy win here. We need to think about the Scottish context and how it would apply. One of the areas that we are looking very carefully at at the moment is the issue of alcohol marketing and sport. We are looking very carefully at what happened in France, because it is quite clear that the legislation that they brought in there is that some of the alcohol companies are getting around it. Without saying the brand of the alcohol, they are using perhaps the font that is closely associated with that alcohol in their advertising around the stadium. Everybody sees that it is not actually an advert for the alcohol, but it makes you think, oh, about that brand, the connection is there in your head. We are looking carefully at how that legislation has landed in France and what we might need to do to close that loophole before it is exploited. It is complicated and cultural, and it will take some time for us to unpack. I do think that we have a long way to go, but we have been for some years now headed in the right direction until the pandemic hit. Another area that we would like you to consider is social responsibility levy and questions from Gillian Mackay. We have heard from previous witnesses about the benefits of introducing a social responsibility levy on alcohol retailers and alcohol focus Scotland are in favour of an alcohol harm prevention tax, which would be linked to the volume of pure alcohol sales and which could be used to offset the harms caused by alcohol. The Scottish Government has previously said that it will not implement measures such as a responsibility levy. Until the wider economic circumstances are right, can the minister clarify what the right economic circumstances would look like and do you recognise the benefit of an alcohol harm prevention tax? I have to say that the minimum unit price of alcohol was the route that we went down, and I know that there was a lot of discussion about the time, about whether the tax aspect of that, whether that money should come back to be spent on treatment and prevention. Part of the reason that that has landed well is because it did not affect the livelihoods of those people selling alcohol and it did not impact on the industry. There is a lot of industry, alcohol industry in Scotland, so increasing or decreasing affordability without impacting on the wider economy is quite a sophisticated way to tackle it. We need to look at what the impact of minimum unit pricing has been and we need to understand how that has changed behaviour. That will require us to wait just a little longer for the full evaluation of that. I would definitely keep the possibility of a social levy under review. I am interested in anything and everything that I can do to tackle that challenge, but I do not think that it is particularly around affordability. I think that we need to better understand the impact of minimum unit pricing, which is in the same way. That would be the two strands of it, one, whether it works and, secondly, reviewing the actual unit price before we could consider introducing a different taxation to tackle the same issue. Sue Webber has a question on that. Thank you very much, convener. It sort of does feed on from what Gillian Mackay was saying, it has been revealed that one of the impacts of minimum unit pricing has been that Scottish consumers have contributed £270 million more than was projected in terms of their spend on alcohol now. With what consideration has the Scottish Government given to the possibility of room-fencing proceeds from alcohol rehabilitation and treatment as the current model feeds the revenue straight back into the supply chain? We are open to considering that. That is why I say that we need to look very closely at what has happened with minimum unit pricing and one of the things that we need to look at is that we carefully crafted it so that it would not harm the economy and it would not harm employment opportunities and local shops and things, but if what has happened is that they are getting a windfall from it, then I think that we need to consider that going forward. What I would say strongly is that we need to better understand exactly what is happening on the ground before we make a decision on our next steps. I am really not averse to the potential for a social responsibility levy. I am willing to consider it. I do not think that this is the appropriate time to do it. When I give over the rest of our time with you in this session to talk about treatment, the first part of our scrutiny is about ABI's and questions from Emma Harper. Good morning, cabinet secretary. We heard evidence about alcohol brief interventions and what they mean for people. That could be an easy win for addressing poor health outcomes related to alcohol. Is that something that we have more evidence about how alcohol brief interventions are working? How do we support a variety of opportunities for the ABIs to take place? You are absolutely right. ABIs are a really useful tool. They are short, evidence-based and structured conversations about alcohol consumption. They are non-confrontational, they are motivating and supportive. They are really attractive tools for health professionals and potentially others to use just opportunistically when there is a chance to have a chat. It can potentially reduce the risk of harm from alcohol. We began a piece of work on assessing evidence on the current delivery of alcohol brief interventions. That was another piece of work that was impacted by the pandemic. Public Health Scotland was carrying out that work for us and wanted to look at how it could better meet the needs of individuals. We are just picking that work up again. We are keen to—we are establishing a revised strategy group to review and discuss the evidence with the purpose of developing new recommendations on how best to take them forward in Scotland. The terms of reference for that group are being finalised and Public Health Scotland will be the secretariat. General practitioners or GP practices are no longer incentivised to deliver alcohol brief interventions. Does that mean that we have to think about alternative ways of delivering ABIs in order to—we often talk about the GP or the practice nurse. That is the first port of call for many people that alcohol might not be what their issue is, but it could be leading to whatever health issue they have now got symptoms that need to be addressed. How do we help to support that wider GP practices to deliver ABIs if they are not being incentivised any more? We are reviewing the evidence as a whole. We will look at what currently happens in practice. I suppose that the way that people access general practice and primary care has changed significantly over the course of the pandemic. We will be looking carefully at who is best placed to deliver ABIs, where people are accessing help and support, where those conversations might happen, whether it might be other members of the primary care team other than the GP. I am keen to look at all that going forward and to come up with some recommendations that will help to support the use of alcohol brief interventions. Most people agree that that is quite a useful strategy for opening up conversations and beginning the process of motivation towards change. We will see what we can do. I apologise, Emma. Just a final week. Obviously, the pandemic has affected alcohol intake. Obviously, it has affected how we support and deal with people. I remind everybody that I am still a nurse. I am interested in how the pandemic has affected ABIs. What have we learned from that that we can do to support ABIs differently? We know what I am thinking of. We can attend anywhere near me for video interventions as well. If I am honest, we do not know the last year that we have data available for us 2019-20. It is just before the pandemic hit. What we saw there was that there were 75,616 ABIs that year, which was 23 per cent more than the previous year. No, it is 23 per cent more than the standard that we asked people to aim for. However, we need a fuller picture of what has happened with ABIs over the course of the pandemic. You will know from previous. I am a huge fan of near me. I think that there is a real opportunity to use that technology. I think that alcohol brief interventions can be a useful tool virtually, as well as in person. We will try to get the evidence to make sure that that is supported going forward. Following up on that minister, we have already heard that the alcohol-related deaths are increasing and have increased 10 per cent since 2020. You have also said that ABIs last year of data were 2019-20. When you said that there was a 23 per cent increase than the standard that you expect. However, in the period between 2013 to 2020, there has been a 28 per cent decline in the number of alcohol brief interventions. We have heard that you are reviewing evidence and tackling it, but what can we do immediately? What can we do in the short term to really uptick again those ABIs, which are so critical, particularly in the deprived areas? The work that is going on with Public Health Scotland to review ABIs began prior to the Covid pandemic. It will reflect on the experience of the pandemic across Scotland. Those actions are well under way, so I am expecting them to be able to report. I am expecting that the strategy group would convene somewhere this year. In terms of immediate actions and immediate levers that you can pull, it is difficult because we do not quite understand what happened or what the barriers were. We really need to understand what led to that increase in deaths right across the UK before we know what is going to be effective at reducing that in future. We also need to understand whether it is going to be repeated if it is a consistent behaviour change or if it is just a one-off. I think that it is frustrating and I am desperate to solve the problem. I am really keen to do what we can. I feel that it is urgent. I feel that every single one of these deaths is a tragedy, but we need to better understand the situation before charting our way forward. We are now going to go on to general treatment of alcohol harms. Evelyn Tweed Thanks, convener. Good morning, minister. It is not easy to track overall spending on alcohol and drug deaths—sorry, services, apologies. Can the minister provide an update on funding for alcohol services, including a breakdown of contributions from all partners? I can. I agree. I think that the Government acknowledges that it is not easy to track the spending, and we are keen to improve that. Angela Constance has responded to that audit report in the chamber. We want people to understand where the money is going and what outcomes we are expecting and achieving from it. The Scottish Government gives health boards £53.8 million a year in baseline funding. That is passed on from health boards to alcohol and drug partnerships. That supports alcohol and drug treatment and recovery services at a local level. As well as that, in 2020-21, the Scottish Government allocated an additional £17 million to ADPs by continuing the commitment that was made in the 2017-18 programme for Government to improve the provision and the quality of services for those with problem drug and alcohol use. As well as that, we are undertaking a whole range of work that is specifically to improve alcohol treatment services across Scotland, including the development of a public health surveillance system and the implementation of the UK-wide clinical guidelines for alcohol treatment. We have also invested in—I think that I have mentioned it before—the Simon Community Scotland programme. We have established a small-scale managed alcohol programme in Glasgow, and we are providing funding of £212,000 over three years for that pilot and for that evaluation. The Scottish Government provides funding to a number of third sector stakeholders, such as Alcohol Focus Scotland, Scottish Health Action and Alcohol Problems, Scottish Alcohol Council and Consortium, to develop their vital work. The final thing to mention is the national drugs mission. Those two things are not separate services on the ground. They are delivered usually by alcohol and drug partnerships. People go to the same services. The investment of £100 million, which is being invested by the national drugs mission over the length of this Parliament—so £250 million is being invested by the national drugs mission over the course of this Parliament. £100 million of that is directly to residential rehab, of which in the last year, if you looked at the data, 45 per cent of the people accessing residential rehab had alcohol problems, about 20 per cent had combined drug and alcohol problems, so that investment also benefits this population. There is obviously a balance between the Scottish Government focusing on drug and alcohol services, and some witnesses felt that there was more of a focus on drugs and drug deaths at the present time. How can the Scottish Government ensure that alcohol services get its share of resources at local level? We are very, very aware of that. Myself and Angela Constance work very closely together, and our officials work very closely together. In fact, I will perhaps ask my officials to come in on this and explain how that works. We recognise that there is learning for us from the work. In alcohol, we recognise that there is learning coming from the national drugs mission that we need to apply in exactly the same way to our services for alcohol. Our services, some of the criticisms that are made that they are not person-centred, that they do not respond rapidly enough, could equally and easily be made about our alcohol services. We are determined to learn the same lessons going across. The other thing is that, just the way that things are structured and the delivery of treatment for alcohol problems and the delivery of treatment of drug problems happens in the same location. Those services are co-located and they are often the same services, so investment in one will benefit investment in the other. One of the pieces of work that we have done jointly, which is quite successful, was the work to tackle stigma. Stigma is a problem in treatment of both areas. Taking a joint approach on that issue has proved quite helpful. We had an advertising campaign recently that was talked about stigma, which covered both alcohol and drugs, and I think that it landed quite well. We will make a difference to the perception that we are very keen. At core, we want a patient-centred public health approach, a rights-based approach, and we want people to be able to access those services easily and for there to be no judgment as they do so, and that applies across the board in addiction. We are keen to learn lessons and very keen to—certainly the work that is going on around the medication assisted treatment and that will be helpful when we have our UK clinical guidelines for alcohol treatment in terms of how we implement them and how we make sure that that is quickly adopted and happens on the ground. I will ask Maggie to come in and say a little bit more as she is in the drug team. It is time. We only have 10 minutes left and we have a couple of members who want to ask questions, so I will bring in Maggie and we will move on to questions from Sandesh Gohani. Thank you, convener. I will be brief. Just to follow up on what the minister said, there are a number of areas that we work very closely between the alcohol team and the drugs team on the official level. Specifically, work around workforce, which has been taken forward by the national mission, is looking at workforce for both alcohol and drug services. Stimlerly, we have lived experience and the whole family approach framework applies to both. Stigma, as the minister said, as well as residential rehab, which is a £100 million commitment from the national mission funding. Around half of people so far who have been funded to go to residential rehab placement this year have been for alcohol specifically. However, the other interesting point that we should not lose sight of is that a lot of people are presenting to services with problems of both alcohol and drugs, so we have to look at those things in the round, because they are not differentiated at the level of the service user in many cases. It is important that the minister has said that the drug and alcohol service is often co-located, and that is almost always the case. The patients going to residential rehab, some of the survey, the work that we have done, has shown that they have dropped out because they were unwilling to wait longer. I am sure that, as the minister knows, when patients present wanting help, they often have a small window, because they often have chaotic lives, they might lose stability, they want to achieve abstinence wanes over time. I am sure that the minister has also seen that Scottish Conservatives have published the right to recovery consultation, with 77 per cent respondents being supportive. Would the minister agree to seriously look at our proposals and to support them? Certainly, I do not think that that consultation has been published yet, or that it has not been published half past four on Friday, but I have seen the media around it. I am not aware that the council ran into the holiday weekend before it managed to get published. We will be poring over that information, and we are very interested in the approach that is being proposed in that bill. We know that there is a mixture of views out there in society from stakeholders and from people with lived experience. We are quite keen to see how that consultation, which I expect to reflect on those diverse views, evolves into a bill. Of course, we are more than happy to consider a bill when it comes forward to look at what your bill states and whether that is something that we can support for Scotland. We are very keen. Much of what the bill aims to do, we are already working on it. We are very keen that people have a right to recovery. We are very keen that they should be able to make an informed decision about what treatment they have. The way that you framed your question gave the impression that the Conservative right to recovery bill is largely about residential rehab. I would be very clear that people need to have access to a range of treatments rather than one. The goal of abstinence or harm minimisation of those goals needs to be decided along with the person who is experiencing drug misuse. I would not say that there is just one path or one goal in recovery. It is usually a long path and a bit of a windy one, so a whole suite of options need to be available to support people as they recover from addiction. We must move on because we only have five minutes left and Emma Harper needs to cover inequalities. To hear from the minister about how we are helping to support tackling alcohol harm in terms of inequalities. In the SHAP briefing that we got, it specifically talked about how LGBT people misuse alcohol in different ways and that sometimes they felt that the services that were available were basically focused on heterosexual people and sometimes the services might be needed to have a more person-centred and holistic approach. How do we help to support reducing alcohol harm in harder-to-reach groups and in areas where there is higher inequalities? That is a really excellent question. SHAP has done some really interesting work on a couple of areas on inequalities, just published studies last month. They have the one on LGBTQ+, but they also had the one from Dundee University, which looked at the deep end practice nurses, alcohol nurses and deep end practices, which particularly targeted socioeconomic deprivation. The evidence around the LGBTQ+, is that that particular community experience more alcohol harm. They use alcohol in a different way. There are probably a number of reasons for that, but being a minority that faces hostility and discrimination would likely influence drinking behaviour. There is also the historical issue that safe places for people are often bars and clubs, so we have to, as a society, reflect on that piece of learning and think about how we can change that going forward. Most of the recommendations about making services inclusive were for people delivering services on the ground. I absolutely support the work that has been done on the recommendations that have been made, and I am quite keen that service delivery reflects that learning. I hear from a number of groups that services do not look like that for them, as well as LGBTQ+. I think that that study showed that most people's perception is that services are for middle-aged heterosexual men. We have women feeling like they cannot access services and young people feeling like they cannot access services, so we really need to reflect on that. We have a problem with alcohol right throughout society, and we really need our services to be inclusive and welcoming and to help people, because it is quite hard to ask for help, so we need them to land when they come in. I represent a rural area, a remote area, and I know that you will be very familiar with challenges in remote and rural as well. Can you tell us a wee bit about how we are looking at tackling alcohol harms in remote and rural areas? I am absolutely right, as a Highland representative representing the most far north and quite sparsely populated in some parts of its constituency. This is an area where we have a long history of alcohol harm. It is an area that I am very interested in. We definitely need to improve access in every part of Scotland, so all those health inequalities that play out in our general health system, we need to be thinking about accessing alcohol treatment, so we need to look at geographical inequalities, women, poverty and LGBTQ+. We are absolutely keen to make sure—because that is a problem that occurs all over Scotland, and perhaps to a greater extent in some of our more rural populations—absolutely our services need to be able to deliver in rural areas. Thank you minister specifically for drawing attention to the inequality that women face in terms of accessing services. 51 per cent of the population are struggling to access services that are being developed, and that should probably be the number one priority given the makeup of this committee. Alcohol-related hospitalisations and deaths are eight times higher in the most deprived areas of Scotland, and that should be a shame for all of us. We really need to figure out how we can target and support those communities. Support mechanisms for alcohol misuse are often far more sparse in those deprived areas, and they are in the most affluent areas, which I have also alluded to. What can we do to narrow that down, narrow that gap and really target into those deprived communities? I am glad to have your allyship on the women. Of course, as women's health minister it would be remiss if I did not highlight the health inequalities that women face. You are absolutely right. There is a stark social gradient in terms of alcohol harms, with those in the most deprived areas being the most affected. We need to take a whole population approach when we are tackling this and alcohol consumption and the risk of alcohol related harms, and that will in turn drive reductions in alcohol harm in our most deprived communities. Those whole population measures, like minimum unit pricing of alcohol, will have an impact in those communities as well. They will not just affect them, they will not just affect rich people, they will affect everyone and have the feel the benefit right across society. I mentioned a study by SHAP that highlighted the effectiveness of alcohol nurses in the deep end practices in Glasgow. Those are nurses who support people with alcohol problems who have complex needs. The Scottish Government is keen to understand that. We find that some people really need effort to put in to ensure that they are able to receive joined-up services. There are probably lessons to be learned across the board about improving access to services for everyone, but there is probably a particular population that we need to do something slightly different for. We need to reach out to them, we need to hold on to them and we need to make sure that we do not let go until they are on a more healthy footing. I think that that is what that work was doing. I am keen to explore that further. I mentioned the Simon community work, so that managed alcohol programme. It is a very small number of people, but it is particularly targeted at homeless people. We are keen to get the learning from that to see whether we can make a difference to that particular population. The final point to make—we have had this discussion before—is that we need to think about what drives alcohol harm. We need to tackle poverty, tackle inequalities, provide good quality affordable housing and enable the best art of life for our children. All of us should absolutely be laser focused on that when we are thinking about tackling alcohol. Minister, I want to thank you very much and your officials for your time this morning. This minister is going to continue to join us in our next part of our agenda, but we are going to take a 10-minute break and return at quarter past 11. Welcome back. Our third item today is another evidence session with the Minister for Public Health, Women's Health and Sport. This session is focused on the provisional common framework on food composition standards and labelling. Welcome again, Middie Todd Minister for Public Health, Women's Health and Sport. She is joined online by Jennifer Howie, the UK framework and intergovernmental relations leader for Food Standards Scotland. Thank you for staying on, Minister. I believe that you have an open statement. Certainly. I want to thank the committee for inviting me here today to assist in their deliberations of the provisional common framework for food composition standards and labelling. Officials in Food Standards Scotland have been working with their counterparts in DEFRA and the Food Standards Agency in Wales in Northern Ireland to develop a four nations approach to deliver repatriated EU functions on common areas of interest in the framework. The ministers of the four nations have agreed the content of the provisional framework, which was published as a UK Government command paper on 17 February 2022. Policy and food composition standards and labelling were and continue to be highly regulated at EU level. The purpose of the framework is to ensure that there is a joined up approach across the UK for the continued maintenance of high standards of safety through delivery of regulatory functions in this area. Throughout the process, we have committed to working collaboratively to develop common frameworks on the basis of consensus and in line with the agreed principles of the joint ministerial committee on EU negotiations. That includes the principle that UK frameworks should both ensure the functioning of the UK internal market as well as acknowledging the apology divergence and that they should respect the devolution settlements and the democratic accountability of the devolved legislatures. Scottish ministers fully support the common framework programme and consider that frameworks are all that is needed to manage any potential legislative divergence in the future. We consider that common frameworks provide necessary and proportionate assurance to respective Governments, legislatures, consumers, citizens and industry on issues concerning public health and that internal market issues are duly considered in food composition standards and labelling policy development but are not prioritised over consumer interests. I am happy to answer the committee's questions. Thank you minister. This is one of quite a few common frameworks that I have been looking at over a period of time in the past few years since the exit from the EU. You say that the four UK partner Governments have agreed on this, but we have just had a session where we have been talking about labelling for public health reasons to do with an alcohol label whatever. Was there any areas of debate around this? Public health goals in particular countries might be slightly different or mechanisms that they feel or be appropriate to get to those goals around labelling. Was there any areas of debate around this ahead of you agreeing to the common framework? What the common framework provides is a way of working together. That does allow for divergence to occur. As I said in my opening statement, we are confident that the common framework provides a useful way of managing those discussions, ensuring that there is early engagement, ensuring that we work together to try to achieve consensus and that where divergence does occur, it does not take our neighbours by surprise. The most likely area of divergence here is that the Scottish Government generally wants to align itself with the EU. If there is an area of EU food information law that changes, it is likely or possible that Scotland might want to align with the EU and the rest of the UK might not. Although, of course, Northern Ireland will have to align with the EU. It is really just a way of working. Do you believe that there is space within the common framework in order for those discussions to happen about anything happening in the future and that there is space for scrutiny at a parliamentary level for us to be able to keep abreast of what is happening in the space? The core purpose of the framework is to prevent disputes through close collaboration between the four UK nations, while respecting the devolution settlement, so enabling policy divergence. The aim of the framework is to avoid where possible the need to trigger the dispute resolution process. In terms of scrutiny, I think that Parliament will engage with the framework through the decisions that it will be asked to take on any change of legislation proposed in this policy area. It is essentially a way of working. The framework is essentially setting down the mechanisms for working together with the other administrations of the four UK nations that share these islands. The framework commits to the Scottish Government to making joint decisions about some food products that it would have previously had autonomy to regulate. Does the minister have any concerns about whether that will impact the Government's ability to regulate food products on public health grounds, for example? I do not have concerns particularly about the framework, as I said. There is a healthy method there, a way of working and collaboration with the four UK nations and a way of resolving conflict and a way of enabling divergence should that be required. I have more concerns about the internal market act on that front. The internal market act tramples over devolution and was not consented to by either Scotland or Wales for exactly those reasons. The public health concerns around the internal market act were very well rehearsed as it passed through Parliament. That piece of legislation concerns me that may well constrain or weaken my ability to take public health action in Scotland, because products that are able to be sold in England will automatically be able to be sold in Scotland, too. Could you provide clarity about the dispute resolution process where differences occur, and are you satisfied that an effective process is in place? I am satisfied that there is an effective process in place. I hope that we do not reach that point. For all the impression that is given that we are regularly in conflict with each other in these four nations, we work quite closely together on a number of issues across the board in health. We have strong working relationships, particularly in my portfolio, so I would expect us to be able to avoid triggering that conflict resolution process. I will bring in Jennifer to talk a little bit more about the detail about how it will work and should it be triggered. Sure. Thank you, minister. I think that you have pretty much covered it, but the intention is very much for officials to continue to work together. Jennifer has frozen. We will bring her back. Essentially, there are different tiers of intervention, and we would expect much of that to be resolved at the official level, as it currently is. We would expect that to continue. For ministers to be able to be pulled in to work together to resolve the issues should that be needed, but that would expect that to not happen on a very frequent basis. Thank you. I move on to the theme of managing divergence. Sandesh Gohani. Thank you, convener. In February, you spoke about how you were keen to remain aligned with EU law, where such alignment is appropriate and in Scotland's best interest. Could you give any examples of where the Government may choose to diverge from EU law? In this policy area, I probably can't. Brexits has been a very recent phenomenon, so in terms of how our systems work since we have left the EU, I think that it would be quite difficult to think of examples since then. I think that it is perfectly possible if you think about how the structures work. The Food Standards Scotland advice as in government on safety of food products. It may be that a different body in the EU body gives the EU different advice, and we might decide to stick with the advice that we had gained in Scotland. It is possible—what I say is that we will align with the EU where we possibly can. We in Scotland are very clear that we did not want to leave the EU, and certainly this Government is keen that we rejoin the EU as soon as we are in an independent country. In the meantime, we will have structures in place that will give us independent advice, and we will make those decisions that are best for Scotland at this moment in time. The Internal Market Act 2020 has already been alluded to, but we have some more detailed questions from David Torrance. Thank you, convener, and my favourite subject minister. What impact will the United Kingdom Internal Market Act 2020 have on Scotland's law and the food composition standards in Labour? In our analysis—this is why it causes so much concern—the operation of the Internal Market Act 2020 means that, irrespective of the necessity or the proportionality of any public health priority in Scotland or, indeed, any other part of the UK, any national measure could be caught and radically undermined by the automatic application of the act's market access principles. In place of a common framework that is designed to manage policy divergence by dialogue and agreement, we would see the effective automatic recognition of standard set elsewhere, regardless of the local circumstance, or the wishes of the relevant legislature, or the policies of the relevant administration. In evidence to committee, Quality Meet Scotland argued that it is vital that a common framework should respect devolution settlements by allowing policy diversion and whether the Scottish Government intends to request any exclusions from the UK Internal Market Act 2020 and the policy that it has recovered by its common framework. The Internal Market Act 2020, although it came into power in 2020, is still bedding in. I would say that we are still trying to understand the impact of that piece of legislation on our public health decisions. I cannot think of an example at the moment where I would be looking for exclusions, but if we get back to the topic of the framework, the framework allows for divergence and it respects the devolution settlement. That would absolutely, for public health reasons and for all reasons, be why we would prefer that mechanism for resolving divergence. Maybe before I come to Evelyn, I will let the minister know that Jennifer, your official, is back online. Sound only, I will not bring her back in just now, but just so that you know that she is there, she will need to refer to her. The minister has helpfully covered my areas. I move on to some questions around the Northern Ireland protocol with Emma Harper. The Northern Ireland protocol interests me because of the Port of Cairnryan and travelling for products and goods between Cairnryan, Scotland and Larn and Belfast. I am interested in the Northern Ireland protocol and how the food compositional standards and labour and framework impacts on that or affects it. Under the UK-EU withdrawal agreement, Northern Ireland will remain in the UK, in the customs territory, but remain aligned with EU regulations. That means that Northern Ireland has to do what the EU regulations require. Scotland did not vote to exit the European Union. Would there be an issue where Scotland could be part of the EU alignment regulations and still work the way that the Northern Ireland protocol is intended? That would be interesting in pursuit. If we chose to continue to align with EU policy, we could work as part of a Northern Ireland protocol. The framework is for country agreement, and it was intended to drive consistent approaches across the UK, while acknowledging policy divergence. It is absolutely clear that any change to EU law will have to apply in Northern Ireland, so there will be divergence. Should the other countries in the UK choose not to align with the EU, Scotland has a policy aim of remaining aligned with the EU, but should England and Wales choose to diverge, there will be divergence across the UK. It is an inevitable consequence of our exit from the EU and the Northern Ireland agreement. However, the framework enables even that situation to be managed carefully in a way that will work so long as the policy options are undermined by robust evidence and the framework policies processes are followed. There is absolutely no reason why any divergence pair say should undermine the framework. The framework enables divergence. It does not prevent it. Emma, have you anything else to add? No, I think that that is okay. I am again just concerned that, if the framework allows or enables for divergence, that means that the framework supports the continuation of a Northern Ireland protocol that has been established to allow Northern Ireland to continue to be aligned with EU regulations. Is that right? Yes, Northern Ireland will automatically align with EU regulations. That is what will happen in future where, as Scotland, we will make a policy choice to align with EU regulations. I guess that is the difference. Emma, I have a final question from Stephanie Calwarhan. I wanted to ask you about the periodic and exceptional reviews. Does the Scottish Government have any concerns about those and how they are triggered or is it something that you are quite happy with? We are quite happy with that. The intention is to review the framework a year after implementation and at three years thereafter. It really is, at heart, just a document that describes a way of working healthily together and productively together. If there are any issues arising, that might be more about whether the framework was followed. We are just all getting used to this new world, so it might be that the framework was not followed rather than the framework itself is faulty. We need to let the processes bed in a little before we can fairly assess whether our review process is appropriate. We will certainly keep an eye on how those things work. I think that, as I said, all four UK ministers are agreed that this is a reasonable way forward. I hope that it provides us with a way of working together that avoids conflict and where conflict and divergence is necessary. It enables that as part of the devolution settlement. How will the Scottish Parliament be able to contribute to the review process and other stakeholders? Is that something that is set up yet? Is there a process for that? There will be future discussions between Scottish Parliament and Scottish Government officials who will definitely consider a possible approach to the post-implementation monitoring framework, but I would expect Parliament to be fully involved. There are individual review processes in place that are currently being developed. I wonder if Jennifer MacDonald wants to say a little bit more about that. FSSs are responsible for three of those frameworks, and they will collectively involve a whole number of departments across the UK. There are consultation stakeholders and so on about how to ensure that the process is well informed, try to cat out and duplication of effort on all four nations, but also to make sure that there is plenty of evidence coming forward to inform decisions. I will ask Jennifer to say a little bit more on that. I hope that everybody can hear me in apologies for my poor line rural Aberdeenshire. Yes, I think that it's fair to say that there's probably a two-pronged sort of way of, you know, a two-pronged way for stakeholders and the parliamentarians is to scrutinise how all the frameworks are working. In terms of the outputs of the framework process, those will be items of draft legislation that come before Parliament. If Parliamentarians fail in respect of legislatures that there's an issue arising in relation to any specific item in terms of the consultation, there would be feedback potentially that way. In relation to the broader programme of frameworks that have been developed in the scripts themselves, Scottish Government officials are working with their cabinet office counterparts and other administrations have been responsible for putting together the programme in terms of the detail of the following important portfolio areas. They are currently developing guidance in terms of potentially annual reports, for example, that might come before the Parliament in specific framework areas, whether they're singular or batched. As the minister says, we wouldn't want to be overburdening the legislatures with framework reports, but should those be forthcoming, which we would expect to be the case, then those reports, as presented to Parliament, would provide another opportunity for feedback. There's the output of specific issues in terms of draft legislate opportunities, which could include feedback on whether the process was considered to have been followed in relation to those items. We're generally on the operation of frameworks and the system. Discussions are on going across the administrations on the latter. We did hear you, Jennifer, a little bit patchy in the areas, but we got the general gist. Minister, we have no more questions for you, so I want to thank you very much for the time that you spent with us this morning on both agenda items. We'll have a minute or two suspension to allow the minister and her officials to leave before we move on to the next items in our agenda. Our fourth item on the agenda is consideration of two negative instruments. The first instrument is the national health service superannuation and pension schemes miscellaneous amendments Scotland regulations 2022. This instrument makes changes to the employee contribution table from 1 April 2022, which updates the salaries, earnings and bans on which the employee contribution percentage is set. The instrument also makes temporary modifications to the NHS pension scheme Scotland regulations, which have a similar effect to section 46 of the Coronavirus Act 2020. Following the expiry of the Coronavirus Act 2020, the instrument will temporarily extend those provisions until 31 October 2022. Section 46 of the Act spends certain rules that apply in the NHS pension schemes in Scotland so that NHS staff who have recently retired can return to work, and those who have already returned can increase their hours without there being a negative impact on their pension entitlements. The Delegated Powers and Law Reform Committee considered this instrument at its meeting on 26 April 2022 and agreed to draw this instrument to the attention of the Parliament on the following grounds. First of all, the committee draws this instrument to the Parliament under general reporting ground for a failure to follow proper drafting practice, as provision should have been made for regulations 2 to 5 to have a retrospective effect rather than coming into force prior to the instrument being made. The committee also draws this instrument to the attention of the Parliament under reporting ground for a failure to comply with laying requirements in accordance with the laying requirements in section 28 of the Interpretation and Legislative Reform Scotland Act 2020. A couple of administrative points there. No motions to annul have been received in relation to this instrument. Do any members have any comments to make in relation to the instrument? Thank you. Just a declaration of interest. I am an NHS doctor and indeed am in the pension scheme. I would have liked to have seen this go a bit further and help consultants and those in the NHS who cannot do extra work because of the pensions causing an issue, as we see in Wales, but I understand that this is not a part of the consultation. Thank you very much. Do we have any other comments from members? No, we do not. I propose therefore that the committee does not make any recommendations in relation to this negative instrument. Does any member disagree with that? We are all agreed on that. The second negative instrument is the national health service, general medical services contract and primary medical services section 17C agreement, Scotland amendment regulations 2022. The purpose of this instrument is to require NHS boards to provide various services to support GP practices and require GP practices to have a practice website and offer certain online services to patients. The Delegated Powers and Law Reform Committee considered the instrument at its meeting on 26 April 2022 and made no recommendations and no motions to annul have been received in relation to this instrument. Do any members have any comments on that? Thank you, convener. I declare my interest as a NHS doctor working in primary care. I would just like to put on record that, whilst I am supportive of us having more online access, I want to ensure that people who struggle to get online do not feel that they are unable to access appointments, especially if they have become exclusively online or the majority are. Those are no longer available when they call in and we need to ensure that we find a balance. I think that most of us, all of us here, would be in agreement with that sentiment. If there are any other comments that people want to make, please let me know. Thank you. I propose that the committee does not make