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Work on reviewing the level of the minimum unit price is under way. That is 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 the minimum unit price is the need to ensure that minimum unit pricing continues as a policy. You will remember that, when the legislation was passed, a sunset clause was built in, which requires the Scottish ministers to lay a report before the Scottish Parliament as soon as is practical after the policy has been in place for five years. That will be on 30 April next year. We just passed the four-year anniversary of the introduction of the policy on 1 May. We are doing both of those reviews simultaneously, but the focus has to be on the five-year review, because there is strict legislation in place on the timetable for that.

There are other issues. We know that the pandemic has changed behaviour and the way we drink. We need to better understand that when we think about the minimum unit price.

We also have the cost of living crisis. We are keen that the minimum unit price should reflect affordability rather than simply cost or price, and the World Health Organization is clear that that should happen. Therefore, the fact that people’s household costs have increased substantially will have an impact on how we review the minimum unit price.

Finally, the United Kingdom Internal Market Act 2020 has changed the landscape. There was a lot of discussion as that legislation went through, and the Scottish Parliament did not consent to it. That may well have changed our ability to take public health measures in Scotland that are different from those in the rest of the UK.

I have alluded to the level of complexity at this time. We need to have a robust evidence base as we review the minimum unit price. I am not going to automatically assume that we uplift it. However, as we review it, there needs to be a robust approach and a solid evidence basis to inform that decision. A lot has changed—a lot more than we anticipated.

It is attractive for us to consider some sort of automatic uplift, but I am not convinced. I talked about the challenge with linking it to inflation, which would not capture the issue of affordability. Inflation is going up, but so is the cost of living, so people have a lot less money in their pockets to spend on alcohol. At this time, we are spending a great deal more on energy and on the highest taxes since the 1950s. We need to look at affordability.

It is perfectly possible for us to do it, and to do it automatically. In order for it to be effective, it probably has to be reviewed on a more regular basis than it has been.

An obvious area would be in relation to labelling, for example. We are very keen in Scotland to have both the 14 units recommendation and calorie labelling on alcohol. Should we choose not to proceed with that on a four-nations basis and should England choose to do things differently, if a product was passed as suitable for sale in England, it could also be sold in Scotland. That would weaken our ability as a Government and Parliament to take public health decisions in and for Scotland. That was one of the well-rehearsed arguments at the time of that bill passing. That is an obvious example.

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 those figures. The big picture is that the population drank less, yet we know that we saw the highest level of alcohol deaths—a 17 per cent increase on the year before, which is tragic. Some people must have been drinking more and we think that that is a pandemic impact, which we think is largely explained by the fact that people who were drinking heavily before the pandemic drank more during it.

We need to understand that better, and to understand whether that was a one-off change in response to an emergency situation or whether that trend has persisted. However, we do not yet quite have the understanding of what happened, and I will certainly be keen to see this year’s data to see whether that trend has stuck or whether it is just a one-off that is related to the initial lockdown particularly, during which the pandemic so seriously impacted healthcare services.

I will bring Amy Kirkpatrick in to see whether she can add a little more detail or clarity to the issue. My understanding is that MUP was a whole-population measure, which was not targeted just at people who were drinking heavily but also particularly at children and young people who were buying very cheap alcohol.

The WHO talks about the three best buys, one of which is affordability. We expected that a general shift would take place across the population if we made alcohol less affordable. My understanding, from my time working in mental health, is that heavy alcohol drinking is on a spectrum—some people are completely abstinent, some drink very little and some drink more and more heavily, until it gets to problem drinking. The MUP policy shifted our drinking to a safer point on that spectrum.

I firmly believe that fewer people will run into the problem of alcohol dependence in the future because we introduced MUP in the past. The challenge is that, when we look back, we see that there have been a number of changes, which I do not think have been entirely down to MUP. We are seeing children drink less; children and young people are less likely to drink and they drink 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 whether she can add more clarity to the issue.

When I first came across the MUP policy, I was slightly sceptical about whether it would reduce the amount that is drunk by people who are seriously addicted to alcohol and whose lives revolve around it . However, when we brought in the policy, evidence suggested that even the people who were more seriously addicted to alcohol reduced the amount that they were drinking.

We are talking about 23 deaths and more than 600 admissions to hospital every single week in Scotland this past year. We have to tackle that.

Scottish Women’s Football is a shining light in this area. It has a very responsible policy. It is sponsored by SHAAP, I think, and it does not accept alcohol sponsorship. That is a great thing, and 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 have brought in legislation. France certainly has, although we have seen examples of how the industry cleverly gets round the measures there. We are mindful of that when we consider any legislation here. I think that Ireland either has legislated or is in the process of legislating on the matter.

We have spoken before about the study that looked at the six nations and showed that children were exposed to the highest level of alcohol advertising and promotion in the Scotland-England match, because many of the other countries, including France and Ireland, already have measures in place to protect children from advertising during sporting events.

You are absolutely right that it is an area of growth, and the pandemic has shifted our behaviour at population level in a way that we would not have imagined. That has happened with food as well. We are consuming in a different way to the way in which we consumed before.

Premises such as pubs that are selling alcohol online have to have a licence and they have to get a premises licence through the licensing board in the area where the premises are located, so they still have to go through a licensing process. I agree that we need to consider and understand how much alcohol is being bought from large national retailers such as Amazon. Much of the regulation of the online world is reserved to Westminster.

During the passage of the recent legislation—I will ask Amy Kirkpatrick to come in on that—we carefully went over whether online sales of alcohol could be considered a public health issue rather than an online sales issue. The UK Government was keen to consider it an online sales issue rather than a public health issue. We will continue to consider that.

We need a bit more understanding of exactly how consumer habits changed over the course of the first year of the pandemic in order to ensure that the strategy of reduced availability is not completely undone by online sales and being able to order something from Amazon in the morning and get it delivered to your house in the evening.

I am not sure whether Amy has anything more to say on that. Most of the discussion on that legislation was around online sales rather than alcohol online sales, but it is a growing trend across the board.

Absolutely. I will bring in Amy Kirkpatrick to supplement what I say. As a Government, we are always looking around the world to get ideas and to see how to solve problems.

Things that happen in Scotland are rarely unique to Scotland. However, it is clear that Scotland has a troubled relationship with alcohol, and we have had that for some time. If you think back to the discussion about the introduction of minimum unit pricing, it was clear that we had more of a problem than most other countries, which is one of the reasons why we were able to safely chart our way through the various legal challenges of that policy. We have to understand that context. We probably need to do more than most other countries in the world to get our relationship with alcohol on a healthy footing.

Alcohol consumption is cultural, and it is interesting to look at different countries. Alcohol is much more available in Italy, for example, where it is more common to have a drink with food; however, people often drink smaller quantities and almost always with food. The way that we drink in Scotland is quite different. Equally, Scandinavian countries have a difficult relationship with alcohol, and those countries brought in quite serious legislation on licensing and availability: people have to go to a specific shop to buy alcohol there. We have all heard stories about just how expensive a pint of beer is in Norway, although people who live there are paid well. That shows you the issue of affordability.

We are—absolutely—happy to look at other countries, but it is quite a complex picture. We have to be careful not to just think, “Oh, that’s an easy solution,” or, “That’s an easy win.” We need to think about the Scottish context and how it would apply. We are looking very carefully at the issue of alcohol marketing and sport and at what happened in France, because it is clear that some alcohol companies are getting around the legislation that was brought in there. For example, in their advertising at stadiums, companies are not displaying the brand of the alcohol but they are using the font that is closely associated with it. Everyone sees it. It is not an advert for the alcohol, but it makes you think about the brand—the connection is there in your head. We are looking carefully at how the 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 unpick it. We have a long way to go, but, for some years now, we have been heading in the right direction—until the pandemic hit.

The minimum unit price of alcohol was the route that we went down. I know that there was a lot of discussion at the time about the tax aspect of it and whether that money should come back to be spent on treatment and prevention. The policy landed well partly because it did not affect the livelihoods of people who sell alcohol and did not impact the alcohol industry, of which there is a lot in Scotland. Decreasing affordability without impacting the wider economy is quite a sophisticated way to tackle the problem.

We need to understand the impact of minimum unit pricing and how it has changed behaviour. We will have to wait a little longer for the full evaluation of that, but I will definitely keep the possibility of a social responsibility levy under review. I am interested in anything and everything that I can do to tackle the challenge. I do not think that this is about affordability; I think that we need a better understanding of the impact of minimum unit pricing, which acts in the same way. The two strands will be to look at whether it works and to review the unit price, before we consider introducing different approaches to taxation to tackle the same issue.

You are absolutely correct that the pandemic caused quite a disruption in this respect, as in many others. We have seen a steady reduction in the amount of alcohol that is being consumed. In the first year after the introduction of minimum unit pricing of alcohol, there was a huge decrease in the number of deaths. They reduced by 10 per cent, which I think is the second-largest decrease in any year since records began. In 2020, which was 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 almost 30 per cent more than the recommended limit.

That does not tell us who was drinking and how they were drinking. There is a real suspicion that people who were drinking heavily before the pandemic consumed more alcohol during it, and that those who were drinking less drank even less.

There was also a big shift in where people drank, because of lockdown. There was much less drinking of alcohol in bars and far more consumption at home. There were also changes in the number of admissions to hospital and an increase in the number of deaths. You might think that, if there was an increasing number of deaths, there would be an increasing number of admissions to hospital, but we actually saw the opposite. That might be about the strain that was being experienced across the healthcare system at the time.

We have a lot to disentangle and to understand about what happened during the pandemic. We also do not know whether it was is a one-off or will alter the trend.

There is one crumb of comfort in all this—although it is really not comfortable at all. Every death is an absolute tragedy; 23 deaths per week is only the tip of the iceberg. Those are the deaths that are directly attributable to alcohol but, in addition, a large number of deaths are related to heart disease and cancer to which alcohol is a contributory factor. It is an absolutely tragic situation. However, the one crumb of comfort is that, although it is recognised that Scotland’s long-standing relationship with alcohol is harmful and that more Scottish people died from alcohol during the pandemic, the increase happened right across the UK and was not unique to Scotland. Actually, our rise of 17 per cent was slightly lower than that of the rest of the UK countries.

That gives me a hope that, perhaps, some of the work and strategies that we have in place were protective during that difficult time. For example, alcohol minimum unit pricing might have meant that, although we had a devastating increase in the number of deaths that year, they were not quite at the level in the rest of the UK.

Minimum unit pricing of alcohol is not the only feather in our cap, however; we have done a lot of work over a number of years. When a nation has such a harmful relationship with a substance such as alcohol, more than one thing has to be done to tackle that. We have therefore taken a range of actions to reduce the availability, attractiveness and affordability of alcohol, in line with the World Health Organization’s recommended approach. We will continue that with a whole-population approach that aims to reduce alcohol consumption and the risk of alcohol-related harms across the population.

However, two consistent threads run through our work; we are keen to focus on two target areas. First, our actions must reduce health inequalities. Secondly, we have to protect children and young people. We are therefore planning and consulting on potential restrictions, as I said, on alcohol advertising and promotion, particularly in order to protect children and young people.

We are keen to give consumers health information on labels, such as through placing on cans the 14 units recommendation. Among the four nations, we are also discussing putting calorie labelling on alcohol. We think that that will be helpful. In addition, over the course of the pandemic, we have twice run our “Count 14” campaign work, to raise awareness of all four CMOs’ lower-risk drinking guidelines that no more than 14 units per week should be drunk. We ran it for four weeks in March 2019, and for six weeks in January to March 2020.