by Wright, Ben;
The backdrop to this vision was an urban drinking environment that had changed considerably in the preceding decade. After the ‘Beer Orders’ were introduced in 1989, brewers had to sell off thousands of their pubs, which were then bought up by new pub companies that sold but didn’t produce alcohol. And as local authorities tried to breathe new life into run-down town centres, these cash-rich ‘pubcos’ planted large new chain bars along the country’s high streets. Alcohol became an important motor of regional economies and late-night drinking licences for music and entertainment venues were handed out much more liberally by local planning authorities. As James Nicholls has written, ‘faced with the prospect of watching their cities go the way of Flint, Michigan or the way of Barcelona, it is hardly surprising that most planning authorities opted for the latter, especially when the architectural models never depicted the scene at a taxi-rank at 2 a.m.’17 With drink now considered a leisure activity to promote rather than a problem to control, an overhaul of the opening hours was a logical next step.
In 2000 a Home Office White Paper called ‘Time for Reform’ concluded that the existing licensing laws were a tangled mess and recommended the abandonment of fixed closing times. After Labour was re-elected in 2001, it introduced a Licensing Bill the following year which proposed an end to fixed licensing hours. In the end, only a tiny minority of licensed premises chose to take out 24-hour licences, but the effects of the 2003 Act were fodder for the tabloids and ‘binge-drinking Britain’ became a national obsession. The vomit-splattered pandemonium of towns after dark was proof, many said, that the Act had been a disaster. In fact, a government-commissioned report in 2008 concluded that the Act had had a negligible impact on levels of drink-related anti-social behaviour and alcohol consumption. Its effect had been neutral. But by the time Labour left office, Britain’s drinking culture was no more Spanish than the Last Night of the Proms.
At the same time, though, the Act had not unleashed a new epidemic of drunkenness. Overall alcohol consumption in the UK had dropped a little in the preceding five years after three decades of rapid increase. In 2004, adult per capita consumption was more than 26 per cent higher than it had been thirty years earlier. By 2015, one in five adults said they didn’t drink alcohol at all, and it has been a decline in drinking among 16–24 year olds that is mainly responsible for the change. Once-a-week bingeing has dropped slightly too.18 In terms of alcohol consumption, Britain is roughly mid-table compared to other European countries, behind France, Germany and Spain.19
Paradoxically, however, rates of alcohol-related mortality have increased.20 If you really want to see the grimmer side of drink, go and visit a liver unit in a modern British hospital.
Nobody would plan to be a member of this particular community but demand for beds is high. I’m shown around the unit at Southampton General Hospital by its head clinician, Dr Nick Sheron, one of the leading hepatologists in the country and a world authority on alcohol and liver disease. Dr Sheron talks with wry affection about his ‘customers’ as he walks me around the ward. I meet a lady in her fifties who has been connected up to tubes here for months, waiting for a transplant to replace her cirrhotic liver, tearfully regretting the years of heavy drinking that brought her here. One of the doctor’s newest patients is in his mid-twenties, the youngest he’s ever treated.
Dr Sheron has seen a huge increase in the number of patients presenting with serious liver disease in the last decade. For a quarter of those who arrive here, it is too late. Their liver damage is at such an advanced stage that they will die within a few months even though they have stopped drinking. For most, it’s the sudden appearance of symptoms that first reveals that their livers are dangerously damaged. It could be a variceal bleed in the oesophagus or they might suddenly turn yellow from liver failure. One of the most shocking features of drink-induced liver disease is its symptomless development. In 2012 there were 8,367 alcohol-related deaths in the UK. Alcoholic liver disease accounted for 63 per cent of those, 18 per cent higher than the number of deaths in 2002.21 ‘You can look at liver mortality as a cipher for liver disease,’ Dr Sheron explains to me. ‘Over the last thirty years or so the mortality from most diseases has gone down, in many cases significantly. Smoking related disease, heart disease, you name it, the mortality rates have gone down. The mortality rates for liver disease as a whole have gone up five times since 1970 and were going up year on year by about nine per cent up until 2008. And practically all the increase has been in alcohol-related liver disease.’
Because 80 per cent of deaths from liver disease are alcohol related, it’s a strong yardstick for gauging the effect of alcohol on a population. ‘Europe is the highest drinking area of the world and has the highest level of mortality from liver disease, and there is a very tight correlation between population level consumption and liver disease mortality,’ the doctor explains. France has seen its liver mortality drop substantially in recent years. In contrast, the two countries that have seen the biggest increase in liver mortality are the UK and Finland.
The statistics and harrowing personal stories of liver disease are not the only evidence that alcohol remains a serious public health problem in the UK. According to the Office for National Statistics, in 2011/12 there were more than a million alcohol-related hospital admissions in England alone and it is estimated that alcohol misuse costs the NHS in England around £3.5 billion every year.22 Dr Sheron explains that alcohol contributes to many other health problems, but in ways that are harder to quantify than liver disease. For instance, alcohol is an addictive drug that causes dependency and has a spectrum of health problems associated with it. It contributes to diseases of the vascular system (such as high blood pressure, heart disease and stroke) and cancer. ‘In Europe as a whole about ten per cent of cancers in males are alcohol related and three to four per cent of cancers in women are alcohol related. If a woman drinks on average a bottle of wine a week it puts her risk of breast cancer up by ten per cent. Because one in ten women get breast cancer the absolute risk is one per cent. But nobody ever has a diagnosis of alcohol-related breast cancer.’ With most diseases the contribution of alcohol is ‘dose-dependent’; in other words, the more that’s drunk the greater the risk.
Then there are all the non-medical effects of drinking too much alcohol. These include disorder and damage, road traffic accidents and the 40 per cent of domestic violence cases in which drunkenness plays a part.
A Political Price
It was this awareness of the damage heavy drinking does that focused the alcohol debate back onto price, a policy nettle politicians have always been wary of grasping, anxious not to penalise moderate drinkers or harm Britain’s whisky, cider and beer industries. A shift in thinking was signalled by a hefty report from the Health Select Committee in January 2010. Its excoriating verdict was that successive government responses to England’s alcohol problem ranged from the ‘non-existent to the ineffectual’, despite UK deaths from liver cirrhosis having increased five-fold over the last three decades while rates in France, Spain and Italy dropped significantly over the same period. It went on:
Just as Government policy played a part in encouraging the gin craze, successive Government policies have played a part in encouraging the increase in alcohol consumption over the last 50 years. Currently over 10 million adults drink more than the recommended limits. These people drink 75% of all the alcohol consumed. 2.6 million adults drink more than twice the recommended limits.
The committee said increasing affordability of alcohol since the 1960s had been the ‘major cause of the rise in consumption’ and its key recommendation was to bring in a minimum unit price for alcohol, echoing the view of the then Chief Medical Officer for England, Sir Liam Donaldson.23
Select committees rattle off recommendations all the time, many of which are ignored by government, but this found a receptive audience within the coalition. For the first time since the First World War, ministers gave consideration to a significant intervention in the alcoh
ol market. The targets were not pub opening hours or licensing rules, but shop shelves of cheap vodka, super-strength cider and extra strong lager. Most alcohol is consumed at home, and the heaviest drinkers, the ones that are doing the most damage to themselves, buy cheap booze from supermarkets. In March 2012, the government published its new Alcohol Strategy, which was built around a commitment to bring in a minimum unit price for alcohol. The Prime Minister’s foreword to the strategy said the policy would reduce binge drinking and cut crime:
For the first time it will be illegal for shops to sell alcohol for less than this set price per unit. We are consulting on the actual price, but if it is 40p that could mean 50,000 fewer crimes each year and 900 fewer alcohol-related deaths a year by the end of the decade. This isn’t about stopping responsible drinking, adding burdens on business or some new kind of stealth tax – it’s about fast, immediate action where universal change is needed. And let’s be clear. This will not hurt pubs. A pint is around two units. If the minimum price is 40p a unit, it won’t affect the price of a pint in a pub.
The announcement was applauded by health professionals and by groups such as Alcohol Concern. It also aligned England with Scotland, where a minimum price of 50p per unit had been introduced by the Scottish parliament in May 2012, to the fury of the country’s whisky distilleries. A legal challenge from the Scottish Whisky Association in the European courts meant the policy had still not been implemented by the end of 2015.
The coalition government’s embrace of minimum pricing did not last long enough to be tested in the courts. Following a consultation on the government’s plans, its final alcohol policy was unveiled in July 2013. Despite David Cameron’s proclaimed belief in the benefits of minimum pricing the year before, the idea was ditched. The reason? A lack of conclusive evidence that it would make any difference, said the government. A craven capitulation to the drinks industry, cried public health groups.
It was known the policy had its opponents in the Cabinet, notably the former Health Secretary Andrew Lansley. He had argued against minimum pricing when he was at the Department of Health and continued to do so after he was reshuffled to be Leader of the House of Commons in 2012.
When we meet in early 2015, I ask Andrew Lansley why minimum pricing should not at least be given a try. ‘Giving it a try involves establishing an extremely unwelcome precedent in public policy making. Trying to control the price of commodities in the marketplace? We don’t want to be in that position. That is not what Conservatives do,’ he tells me sharply. He claims a minimum unit price would have to be 50p or 55p for it to make any difference, an amount which would shift hundreds of millions of pounds from the pockets of customers to retailers. ‘There’s no justification for that,’ the former Health Secretary says. ‘There was no evidence it would work. It would have been a large-scale measure to intervene in the market at a time there’s a cost of living issue for people. It was going to be very unpopular. It’s not good politics at all.’24
The Conservative Party’s chief election strategist, Lynton Crosby, advised David Cameron to ‘get the barnacles off the boat’. In other words, to abandon any extraneous and distracting policies that might make the Conservative Party’s voyage towards polling day unhelpfully choppy. Minimum pricing was considered to be exactly such a policy, so overboard it went.
Drinks companies such as Diageo strongly oppose minimum pricing, arguing that it will have no impact on consumption among heavy drinkers and could damage the companies’ exports if the idea is picked up by other countries. Andrew Lansley is convinced the voluntary cooperation between the industry, government and medical professionals would shatter if minimum pricing was imposed. In 2011 the Department of Health launched a ‘Responsibility Deal’ with the industry, which includes commitments to more informative bottle labelling and a pledge to remove one billion units of alcohol from the UK market by December 2015. ‘We’re working with the drinks industry so people can still enjoy alcohol while mitigating the risk,’ concludes Lansley.
‘That’s complete bollocks!’ Dr Nick Sheron shouts, as he clicks through his graphs on alcohol price, consumption, strength and harm several weeks later. The doctor is despairing at the government’s opposition to minimum pricing. Dr Sheron points out that in 2008 Labour introduced an alcohol duty escalator (which automatically raised prices at 2 per cent above inflation); George Osborne abolished it in his 2014 Budget, to loud cheers from brewers, West Country cider makers, whisky distillers and the press. Politicians have always known there are few votes in raising the price of alcohol. But Dr Sheron is convinced a minimum unit price will make his ward less busy: ‘My patients are buying the cheap booze. Irrespective of their income they are not drinking Chateau Lafite. And therefore when you look at the impact of a minimum unit price it’s really concentrated at these harmful drinkers. Changes in price have a dramatic impact on the really heavy drinking end of the scale because they’re already spending a large proportion of their income on alcohol. There’s been a wealth of studies showing the connection between population level consumption and liver mortality as a cipher for other alcohol-related diseases. There’s an equally clear connection between the price of alcohol and consumption of alcohol. If alcohol becomes three times more expensive my patients have no choice but to reduce their consumption.’ Dr Sheron reels off a list of other policies he’d like to see, including new restrictions on the social media marketing of alcohol to young people and a ban on alcohol brands’ sponsorship of sport.25
In January 2016, while many people were trying to give up alcohol for what is now dubbed Dry January, new drinking guidelines were published by the government, the first full review of alcohol advice since 1995. Its conclusions were sobering for people who thought their three glasses of wine a night were good for their health. The government now says men and women should consume no more than fourteen units of alcohol a week, the equivalent of six pints of beer or seven glasses of wine. That’s a reduction from the previous guidelines that set daily drinking limits of three to four units for men and two to three for women. The guidelines say women should not drink anything during pregnancy and recommends people have ‘several’ alcohol-free days a week. England’s Chief Medical Officer, Dame Sally Davies, said: ‘Drinking any level of alcohol regularly carries a health risk for anyone, but if men and women limit their intake to no more than fourteen units a week it keeps the risk of illness like cancer and liver disease low.’ She said the guidance was intended to give people information so they can make informed decisions about their drinking.
There were predictable shrieks of ‘nanny state’ from some, and even David Cameron distanced himself from the recommendations, saying: ‘This Tory isn’t a nanny.’ But guidance is just that. Cameron’s government appears to have buried its flirtation with price setting, choosing instead to let people decide how they balance the harm alcohol does with the pleasure that it brings.
On my way out of his office, I ask Dr Sheron if he thinks Britain has a particular problem with drink. ‘We’re getting the worst of both worlds,’ he says. ‘As well as feast-drinking on Friday night to celebrate battles won during the week we’re now drinking wine with meals. We’ve adopted Mediterranean habits as well. So we have a hybrid culture where it’s OK to drink on a daily basis and it’s also OK to go and get battered at the weekend.’
Travelling back to London on the train, I watch men in suits swigging from cans of Stella on their post-work wind-down. At the local supermarket the shelves closest to the door are piled high with bottles of discounted wine that cost less than a couple of pizzas. At the weekend, my local high street will again be a raucous, booze-drenched mess by midnight. Drink has a presence in our lives that would have horrified those priggish temperance campaigners in the nineteenth century. But the freedom to drink freely has been a prized part of British life for centuries, providing politicians with an enduring dilemma. How should the state help dependent drinkers? Is it their duty to reduce consumption? How should alcohol
be taxed? Where is the balance between an industry’s right to sell a legally available commodity and a state’s responsibility to minimise harm to its citizens? When it comes to drink, politicians have plenty of personal experience, as previous chapters have shown. The policy questions, though, remain as thorny as they have ever been, despite the accumulating evidence on the problems alcohol brings in its wake.
EPILOGUE
Last Orders?
It is tempting to assume that politicians themselves will soon mothball their ministerial drinks cabinets and shut the parliamentary bars for good. The days when a Chancellor of the Exchequer would enjoy a three-course lunch and a bottle of Margaux before delivering a Budget speech in the Commons are unlikely to return. The pace of the job is now too unrelenting, the scrutiny too great. At some point soon, Charles Barry’s leaking, scaffolding-supported Palace of Westminster is going to need an epic renovation that will take many years and cost billions of pounds. No other workplace in Britain currently has as many places to buy and drink alcohol on site and when the builders move in it is hard to imagine them surviving. In the Britain of Dry Januaries, increasingly dire warnings of the harm done by drink, as well as public intolerance of taxpayer money being lavished on politicians, a refit of the bars is unlikely. Instead, there will be more juice bars and mindfulness zones, where politicians and the people who orbit them can extinguish their stress through meditation rather than alcohol. In California, corporate contacts are made at yoga sessions. In a not too distant future, political relationships and deals from Westminster to Washington may well be fused in a downward-facing dog.