Oral Answers to Questions

Kenny MacAskill Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Dame Andrea Leadsom]

The hon. Lady raises an important point. The long-term workforce plan commits to increasing the number of general practice nurses by more than 5,000 by 2036-37. In her area, the number of doctors in general practice in the NHS Birmingham and Solihull ICB increased by 134 full-time equivalents between 2019 and 2023, but the number of nurses decreased slightly, by 34 full-time equivalents. However, over the same period, direct patient care staff increased by 1,195 full-time equivalents. I think that demonstrates to the hon. Lady that the actual resources in GP practice are increasing, with specialisms such as physiotherapy and pharmacy, as well as nurse prescribers, to provide patients more access to good healthcare.

[Kenny MacAskill (East Lothian) (Alba)]

8. What steps she is taking to support the recruitment and retention of community and district nurses.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

As the hon. Member may know, in September 2023, we met our commitment to deliver 50,000 more nurses working in the NHS compared with September 2019. As of January 2024, there are over 68,800 full-time equivalent community nurses working in NHS trusts and other core organisations across England, which is over 2,000 more than a year ago. However, we want to go further, which is why the NHS long-term workforce plan sets an ambition to increase training places for district nurses by 150%, to nearly 1,800. It also commits to improving retention in the NHS.

[Kenny MacAskill]

In Scotland, the vacancy rate for registered nursing posts in the community is 8.5%, and for registered district nurses it is 6.6%—in England, the situation is actually worse in most parts. However, these posts are fundamental, not just to care in communities and to our communities themselves, but to addressing bed blocking. It is obviously for the Scottish Government to address terms and conditions of employment, but their overall funding package is dictated by the block grant and Barnett consequentials. Is it not time that the Department stood up for the NHS? When there is money for weapons abroad, why can we not provide care at home? We were told during the referendum that we would be better together and that the NHS would be protected. Instead, it is being undermined.

[Andrew Stephenson]

We hear from Opposition Members who love nothing more than to crow and criticise as their health system declines around them, despite record funding from the UK Government. Scotland has, sadly, some of the worst health outcomes in the western world. Earlier this year, when the UK Government stepped in to offer support, the SNP Health Minister rejected the offer. I reiterate that if the Scottish Government need help to reduce their waiting lists, we stand ready to provide such support.

Oral Answers to Questions

Kenny MacAskill Excerpts

Tuesday 1st November 2022 Commons Chamber

[Neil O’Brien]

That is extremely concerning. This year, in NHS Hampshire and Isle of Wight ICB, there were 1,255 active dentists, compared with 1,248 the previous year. However, there is clearly an issue, which the hon. Gentleman was right to raise in the House. I am happy to talk to him more about that offline to ensure that we can solve that important problem.

[Kenny MacAskill (East Lothian) (Alba)]

8. What recent representations he has received on recruitment and retention of the nursing workforce.

[The Minister of State, Department of Health and Social Care (Will Quince)]

We are on target to meet the 50,000 nurses manifesto commitment, with nursing numbers more than 29,000 higher in August this year than they were in September 2019 and more than 9,100 higher than in August last year. We are working across a range of delivery partners to invest in and diversify our training pipeline, conduct ethical international recruitment, improve retention and support return to practice.

[Kenny MacAskill]

Cancer services are buckling both sides of the border and workforce challenges remain the biggest barrier to reducing waiting lists and meeting need. Will the Minister ensure that the long-term workforce plan being developed by NHS England gives consideration to the plans being prepared by NHS Scotland to minimise duplication and try to ensure the best possible patient outcomes in both countries?

[Will Quince]

I thank the hon. Gentleman for his question. We remain absolutely committed to growing and supporting our vital NHS workforce. In addition to the work already in place to continue growing the workforce, we have, as he mentioned, commissioned NHS England to develop a long-term plan for the workforce, looking at the next 15 years. It is important that we do that in tandem and I will have conversations—I think later this week—with my counterpart in the Scottish Government.

Dialysis Care Outcomes

Kenny MacAskill Excerpts

Thursday 19th May 2022 Westminster Hall

[Kenny MacAskill (East Lothian) (Alba)]

It is a pleasure to serve under your chairmanship, Sir George. First, I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing this debate and for putting forward such an eloquent statement, including the passionate and compassionate testimony. There is something about oral testimony. Whether it is as an elected Member or, indeed, a Minister, if we can actually see something, or hear or feel it, that is much more powerful, no matter how good a briefing may come from an individual, a member of our staff, or indeed an able civil servant. The comments regarding Peter Shannon and his family hit home.

I think that we were all aware, even before we were briefed on this issue or became elected Members, that people with kidney and renal disease suffer greatly. It is life threatening. Clearly, once someone is on dialysis, that is a significant issue. Not only is it life threatening if they do not obtain the treatment, but the treatment itself is life changing, not only for the individual—their life circumstances change in deeply restrictive ways, including through a loss of employment, as the hon. Gentleman said—but through its impact on other members of the family. Treatment can require family members to change their employment situations, and it can affect youngsters who perhaps do not get the same parental attention that would be available to others.

The hon. Gentleman eloquently put forward many points that I support and sustain. We are all largely on the same side in the debate. Nobody enters party politics or, indeed, comes to Westminster, to make their constituency worse off or endanger the livelihoods of their constituents. I will make some points on which I have differences with the Government, however. There are Governments in other countries who do not share my political hue or perspective—they are probably closer to right-of-centre than the UK Government—but who have policies that I will suggest later. I want to touch on two aspects of the debate: first, the difficulty people have in obtaining treatment for themselves or their children, and secondly, the difficulties faced by those undergoing home dialysis treatment, who the hon. Gentleman correctly mentioned.

The travel problem is a constituency issue, as the hon. Gentleman said in his speech. A constituent of mine—a Polish woman trying to sustain her life and her family—came to see me because her child requires dialysis treatment. In Scotland, it is difficult enough to get dialysis treatment for adults, but for children it can take place only in Glasgow or Aberdeen. She lives in East Lothian, and taking her child to Glasgow would mean travelling a considerable distance. He cannot go on his own; he has to be taken by his mother or father, who would have to take time off work. That affects the wider family and creates costs.

That is not a matter for the Minister but for the Scottish Health Secretary, and I have written to him and await a reply. At the present moment, treatment is a postcode lottery. Some health boards are particularly generous; others are entirely lacking. For my constituent in Musselburgh, trying to get treatment is financially draining, extremely difficult, and traumatic—not just for her son, but for her whole family. These matters have to be addressed along the road. I have no doubt that similar issues in England must be considered, and the Minister will no doubt consider them.

Home treatment has been worsened by covid—in mental health terms—and by the fuel crisis, which is causing real difficulties. At the moment, there is an entirely spurious euphemism about people “self-disconnecting.” There is no such thing as self-disconnection. People are not saying, “I’m going to save for a holiday in Marbella, so I won’t put my power on”. As is often said, they have to choose between heating or eating.

For people on dialysis, the issue is far worse. It is not simply about access to heating, which is necessary—as the hon. Gentleman said, people feel the cold more when they are ill—but about access to power. Power means that people can charge their mobile phones so that they can call 999 if there is a significant problem; it means that they can wash their clothes in the washing machine if they have to go to the doctor’s or to hospital and want to uphold their decency and values by looking smart and presentable; and it means that they can afford to keep their dialysis machine on when it is ratcheting up the costs. The euphemism of “self-disconnection” is an entire fraud. There are significant issues for those who are on dialysis.

As the hon. Gentleman pointed out, people in deprived areas tend to have treatment elsewhere rather than at home. There is a reason why: most people on prepayment meters are unable to access a dialysis machine. I can understand why restrictions are imposed and why it is difficult, but that is fundamentally wrong. They should be able to access machines. The way to solve the problem is to level the charges for those on prepayment meters—not just the most deprived, but those who live in private tenancies and who have those meters forced on them. At the moment, those on prepayment meters pay a higher standing charge and a higher tariff even though they have lower incomes—that is perverse. There is no technical impediment to power companies levelling the charges, and it could be dealt with. It requires Ofgem to take action and the Government to impose it, so that is my point on prepayment meters.

I subscribe to aspects of work done by other countries, even by those that do not have a left-of-centre position. Other countries bring in social and disability tariffs, so that those who have least or who are sick can be charged at a lower rate. Belgium, for example, operates a system where the third of people with least are charged at a lower rate, and other countries have circumstances where people who receive dialysis can get financial support.

At present, the financial support provided in this country is haphazard and goes nowhere near meeting the costs required to run and operate a dialysis machine. On that basis, there has to be political change and the Minister has the power to provide that. It is not a matter of blaming Ofgem, because Ofgem takes its directions from the Department for Business, Energy and Industrial Strategy. It is those decisions that have to change.

We all agree that we have to provide greater sympathy and mental health support, as well as better access for people to get to treatment centres, but, fundamentally, those being treated at home have to be able to pay for the treatment they require.

Tobacco Control Plan

Kenny MacAskill Excerpts

Thursday 10th June 2021 Westminster Hall

[Kenny MacAskill (East Lothian) (Alba) [V]]

It is a pleasure to serve under your chairmanship, Mrs Miller, as others have said.

I also follow others in thanking the hon. Member for City of Durham (Mary Kelly Foy) for securing this debate. I also thank Action on Smoking and Health for providing a briefing for it. I am conscious that most of this debate and this documentation relates to England. There are some aspects that apply to Scotland; indeed, I hope they will be replicated in Scotland and I will do my best to encourage some action to be taken, because some actions are cross-border, if not universal. It is from that perspective that I come to this debate.

As others have said, or confessed to, I do not smoke; I never have smoked and I have discouraged my family from so doing. I come from a generation in which youngsters, such as myself, who were quite interested in sport were told by Jim Watt, the boxer, that he could be caught by a right but never with a fag in his hand. I think that Scotland would be a better place if we had had similar efforts on alcohol, but we only concentrated on smoking. That is where we are coming from. We have made progress from the time of my childhood in the ’60s and ’70s, but there is still a considerable distance to travel, especially when we find smoking rooted in the poorest areas, where there are already underlying health vulnerabilities, and indeed in other sections of our society. There is considerable work still to be done.

The question is this: what action is to be taken? It is not a question of what action per se, because action has to be taken; it is more about the extent and calibration of the action that is taken. I say that because I wish to ensure that the social progress that we need to make, and want to make, in tackling smoking and the social ill that it is does not come at a cost to other communities or, indeed, in the form of other aspects that cause harm in our community.

I come from the perspective of having served as Justice Secretary in Scotland for seven and a half years. I established a serious organised crime taskforce. As other speakers have mentioned, there is a link between illegal tobacco and serious organised crime. Not only is there a link between them; it also turns into other harms that plague our communities. In my interlude between Parliaments, I chaired the Scottish Anti-Illicit Trade Group, which sought to bring together all organisations involved in law enforcement and keeping communities safe, at whatever level and in whatever jurisdiction. Indeed, it also brought in business, because a problem shared is a problem halved.

I want simply to highlight that cost loading has limits. That is not to say that there should not be cost loading. It is quite correct that the “polluter pays” aspect should be considered. I certainly argued that as Justice Secretary in the case of alcohol, and that has been taken up. Equally, to what extent do we load it? I am no free market capitalist, but I recognise, as did Adam Smith, that there has to be some regulation and that we have to ensure that there is some control over the market, because we know that in other aspects of society, if we close down supply, we find it simply results in aspects coming around in other ways.

I am not here to make a special plea for big tobacco. I would not seek to do that. They can fight their own battles, but there is an effect on others. As was mentioned by the hon. Member for North Antrim (Ian Paisley), small grocers—people who pay their taxes—are affected. They employ staff, provide for their communities, work on limited margins and yet they lose out. The tragedy we face is that people view illicit tobacco as simply ripping off big tobacco or, even more likely, ripping off the taxman—they have no love for him either—but the reality is that they are harming their communities and those who pay their taxes and work hard. They are harming their families and, indeed, their neighbours who work in and depend on employment in local stores, whether they purchase from a pop-up Facebook page or from a white van man.

Action has to be taken, and I support calls for an improvement in what we do to tackle the illicit trade. Much more could be done at a governmental level on both sides of the border. In terms of today’s debate, I welcome progress and fully support what has been called for here today. I simply emphasise that we have to ensure that we get the calibration right. In seeking to tackle harm within our communities, we must keep it proportionate and at a level that will not be counterproductive, because we do not want to make further progress in tackling tobacco that at the same time results in fuelling organised crime and in other aspects being abused. It is therefore a matter of balance.

Local Contact Tracing

Kenny MacAskill Excerpts

Wednesday 14th October 2020 Commons Chamber

[Kenny MacAskill (East Lothian) (SNP)]

It is often said that the principal duty of Government is to keep their citizens safe and secure. That applies not just to law and order. If my recollection of policing history is correct, the City of Glasgow police, formed before Sir Robert Peel’s Metropolitan police, had public health duties, not just the duty to address violence and crime. Then, of course, the scourge was cholera, but it remains true today not just in the ethos of Police Scotland: Governments and agencies have a public health duty and that is at the core of keeping citizens safe and secure.

It follows on from that that actions and ideology are used and need to be scrutinised and investigated. It is the duty of the Administration to deliver, but it is the duty of the Opposition to challenge. At the heart of this debate and, indeed, at the root of the subject under discussion lies the charge that the Government have supplanted good governance with ideology and that the choices they have made were based not on best practice, let alone best value, but on ideology; on how they fitted in with their free market ideology and, worse still, how they benefited their friends and cronies; it was not just about the underlying ethos regarding centralised or local systems.

Why are we having this debate? It is because there has been, and is, clear policy failure. Let us remember that, at the outset of the pandemic, our never knowingly modest Prime Minister boasted that we would have a world-beating test and trace system. Why? Because, then and now, test, trace and isolate is key to addressing this pandemic, as it is to addressing other such viruses. Previous pandemics show that that was fundamental. Indeed, all the evidence from abroad, where many, if not most, countries are doing significantly better, shows that it remains fundamental. But what was bragged about by the Prime Minister is far from the reality and experience of those on the ground.

Monday’s minutes from SAGE, released shortly after the chuntering broadcast by the Prime Minister, when, once again, soundbite rose over substance, were not just critical, but fundamentally caustic. They disclosed that the scientists—indeed the scientists behind the science that the Prime Minister claims to be following—had neither faith in the strategy nor faith in the direction being taken. The current situation on test and trace, let us remember, is critical and is, in the Prime Minister’s words, meant to be world beating. Importantly, some insurers may argue with those seeking to claim some recompense that this is an act of God that negates any pay-out for what they have been paying in over months and years, but this strategy most certainly is man-made and the fingerprints of the Prime Minister are all over it. It is a deliberate policy choice that has been made and it is a consequential failure that is rooted in those ideological choices, for there were, and are, other options, as the hon. Member for Leeds West (Rachel Reeves) and others have commented on. It was not forced on the Government by events; it was chosen by them through dogma, as they have disclosed in other policy positions throughout their tenure. They could, had they wished, have gone with the experienced practitioners who were tried and tested and who had done this before, but they rejected them and accordingly that failure is their policy—their political choice, on the basis, sadly, of their political prejudice.

Let us look at the evidence. In Scotland and Wales, test and trace is built on the public health experts who are in place. They are the local officials on the ground who have been tested over previous pandemics such as flu. We have, as others have mentioned, a 90% success rate. In England, through Serco, it is 61%. That gap threatens lives. It cannot be explained away by the greater population of England, or indeed by the greater urbanisation or density of England. Why is that? If we look at pillar 1 in England, which is being delivered by Public Health England and by public health officials, there is a success rate of 95%, which exceeds that of Scotland and Wales. Therefore, it is not England per se, but the system that England is using for pillar 2 that is failing. That is clear, as the public health-based systems in Scotland, Wales and England are delivering, and it is the privatised Serco-based model in England that is failing.

That brings me to the next subject: speed. Speed is an issue in this debate. It is an aspect of health actions and of the delivery of policy choices. Speed is essential for infection control. It is also vital to changes in normal Government procurement rules, yet it seems that what should be a mitigatory factor for changes to the usual competitive tendering rules is, in fact, a condemnatory matter for Government policy choices based on ideology.

Speed is vital in health actions with regard to this virus. That is clear in all pandemic control, but especially for covid. Why is that? Because people can be infectious two or three days before they are aware of the symptoms. Hence test, trace and isolate is fundamental, or, as we are sadly seeing, the R number simply increases exponentially. Speed is also acknowledged in competitive tendering rules. Latitude is understandably given where urgency is required in cases of emergency, such as we face at the moment, but value for money is still to be sought even if the best-value rules are overridden. However, as with the need for safety and security in policy that I have detailed, there also needs to be probity in office and in the actions of Government.

Let us look at what has happened. The Government are charged with failing to deliver an accurate or speedy response, as the 61% showing testifies to. The reality is that they did not deliver a speedy response to the pandemic, but they delivered an entirely inadequate testing system based on a procurement system that has used speed as an excuse, if not cover, for making ideological choices. If truth be told, they have failed to secure their citizens, but they have certainly satisfied their cronies. Transparency and clarity there must be, but probity and competence are also required.

Let us consider the facts, because that is where I believe the Government are found wanting. Pillar 1 in England, as in Scotland and Wales, has delivered. Why is that? Because it is built on Public Health England, and on local public health agencies in Scotland and Wales—the same people who have dealt with viruses in the past; those who have dealt with meningitis outbreaks and norovirus, and indeed, in past generations, the cholera that I mentioned. In public health emergencies, they come to the fore; they are trained for them, they prepare for them and they are experienced in them.

Of course, that does not preclude the private sector or deny the need for recruitment of additional staff. That is self-evident when we face a crisis on this scale. But all that should be done under the guidance and the direction of those skilled and experienced staff who are trained in public health, who know what they are doing and—this is core to the motion—know the area that they are serving.

However, ideology has overridden that. The most damning evidence is from the independent adviser to the independent SAGE, Sir David King, who said that the Government claim to be following the science but have ignored the scientists. Instead of those tried-and-tested experts and others—new and old, experienced and not, but working with and to them—we got an army of consultants. Not medical consultants, who would have been welcomed by the population at large, but management consultants and consultancy firms who are neither qualified nor—again, this is fundamental to the motion—local, such as Sodexo, Serco and Deloitte.

We got 50 Deloitte testing centres, which then subcontracted to Serco, Sodexo, Mitie, G4S, Boots, Uncle Tom Cobleigh and all to carry out their mandate and, indeed, to staff and resource them. What should have been a local response delivered by public health officials has become a centralised service, divvied up and shared out among corporate pals—given to their pals; their family and friends, without going into other aspects; their corporate friends, and indeed big business donors. Who cares what their experience is in public health as long as they are on side politically? Why let public health get in the way of old pals’ needs?

It gets worse. On 9 October, Sky News mentioned 1,114 consultants from Deloitte employed on test and trace, as well as 144 from McKinsey, BCG, PwC, KPMG and EY. Who cares what the acronym is, what knowledge they have, or where they are based? To be in charge of public health is a beanfeast and a bonanza for consultants when it should be about caring and providing for our citizens. It is management over medical and it is centralised, not localised. If it was not so tragic, it would be farcical, if not comical. If only the percentage of tests delivered met the increasing percentage of consultants being hired.

Neither public health nor public procurement is being satisfied with the current policy. Daniel Bruce of Transparency International warned, regarding the circumventing of competitive tendering proposals, about a blank cheque, but it is not a blank cheque for public health officials—it is a blank cheque for consultancy profits. It is not a de minimis amount, either, for we know that the magic money tree has been found and is being well and truly plundered. Although much is welcome, this most certainly is not. There have been 117 contracts worth £1.7 billion, 115 of those under fast-track rules dispensing with normal competitive tendering requirements, and two contracts of £200 million administered by Whitehall Departments. We even have contracts going to firms with Tory MPs as paid consultants. I am implying nothing, but when less scrutiny is required, more care should certainly be taken by those in office. This plethora of deals to family, friends and cronies does a political disservice and is as unhealthy as the virus in terms of the public good. While best value has been dispensed with, value for money is still required, not just by Daniel Bruce but by civil service rules. Fundamentally, as ever, probity and rectitude should be followed in government.

This debate is not simply about localised versus centralised. At its heart, it is a question of strategy by the Government, who have chosen, in addressing this pandemic, that it should be seen, and rather tragically has been seen, as increasing the percentage of consultants rather than the percentage of public health officials. Instead of seeing increasing largesse in public contracts going to consultants, not public health officials, we should have been seeing it going to those on the frontline who are dealing with need. Truncated procedures are needed, and they are acceptable, but the fact is that taxpayers are paying the price and citizens are bearing the cost, while, at the same time, corporate profits are being increased and public health officials undermined. It has become corporatism, with centralised cronyism, when it should be public health, localised and competent. It is, frankly, a national scandal.

Covid-19 Update

Kenny MacAskill Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

The challenge is that the primary transmission of the disease is between households and households mixing with one another. The approach that we have taken in England since we came out of the initial full-blown lockdown has been to put travel restrictions in guidance rather than law, because we feel that that is the most appropriate thing to do. That is not the approach being taken in Wales, but that is how we are currently handling it in England.

[Kenny MacAskill (East Lothian) (SNP) [V]]

It was a political, not a health, decision to pursue a private sector route for testing. Scotland has chosen differently, but there are concerns that ongoing capacity issues in England and Wales will have an impact on Scotland. Will the Secretary of State confirm that Scots will not be prejudiced by the Tory Government’s preference for private profit over public health?

[Matt Hancock]

Quite the contrary; the UK-wide testing system delivers enormous numbers of tests to people in Scotland, and I know from having studied it that people in Scotland are really grateful for the fact that we work together, with the UK Government delivering testing in Scotland alongside the Scottish NHS delivering testing in Scotland. It is that sort of coming together that people look for during a time like this.

Alcohol Harm

Kenny MacAskill Excerpts

Tuesday 17th March 2020 Westminster Hall

[Kenny MacAskill (East Lothian) (SNP)]

I thank the hon. Member for Congleton (Fiona Bruce) for introducing this debate, and you the Chair for allowing it, Mr Paisley. There is a perennial and universal issue across the UK and Ireland. No nation or region is exempt. Policies may differ, but the challenges remain the same. I declare that I sit on the commission on alcohol harm. Presumably my past experience as Scottish Justice Secretary in invoking legislation on alcohol, including kicking off minimum unit pricing—as opposed to past indiscretions of which I am less proud—have allowed me some focus. We must consider how alcohol harm comes about.

The papers available to me as a result of sitting on the commission on alcohol harm have been revelatory to me, even as somebody who served for seven and a half years as Justice Secretary and has been aware of the harm across huge swathes of our society, as correctly pointed out by the hon. Member for Congleton. The testimony from children in particular—those who have grown up in families with alcohol-dependent parents and where other siblings have been affected by other issues—is quite distressing, to say the least. For that reason, we require a reaction.

I have a personal interest too. Bus passes are issued to people at a lower age in Scotland than elsewhere in the UK. I went to two funerals lately of friends with whom I grew up, neither of whom lived long enough to get their bus pass. Both of them succumbed to alcohol. Nobody sets out to succumb to alcohol and die as a result of it. In the case of those two close friends, it happened because they had underlying issues. They were lost souls and had problems, and indeed had suffered themselves. It was a tragedy, and they deserve our sympathy every bit as much as anybody else who dies from any other aspect. The issues remain universal, and how we tackle them. It is about affordability, availability, and advertising.

I am certain, through my experience of seven and a half years, that more education alone will not work. That was stated by someone in the alcohol industry when I first went into office. Someone said, “What we need is to educate people better.” That is utter nonsense. We have been doing that throughout my lifetime. Do we need to educate better? For sure we do. The idea that we will be able to tackle the problem in our society simply through better education or greater awareness is not capable of being sustained. Action needs to be taken. As the hon. Member for Congleton correctly said, that does not mean that one needs to be a prohibitionist. I most certainly am not, and I enjoy a drink along with my friends and indeed my family. Alcohol is an important part of our economy, and an important lubricant within wider social aspects. As hon. Members said in interventions, it will be affecting how our people deal with matters. It cannot simply be a matter of prohibition.

Affordability is key. Minimum unit pricing is important, and David Cameron supported it when I introduced it in Scotland. England and Wales should take it on board, and Wales, to its credit, is looking at that. Equally, it has to be borne in mind that minimum unit pricing was never meant to be a stand-alone policy; it was meant to tie in with other tax regimes, and that means other fiscal and tax charges. We need the proverbial belt and braces. Scotland cannot deliver all it wants through MUP without being able to control the excise duty, so there has to be action on that. While I support steps to protect the Scotch whisky industry from actions and levies imposed in the United States of America, I am disappointed that we have not seen a continuation of the increase to tackle it hard here.

However, this is about not just affordability but availability. I am always reminded of John Carnochan, the head of our violence reduction unit, who talked about alcohol problems in our peripheral housing schemes. He made the point that if he wanted a haircut, he went to the barber, and if he wanted new shoes, he went to a shoe shop, so why, if he wanted alcohol, could he go to virtually any shop? Within 500 metres of where I live, in both London and Edinburgh, people can go out of their front door to anything upward of 40 outlets that sell alcohol on or off-trade. The likelihood is that as a result of coronavirus, there may be a cull of the on-trade outlets, but the off-trade outlets will remain, and that is where the significant problem has grown. In my lifetime, off-sales have gone up massively and the on-sale trade has declined massively. That is an issue, because alcohol consumption is a learned pattern. People need others there who encourage them to moderate their drinking and make it a social pastime, as opposed to them perhaps sitting at home consuming to excess. That is why even in Scotland, action has to be taken to restrict availability. There are far too many off-sale outlets. We need to encourage licensing boards not to issue licences and, where there is over-provision, to ensure that that does not happen.

Equally, there is the question of advertising. For alcohol, it is becoming almost subliminal. The evidence coming through from young people giving testimony to the harms commissioner is clear: they view alcohol almost as another product, but it is not. We enjoy it and benefit from it, and our economy even requires it, but it is not another product—it is a licensed drug. Therefore, how we make it available and allow it to be advertised is fundamental. We are taking action as a society to ensure that we restrict smoking so that it is no longer the cool thing to do. We need to do likewise with alcohol, because the advertising at sporting events has most certainly had a detrimental impact.

I welcome the steps that the Minister has taken. I look forward to further action from her and the UK Government, but it is also fair to say that those in the devolved Administrations also have to take action, because we are on a journey. We cannot stay as we are. The harm is too great and further action is needed. To sum up, this cannot simply be about education; we need to tackle affordability, availability and advertising.