Health reform is perhaps the most divisive issue in Britain's government. Tory plans to re-structure the NHS has the potential to rip the coalition apart, but David Cameron is standing behind his beleaguered Health Secretary, Andrew Lansley.
But there is another health issue that the Prime Minister and the Health Secretary do not agree on: the new Alcohol Strategy, which is expected to be announced any day now. David Cameron wants a minimum price to be imposed on cheap supermarket alcohol, while the Health Secretary prefers self regulation.
According to this report in the Telegraph, "the Prime Minister has decided that when it comes to alcohol, something pretty radical now has to be done and he is keen on the minimum price. It is complicated how this can be delivered, particularly under European law, but it is clear that the voluntary approach has not worked."
The British Medical Association and Royal College of Physicians have said that minimum pricing for alcohol would be the most "simple and effective mechanism" for tackling the health problems caused by alcohol abuse. The charity Alcohol Concern is urging members to urgently write to their MPs as this "will be our last chance to influence the shape of the alcohol strategy, which will shape public policy on reducing alcohol harm for years to come." The health arguments for increasing tax on alcohol are compelling: England spends an estimated £20 billion a year on health-related problems caused by alcohol abuse.
But the drinks industry are a formidable opponent. The Wine and Spirit Trade Association claims that "the industry is already delivering a range of work to foster a sensible drinking culture and help consumers make informed choices about alcohol consumption." They also quote impressive statistics about how many jobs the drinks industry supports.
Last year the Health Secretary launched a new self-regulatory deal with the drinks industry which is "committed to take action to improve public health." But the health groups which had been involved in the talks pulled out of the partnership last year and Don Shenker, CEO of Alcohol Concern, said the deal represented "the worst possible deal for everyone who wants to see alcohol harm reduced" as it set no sanctions if industry failed on its pledges.
As politicians in Westminster try and summon up the courage to stand up to the drinks industry they should look north and west and learn from their neighbours. The Irish Government are considering a radical reform of their alcohol tax regime and are even considering banning advertising at sports events by the drinks industry. The issue is also under discussion in the Welsh Parliament.
The hardest drinking members of the United Kingdom are the Scots - where excessive drinking costs an estimated £3.6 billion a year in preventable health costs. Nicola Sturgeon, the SNP's Health Secretary, said "each and every week since the year 2000 enough alcohol is sold in Scotland to allow every adult to exceed the weekly recommended limits for men. Scots are now drinking a quarter more than counterparts in England and Wales"
Scotland is facing up to its terrible legacy of alcohol abuse by introducing a new tax on the sale of cut price alcohol in supermarkets and off-licences. The new law will be the first in the EU which imposes a minimum price on alcohol (45p is the estimated minimum price) but the bill faces legal action by the drinks industry - perhaps under EU competition rules.
The most interesting lessons that can be learned from the new Scottish alcohol tax is how existing rules (introduced last year) on bulk discounting are already being being avoided by the supermarkets. Hard-drinking Scots unwilling to pay the extra tax can simply order online and English suppliers (and supermarkets) will happily send a crate of very cheap booze north of the border.
The University of Sheffield have been studying alcohol consumption in Scotland for many years and they recently issued a report which assessed the public health impact of introducing a minimum price per unit of alcohol sold in Scotland. Their research shows that the impact of a 45p minimum price would cut consumption by 3.5% but a minimum price of 70p per unit of alcohol would cut consumption by a whopping 16.9%. But it's unlikely the SNP have the political courage to impose a minimum price of more than 50p.
The Sheffield report shows precisely how a minimum price on alcohol would have a positive impact on ill-health, offending behaviour and wider costs to society. David Cameron will visit Edinburgh soon to discuss independence with the wily SNP leader, Alex Salmond. What better way of impressing his hosts than by showing genuine willingness to listen to the SNP's experience of imposing a minimum price on cut price booze.