Alcohol Policy UK

NHS must take long term approach to tackling unhealthy lifestyles

A new report states the NHS needs to change its approach to health prevention in order to successfully impact on key health risks including alcohol misuse, obesity and smoking. 'Commissioning and behaviour change; Kicking Bad Habits', produced by the King's fund, says more work is needed to ensure NHS staff are suitably skilled to ensure people choose and maintain healthier lifestyles. A long term approach from the NHS must be delivered as the UK's unhealthy habits are deep-rooted within society and can not be addressed by short term measures.

Key recommendations from the report include:

• The NHS needs to make better use of social marketing techniques and data analysis tools to identify, target and effectively communicate messages and motivate people to change how they live.
• Public health programmes shouldn’t rely on just one approach such as information campaigns or financial incentives as the evidence shows the most effective behaviour change interventions employ a variety of tactics.
• A robust evaluation of short and long-term changes in behaviour and health outcomes should be made a requirement of all public health programmes in order to build an evidence base for the future.
• Frontline staff should be more proactive in promoting healthy habits to the patients they see every day and for contracts and incentives to be used to encourage such behaviour.
• Government departments and local agencies involved in tackling unhealthy behaviours must better co-ordinate their efforts and ensure that targets are agreed to support their shared objectives.

The report comes in the wake of the recent National Audit Office (NAO) review of alcohol treatment which found varied levels of provision of alcohol services from PCTs across the country. However health commissioners are becoming more accountable for alcohol within local partnerships since the new PSA for alcohol and drugs (PSA 25) was introduced. PCTs are required to be part of Local Area Agreements within each authority, see here for more on the strategic delivery framework for alcohol.

The King's Fund have set up a Kicking bad Habits project page that includes a number of related reports and presentations.

Report highlights efficacy of pricing measures on alcohol consumption and harm

The second part of the University of Sheffield report, the 'Independent Review of the Effects of Alcohol Pricing and Promotion' was released last week as new measures were announced by the Home Secretary to tackle irresponsible drinks deals. The findings largely detail that alcohol pricing policies are effective in reducing alcohol related health, crime and social costs, yet will not be implemented by the government.

A summary of findings highlighted that based on minimum pricing policies applied to a unit of alcohol:

For health:

• Increasing levels of minimum pricing show very steep increases in effectiveness;
• Overall reductions in consumption for 20p, 30p, 40p, 50p, 60p, 70p are: 0.1%, 0.6%, 2.6%, 6.9%, 12.8% and 18.6%.
• Minimum prices targeted at particular beverages are less effective than all-product minimum prices
• Approximately 27% of off-trade alcohol consumption is purchased for less than 30p per unit, compared to 9% in the on-trade. 59% of off-trade consumption and 14% of on-trade consumption is purchased for less than 40p per unit
• A total ban on off-trade discounting is estimated to reduce consumption by 2.8%
• It is unclear what impact banning advertising would have
• A 40p minimum price gives an estimated reduction of around 41,000 hospital admissions per annum

For crime, unemployment and social impacts:

• A minimum price of 30p is estimated to reduce total crimes by around 3,800 per annum whereas a 40p minimum price is estimated to reduce crimes by 16,000 per annum
• Crime harms are estimated to reduce particularly for 11-18 year-olds as they are disproportionately involved in alcohol-related crime
• Unemployment is estimated to reduce as prices increase: e.g. 3,800 avoided unemployment cases per annum for a 30p minimum price versus 12,400 for a 40p minimum price
• The largest financially valued component of harm avoided due to policy changes is in the estimated unemployment reductions, valued at £303m per annum for a 40p minimum price

However despite the report having been commissioned to inform government policy makers, pricing controls will not be implemented. It is believed that the current economic climate may have further influenced the concern that such a move would further broaden the government's unpopularity with voters. However it is thought that Scotland may be moving towards a minimum pricing move, according to a BBC report.

Those who were calling for pricing controls in the UK will be frustrated that the forthcoming mandatory code for retailers will not stop 'loss-leading' by supermarkets, a key feature of the University of Sheffield report and highlighted as them most important issue for a code by consultation responses to government proposals to improve retailing practice.

Full versions of parts 1 and 2 of the 'Independent Review of the Effects of Alcohol Pricing and Promotion' can be found under the research heading here.

New alcohol measures tackle irresponsible drinks deals - but not 'loss-leading'

Government officials today announced new measures to tackle irresponsible retailing practice such as 'happy hours' and 'buy one get one free' promotions. The measures will be delivered through a new code of practice that retailers will be legally obliged to comply with following findings that the existing voluntary code was widely flouted. Although the new mandatory code is yet to be produced, a Home Office/DoH press release announced key measures were to include:

• banning offers like 'all you can drink for £10'
• ensuring that customers in supermarkets are not required to buy very large amounts of a product to take advantage of price discounts
• ensuring staff selling alcohol are properly trained
• requiring that consumers are able to see unit content of all alcohol when they buy it
• requiring bars and pubs to have the minimum sized glasses available for customers who want them

But the announcements are likely to frustrate some groups, as the heavy discounting of alcohol by supermarkets will not be curbed, despite consultation responses identifying loss-leading by supermarkets as the most important issue to be addressed by the retailing code. Others had also called for minimum pricing measures which would help control loss-leading as well as the supply of 'high-alcohol low-price drinks' often targeted at binge and severely dependent drinkers.

The decision not to choose minimum pricing may be in part influenced by the current economic climate but is more likely to reflect a likely negative impact on the government's popularity; Jaqui Smith announced she did not want 'to stop the vast majority of people who enjoy alcohol and drink responsibly from doing so'.  However health lobbyists may criticise the lack of pricing control, especially following the review of the relationship between pricing and consumption by the University of Sheffield that has shown price is an effective control for alcohol related harm and would not adversely impact the majority of responsible drinkers. A recent BMJ report also advocated pricing control as more effective than treatment in further reducing alcohol harm.

It was also announced that local government and police partnerships are being given £3.5M to tackle alcohol-related problems with an extra £1.5M being given to high priority areas to assist with tackling under-age sales and communication campaigns.

The full consultation report, detailing responses and feedback from agencies and the public on the the new code and measures can be found here.