Alcohol Policy UK

MPs call for alcohol guidelines to be reviewed - and emphasise 'alcohol free days'

MPs on the Science and Technology Committee have called for greater efforts to help the public understand alcohol guidelines. It also calls for a further scientific review to build public confidence, although based on the evidence presented the guidelines should not be relaxed. See here for the report chapters or the full report here.

Andrew Miller, MP and Chair of the Committee, said:

"Alcohol guidelines are a crucial tool for Government in its effort to combat excessive and problematic drinking. It is vital that they are up-to date and that people know how to use them."

"While we urge the UK Health Departments to re-evaluate the guidelines more thoroughly, the evidence we received suggests that the guidelines should not be increased and that people should be advised to take at least two drink-free days a week."

In 1987 what was known as "sensible limits" were defined as a weekly consumption figure (14 and 21 units). A review of the guidelines came in the early nineties following scientific evidence that moderate alcohol consumption may reduce Coronary Heart Disease risk. From then the Government somewhat controversially switched from weekly to daily guidelines. Although daily guidelines might prevent people from assuming they could 'save their units up', critics highlighted that they "appeared to endorse daily drinking" and so increased possible interpretation of the advised amount by as much as 50%.

The Committee noted that evidence is still equivocal for health benefits of "little and often" consumption, which appear to apply only to men over 40 and post-menopausal women. Nevertheless, alcohol appears to inhibit the formation of coronary fatty tissues, and thus offer some protective effect. In addition the effect of alcohol in reduction of blood clotting plays a part. There is very little evidence for a protective effect on the development of diabetes or cancers. The health benefits have therefore been cited as much overplayed and there is now ample evidence of the cancer risks.

The Committee notes that public understanding of units and how the guidelines apply to them is still poor. Last year a survey found only 2 in 5 adults could identify the unit content in common drinks.

The Committee concludes that a proper review of the evidence should be conducted to review and build confidence in the guidelines. It should include whether guidance should be widened to include individual drinking episodes, and whether further research is needed for specific groups, such as older people. The Committee feels that there is no reason to change the concept of units, but more efforts should be made to explain them to the general public.

In addition, the public should be encouraged to have at least 2 alcohol free days each week, as is the case in Scotland. The Committee recommends an on-line resource where people can obtain individualised advice on alcohol, to counter concerns amongst the public that generalised information does not apply to them.

It also notes that the co-operation of the drinks industry remains important for achieving the Public Health Responsibility Deal's alcohol pledges, though urges caution as "sensible drinking messages may conflict with the business objectives of drinks companies."

See reports from The Guardian, BBC, and NHS Choices. Recent Alcohol Research UK blogs discussing the limits have explored comparable guidelines and simple messages and are the guidelines 'nannying'?

Working with Older Drinkers: Alcohol Insight warns of growing need to recognise alcohol problems amongst older people

An Alcohol Insight funded by Alcohol Research UK has explored alcohol problems and treatment needs need amongst older adults. The project found that evidence suggests a significant and growing number of older people are at risk of alcohol-related harm: 

• 20% of men and 10% of women aged 65 and over exceed recommended drinking guidelines and 3% of men and 0.6% of women aged 65-74 are alcohol dependent.
• There has been a steady increase in the amount of alcohol consumed by older age groups in recent years.
• Consumption patterns suggest that the ‘baby-boomer’ cohort is likely to have higher levels of alcohol consumption in old age than previous cohorts of older people.

The Insight found alcohol problems are less likely to be detected in older people as a result of complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help. See the full report here.

However older drinkers are just as likely to benefit from intervention as younger drinkers, though approaches should focus on quality of life in addition to issues surrounding alcohol and aim to promote independence and reduce risk. The Insight recommends further understanding amongst health and social care staff and substance misuse practitioners into the complex factors affecting older adults and alcohol misuse. It also suggests further recognition by commissioners and prevention programmes that address risk factors and strengthen protective factors.

Earlier this year a report from the Royal College of Psychiatrists advised over 65's should not drink more than 1.5 units of alcohol a day, and separate recommended guidelines should be considered. An Alcohol Concern Wales briefing paper was released earlier this year and presentations from an alcohol and older people event are available here. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

'Alcohol and sex: a cocktail for poor sexual health' - report highlights missed opportunities within Sexual Health settings

A new report from the Royal College of Physicians (RCP) and British Association for Sexual Health and HIV (BASHH) warns of significant missed opportunities to tackle alcohol misuse in sexual health services - BBC report.

Download Alcohol and sex: a cocktail for poor sexual health 

It says more than one million young people attend sexual health clinics each year, presenting a unique opportunity to communicate key messages alcohol messages and the delivery of brief interventions (IBA). The report highlights evidence linking alcohol consumption to poor sexual health, particularly in the young:

• 82% of 16-30 year olds report drinking alcohol before sexual activity
• People who drink heavily are more likely to have unprotected sex with multiple partners
• 20% of white 14-15-year-old girls report going ‘further than intended' sexually when drunk.

The report highlights 16-24 year olds make up just 12% of the population, yet they account for nearly half of the sexually transmitted infections diagnosed in sexual health clinics.

Key recommendations from the report include:

• Sexual health services should provide information that highlights the link between alcohol consumption and poor sexual health outcomes and signpost sources of useful advice on drinking sensibly
• All clinicians providing sexual health services should be trained in asking about drinking habits through use of a recognised screening tool
• All sexual health services should develop a robust care pathway to refer patients for further support, including local alcohol services
• New commissioning arrangements should ensure that the service specifications for sexual health in primary care and specialist services include opportunistic alcohol screening and brief interventions for young people.

A resource pack for Delivering IBA in Sexual Health settings was recently released by Sexual Health South West and NHS South of England.

Cameron eyes up minimum pricing says The Telegraph

The Prime Minister David Cameron is reportedly instructing officials to look at minimum pricing options, the much debated population level policy approach to reducing alcohol-related harm. Although Whitehall officials say no decision has yet been made, a Daily Telegraph report suggests measures could be outlined in the forthcoming national alcohol strategy expected in February 2012.

Cameron is reported to have instructed Whitehall officials to look at options to achieve a minimum price by either tax restructuring or, as currently being sought in Scotland, a standard minimum price per unit. Both could face difficulties under EU law as minimum pricing opponents state it breaches competition law, whilst the IFS recently advised lobbying for EU law changes to achieve tax restructuring for this purpose.

The news is controversial given the voluntary approach championed by the Health Secretary who has recently spoken out against minimum pricing. However Cameron has often appeared keen to take decisive action on the “unbelievably low prices of some drinks”, and appeared to back Manchester’s move towards implementing a minimum price via a local bye-law.

The move would be likely to win widespread praise from health groups who have repeatedly called for minimum pricing, citing evidence of the link between falling prices and rising consumption over the last 30 years. Work by the University of Sheffield has modelled the impact of minimum pricing approaches, suggesting a 50 pence per unit minimum could save 3,000 lives a year.

However opponents, mainly sections of the alcohol industry, retailers or those opposed to such Government intervention, refute the evidence and suggest it would unfairly penalise responsible drinkers – a claim equally rejected by its supporters. Interestingly it is the public’s perception of minimum pricing that many say has prevented Governments supporting it. Despite some possible growing acceptance, polls have suggested around half of adults are still opposed to the measure.

Further reports from the Guardian, Daily Mail and the Press Association.

DH announce new details for Public Health England & the transfer of public health to Local Authorities

The Department of Health (DH) have released a suite of fact-sheets about the new public health system promised as part of the NHS Reforms. This includes further details of the responsibilities of local government and the operating model for the new Public Health England (PHE), following the Public Health white paper.

Public Health England (PHE) will be an executive agency of DH taking national leadership for public health issues. It will provide some services, including health protection, information and intelligence, and will continue to use social marketing and behavioural insights to guide activity in new directions. It will set out to be the driver for building an evidence base for public health activities, supporting the development of a specialist and a wider public health workforce working for a range of employers.

Directors of Public Health, jointly appointed and employed by LAs, will work with a range of new partners to tackle health inequalities and the links with crime reduction and the prevention of violence. The DH will provide the legal and policy framework and ensure that public health is central to government priorities.

Local Authorities (LAs) have a history with public health but in 1974 the NHS took over most public health functions. LAs may be considered best placed to co-ordinate partnership activities across areas of housing, regeneration, education, children and young people, strategic planning and fire and road safety. LAs will be expected to consider health and health inequalities in all their policies through the development of Joint Strategic Needs Assessments (JSNAs) and Joint Health and Well-being strategies, which will integrate efforts under the umbrella of a community wide approach.

The new model for public health will operate with an Outcomes Focus, due to be published in 2012, with statutory changes planned for April 2013. The NHS Operating Framework and Adult Social Care Outcomes Framework will include outcomes for increasing life expectancy, reducing premature death and reducing health inequalities. The key indicators are expected to measure improvements across the wider determinants of health.

Of course the NHS reforms have not been without controversy. A recent Health Committee report voiced concerns over the threat to public health spending given the scale of cuts facing LAs. It also questioned national level policy including the Responsibility Deal, asking at what point stronger intervention is applied if 'nudging' is not shown to be enough. Alcohol treatment has long been considered under-invested compared with drugs, so the forthcoming national alcohol strategy is much anticipated.

NHS Operating Framework 2012/13: implications for alcohol harm reduction?

The NHS Operating Framework 2012/13 was recently published and sets out business planning arrangements and national priorities for the year ahead. The framework contains a number of 'Domain areas' within which there is scope to consider implications for alcohol harm reduction.

Domain One is prevention of premature death, which strongly advocates the early recognition and treatment of chronic conditions. The document supports better outcome development and includes the prevention of cancers - relevant since 40% of common cancers are preventable through lifestyle changes.

Domain Two is the enhancement of quality of life in long term conditions. Alcohol adversely affects hypertension, diabetes, medicines compliance and overall recovery from conditions. As reflected in the mental health strategy No Health without Mental Health, the improvement of access to services is important, alongside targeted support for the most vulnerable adults and young people at risk.

Domain Three concerns recovery from episodes of ill health/injury. Supporting patients to reduce alcohol related harms can improve recovery and reduce emergency re-admissions. Domain Four sets out the need for a positive experience of care for patients, via integrated and co-ordinated services whilst Domain Five includes the safeguarding of patients from avoidable harms.

The Operating Framework includes QIPP as a driver of good practice, and there are many examples of Quality (for example NICE Guidance adherence), Innovation (the Rapid Assessment, Interface and Discharge model operating at Birmingham City Hospital or other initiatives), Productivity (such as role appraisal and better integration of services) and Prevention (the IBA agenda), where the alcohol field is making achievements.

Central to the Government's reforms are the new Health and Well-being Boards which will support Joint Strategic Needs Assessments (JSNAs). It is hoped that the new joint health and well-being strategies, with their focus on shared priorities, seamless care, improved outcomes and reduced health inequalities, will similarly highlight alcohol harm reduction as necessary for the fulfillment of their aims.

The Public Health Outcomes Framework is expected next year following consultation responses. Also expected in early 2012 is a new national alcohol strategy. For analysis of the health reforms and wider implications try the King's Fund or the Nuffield Trust.

Protect children from alcohol misuse: Turning Point call for early intervention

The health and social care provider Turning Point has said alcohol misuse within families is an escalating concern in its new report "Bottling it up: the next generation". It says early screening and identification of families is needed urgently to prevent the ‘inter-generational cycle’ of alcohol misuse which blights the lives of children and undermines their life chances. 

Up to 2.6 million children live with parents who drink at "hazardous" levels and around 700,000 children are thought to live with dependent drinkers. As picked up in the Daily Express, pressure put on women to be "supermums" was felt to be increasing alcohol use as a coping mechanism. Turning Point said more than 5,000 people who used their alcohol treatment services last year were parents. 

The report says children of parents who misuse alcohol are more at risk of depression, anxiety and increased anger. Turning Point also highlighted JRF research which found that children who see their parents drunk are twice as likely to get drunk themselves. Children living with drinking parents are also more likely to experiment at an early age with alcohol and drugs, increasing the risk of their own later life substance problems. 

In the report Turning Point call on the Government to place a duty on Local Authorities to develop strategies that take into account the harms to family life and children's development. They also advocate the development of services which are more family focused and home-based, better liaison between adult and children's services, and more information available to help affected children.

The charity Adfam exist to improve the quality of life for families affected by drug and alcohol use - and have a find help here page. Alcohol Concern's Embrace project was set up to develop better policy and practice around alcohol and children, families and domestic abuse. Embrace pilots aimed to develop a more family-focused approach to their clients and to take account of domestic violence and abuse throughout their work.

Further alcohol-related reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance or see the Drinkaware web-page for parents.

Adopting healthier lifestyles could prevent 40% of cancers

Cancer Research UK have highlighted the significant role of lifestyle choices in up to 40% of cancers. More than 100,000 cancers – equivalent to one third of all those diagnosed in the UK each year – are being caused by smoking, unhealthy diets, alcohol and excess weight, the Charity says.

Tobacco as ever features as a major cause of mortality, but alcohol consumption is also defined as a major risk factor for some cancers and a smaller risk factor for many others. The research links alcohol to oesophageal, oral, laryngeal, liver, breast and bowel cancer risk in particular.

Of the 158,700 cases of cancer diagnosed in males each year and the 155,600 in women, alcohol ranks as the 4th highest risk factor for males and the 6th highest for women.
President of the Royal College of Physicians Sir Richard Thompson said the report is a "wake up call" to the government to take stronger action on public health. The report comes shortly after Andrew Langford, Chief Executive of the British Liver Trust spoke out on Government policy with liver cancer deaths rising 74% since 1997.

The Department of Health's Public Health pages list key elements to its approach to addressing lifestyle issues, including the white paper and the controversial Responsibility Deal. A Change4Life social marketing strategy was recently released, committing to delivering alcohol messages within a wider lifestyles agenda.

News & updates Dec 2011: Scotland's multi-buy ban 'working'; minimum pricing; British Liver Trust's anger over policy; 313 DBOs so far; 'Dry bars' and 'Booze Buses'

Scotland's ban on multi-buy deals has reduced sales according to figures from retail analysts Nielsen. Sales of wine fell 5%, spirits by 3% and beer by 8% during the first eight weeks of the ban compared to 2010. See reports from the BBC and the Herald. The ban was introduced as part of The Alcohol Scotland Act which introduced new licensing laws from 1st October 2011. Measures also include a ban of multi-buy deals, alcohol advertising restrictions, Challenge 25 scheme, and a new tax on some licence holders.

Minimum pricing, also on the cards for Scotland, is explored in a recent Economist feature 'The battle of the booze', which suggest legal challenges could await both national efforts in Scotland or local approaches in England. Scottish industry figures have been speaking out on minimum pricing as 'certainly misguided, and most probably illegal'. But the Scottish Government have said its "probably not illegal", though can only be truly tested in court once enacted.

Meanwhile a national summit to build support for minimum pricing in England will take place at Manchester town hall next year. The Association of Greater Manchester Authorities (AGMA) are drafting a bylaw to stop the sale of alcohol below 50p a unit in local shops and businesses, but want to build a 'coalition of support' for a national approach.

Trade leaders have continued to call for a cut in VAT and also called for production costs to be included in the forthcoming 'below cost ban', which the IFS recently desribed as likely to only impact 1% of off-license units. However the IFS also advised lobbying on EU legislation to allow the re-structuring of alcohol taxation over minimum pricing.

England's Government-led policies on alcohol and public health have been branded 'a joke' by the British Liver Trust. Commenting on figures showing a 74% rise in liver cancer deaths since 1997, Chief Executive Andrew Langford said there are only "weak policies or no action at all... Almost all liver disease is preventable yet we are met with a sheer resistance to tackle it." Liver disease is the only health problem out of "the big five" - cardiovascular, respiratory, circulatory and cancers - showing an increasing trend. Alison Rogers, before leaving the British Liver Trust, also spoke out saying the Responsibility Deal was "fundamental conflict of interest".

The Home Office has reported 313 Drinking Banning Orders (DBOs) have been issued on conviction since they became available to local authorities last year - see MA report. DBOs can be put in place to stop an individual convicted on an alcohol-related offence from entering licensed premises or ban them from entering pubs in a specific area. See Home Office DBO pages for more.

Five men behind a counterfeit vodka manufacturing and bottling plant in Leicestershire were sentenced to 17 years reports the MA. One in 5 off-licenses were thought to be selling counterfeit alcohol a Staffordshire sting found. Suspected criminals were arrested after they were tricked by police who lured them in with a hoax offer of free beer - The Guardian.

Liverpool's first dry bar has opened reports the Guardian. Owners say 'Brink' is a social enterprise which actively promotes itself as a 'dry bar', not simply a cafe, and will appeal to people in recovery or simply those that want to avoid the "testosterone, drunk and drug-fuelled club and bar scene". 'Violence, abuse and vomit' was the headline for a night with the 'booze bus' medics in a recent Observer feature. 

Alcohol-related hospital admissions up 9%, doubling over a decade

The latest data for alcohol-attributable conditions has shown a 9% rise on the previous year, resulting in a doubling over the decade. For 2010/11 the figure was 1,898 alcohol-related hospital admissions per 100,000 population in England, up from 926 admissions per 100,000 in 2002/03.

The LAPE figures are produced by the North West Public Health Observatory, based on calculations which reflect the role alcohol misuse plays in conditions such as high blood pressure, heart disease and cancers (by calculating 'attributable fractions' - details here). The figures also include alcohol-only conditions, such as alcoholic liver disease, also increasing.

The rising trend in alcohol-related admissions is thought to reflect decades of rising alcohol consumption up until 2004, when consumption began to fall. Since many alcohol-related conditions develop over time, a significant lag means admissions look likely to continue rising. London saw the biggest jump in the last year, at 14%, followed by the East of England with a 10% increase. See here for a previous exploration of alcohol trends and consumption.

Alcohol-related hospital admissions passed the one million per year mark in 2010, drawing criticism from health groups on inadequate Government policy. The latest figures have prompted similar calls, with Shadow public health minister Diane Abbott swiping at the controversial Responsibility Deal, stating: "It is clear that for Andrew Lansley, the be-all and end-all is whether his friends in big business are happy, and, unfortunately, it is costing our NHS and British families an absolute fortune."

However the Health Secretary reportedly placed blame on Labour's so-called '24 hour drinking' 2003 Licensing Act, though a full-fact analysis had previously contested the theory following similar claims from the Home Secretary Theresa May. Speaking on the hospital figures, Lansley said "Our alcohol strategy, which we will set out in the new year, will outline what further steps we are taking to tackle this growing problem."

See reports from The Guardian, Telegraph and Press Association.