Alcohol Policy UK

Public health programme for alcohol misuse found lacking by Healthcare Commission and Audit Commission

Two independent watchdogs have called for a renewed drive to improve public health services after analysing the success of policies over the past decade. A new report by the Healthcare Commission and Audit Commission assesses the impact government policy has had on: narrowing health inequalities; improving sexual and mental health; and reducing smoking, alcohol misuse and obesity.

The report, Are we choosing health? The impact of policy on the delivery of health improvement programmes and services, finds the government’s ambitious public health programme has helped significantly improve overall life expectancy and reduce mortality from the big killers. There have also been advances in tackling smoking and improving sexual health, two areas where health inequalities are significant. While smoking remains England’s single greatest cause of preventable illness and early death, the number of people who smoke has fallen considerably in recent years. Teenage conceptions are at their lowest level in over 20 years and there is better access to genitourinary medicine services and chlamydia screening, although progress in relation to contraceptive services has proved challenging. But these rates of improvement have not been matched in the areas of alcohol misuse and obesity.

In England, which has the fastest rising rate of childhood obesity in Western Europe, a third of school age children are overweight or obese. Deaths associated with alcohol consumption have risen. In men, the death rate doubled from 9.1 deaths per 100,000 in 1991 to 18.3 in 2006. For women, the rate increased from 5.0 to 8.8 deaths per 100,000 over the same period, a rise of around 80 percent. If the trends continue, alcohol and obesity will have an increasingly profound effect on public health and service delivery, the report says.

On alochol, the report comments that the 2004 alcohol strategy for England (AHRSE) was not accompanied by clear measurable objectives or a systematic programme to drive change through the system.  As a result, improvement at a local level has been inconsistent.

Anna Walker, the Healthcare Commission’s Chief Executive, said:

The government has begun to tackle the big killers but more needs to be done on some of the main issues affecting our health such as obesity, alcohol and smoking. The government should also apply lessons learned from its most effective programmes to ensure that the problems of obesity and alcohol misuse do not derail health improvement in the future.  We do not want to see any reversal of the health gains that have been made. Health inequalities also remain a challenge.

New smokefree guidance helps councils deal with noise problems

A news article from LACORS says that a steady stream of complaints to councils from residents about noise from smokers congregating in beer gardens and outside pubs and clubs has prompted LACORS and the Chartered Institute of Environmental Health to update its smokefree guidance to help councils deal with the problem.

Councils use ‘statutory nuisance’ powers on a daily basis to tackle all types of noise nuisance, from barking dogs to blaring stereos – but the legislation isn’t always effective when dealing with noise from licensed premises such as pubs and nightclubs. Since England’s workplaces went smokefree on 1 July last year most councils have received complaints about the noise outside licensed premises, particularly in town centres and other built-up areas.

The new guidance, Tackling Noise – Guidance relating to licensing and smokefree issues (Revised), sets out the powers available to councils to deal with the problem of nuisance noise and the different options they could consider when investigating residents’ complaints.

Thanks to the Noise Act 1996, which was recently extended to include licensed premises, councils now have an extra power to deal with night-time noise. Licensees can be given an instant penalty of £500 over excessive noise coming from their premises, such as a beer garden or ‘smoking shelter’ – but could also be prosecuted and fined up to £5,000 if they fail to comply with a warning from the council.

Councils can also use the licensing regime to tackle the problem of noise from people gathering on pavements outside pubs and clubs. If the council decides that the noise is likely to cause a public nuisance it can impose licensing conditions, such as requiring door supervisors, not allowing people to take drinks outside or barring re-entry after a certain time.

The guidance even sets out how councils can use the Anti Social Behaviour Act 2003 to take action against public disorder offences with the help of the police if necessary. Cllr Geoffrey Theobald OBE, chairman of LACORS, said:

Smokefree pubs, clubs and restaurants have proved a big hit with the public but it has also led to an increase in noise complaints to councils from local residents. Councils have a number of options open to them so it’s good news that they now have a one-stop-shop for advice on dealing with noise from licensed premises.

Councils are committed to putting local people first and will use every tool at their disposal to make sure residents can enjoy peace and quiet in their own homes. Noise levels in our towns and cities are rising so it’s good news that many councils are already working closely with pubs and clubs in their area so they can address any noise problems before enforcement action is needed.

Hospital admissions for alcohol related harm: key guidance and tools released

Following the publication of new data on alcohol-related admissions, a number of supporting documents and tools have been released to help the monitoring and delivery of work to reduce the admissions, as measured by National Indicator 39. This guidance will be especially welcomed by partnerships trying to reduce hospital admissions through Local Area Agreements, who have previously had limited information or guidance on how to address the complex and challenging realm of alcohol related admissions.

Key documents include Hospital definitions for alcohol related harm which provides technical information and definitions for the Vital Signs and National Indicator 39, as well more general guidance in Hospital admissions for alcohol related harm: understanding the dataset.

Also published is the most recent review of the relationships between alcohol consumption and related harms in Alcohol attributable fractions for England. The report calculates alcohol-attributable fractions (AAFs) and presents new AAFs specific to England based on the most recent population estimates of alcohol consumption data in England.  It also states that there are a significant proportion of avoidable deaths and hospital admissions attributable to alcohol consumption each year, particularly in young people.  The report suggests the figures presented are still likely to be an underestimation of the harm attributable to alcohol consumption in England.

Alcohol-related hospital admissions account for 6% of all admissions - new data published

New national hospital admissions data were published on 22nd July. They provide a more accurate picture of alcohol-related hospital admissions using new methodology. Previously, admissions statistics only counted the three most common types of alcohol-related diseases: alcoholic liver disease, alcohol poisoning, and mental and behavioural disorders.

The 'new' methodology measures a total of 44 conditions which research shows are caused by or strongly associated with alcohol consumption.  (It's not new - see the 2004 Public Health North West alcohol strategy group's Taking Measures report).

The new figures show there were 811,000 admissions in 2006 (accounting for 6% of all admissions) compared with 473,500 in 2002.

There was plenty of media coverage, including:

• Hospital alcohol admissions soar, BBC News
• Alcohol hospital admissions four times higher than official figures, Telegraph
• Alcohol-related hospital admissions four times higher than official figures, Guardian
• Alcohol hospital admissions hide individual tragedies, say doctors, BMA

Get the data here.

Consultation out on the regulation of the industry, price and promotion

A number of key consultation documents have now been released as policy makers seek views on key proposals to change the way the industry is regulated for price and promotion, and the role of the NHS.  The consultation asks for views on:

• how a new alcohol retailing code could be used to end poor retailing practice that leads to alcohol-related health and social harm
• whether this code should be backed up by new legislation to make it mandatory
• what action the Government should take if the voluntary agreement on alcohol labelling is not implemented
• what more can be done by the NHS and others to make sure advice and help on alcohol are available for those who need them.

This week the Department of Health released a series of documents that include the evidence from independent reviews, new statistics and recommendations on how policy may change the way the industry is regulated (all here). Key documents include:

• Safe, Sensible, Social - consultation on further action - provides a summary of the current situation, the future options and consultation process. A separate document also provides a detailed impact assessment of the various proposals and the likely effects they would have.
• Pricing and promotion review - provides phase one findings from the University of Sheffield providing  an independent assessment of the impact of  price and promotion on alcohol consumption. Phase two will be released later in the year providing policy models and recommendations.
• Labelling review - provides a detailed assessment of the extent to which voluntary labelling schemes have been adopted and the possibilities and implications of further approaches to labelling.
• The cost of alcohol harm to the NHS in England - provides new figures and analysis on the extent and cost of alcohol misuse to the NHS.
• KPMG independent review on the industry's social responsibility standards

A closing date of October 14th has been set for consultation responses.

Tougher drinks industry laws may be 'imminent' as cost of alcohol misuse now '£25 billion'

A Department of Health press release announces that consultation has begun on whether mandatory laws will be brought in to ensure the industry puts an end to irresponsible promotions and practices such as happy hours. The consultation is considering whether the current voluntary code should be made compulsory. Retailers could therefore be legally required to:

• restrict the way alcohol is sold such as offering drinks in small as well as large glasses or measures
• restrict happy hours or irresponsible price based promotions
• display alcohol in off-licence premises in separate areas give point of sale information eg on units, allowing customers to make an informed choice
• train staff in shops and venues to recognise and refuse alcohol to underage or drunk customers

Manufacturers are also being told that they must put the required advice and warnings on all containers by the end of the year if they are to avoid new legislation. 

Three independent reviews were published last week that show a lack of adherence to voluntary agreements.

1. The KPMG review of alcohol industry standards found that voluntary agreements are not being followed. It also found evidence of poor practice in the way alcohol is promoted.
2. Independent monitoring of voluntary labelling agreements show disappointing interim results. Inclusion of unit information was agreed with industry in 1998. Despite this, 43% of products surveyed did not contain unit information at all, and only 3% followed the labelling scheme in its entirety.
3. Interim findings from the first stage of the price and promotion review, being carried out by the University of Sheffield, finds clear UK and international evidence linking the sale of cheap alcohol to increased consumption, particularly amongst young people and those already drinking at higher risk levels. This leads to stronger evidence that irresponsible retail practice fuels excess drinking and hence harm to health. The second phase of the review is due to report later this year. When this is complete, the impact of a range of different options for regulating or restricting how alcohol is priced and promoted will be examined

See also Alcohol Concern’s recent report Unequal partners: A report on the limitations of the alcohol regulatory regime. The report highlights the lack of impact from the current approach and puts forward a number of recommendations including new independent review bodies for licensed premises, government enforcement arms and new responsibilities for licensees such as compulsory inclusion of harm reduction policies.

See the consultation document here

CMO calls for zero blood alcohol limit for young drivers

The Chief Medical Officer for England, Sir Liam Donaldson, called this week for the drink-drive limit on under 20s to be zero.

He made the zero limit the central proposal of his annual report, which focused this year on the health of teenagers. His proposal ran straight into controversy, with the RAC suggesting a zero limit would be unworkable, and others calling for a lower drink-driving limit for everyone, rather than an alcohol ban solely for young people. Donaldson said 14 European countries already had what is effectively a zero limit for young or novice drivers: they permit a trace in the bloodstream in case the driver has used mouthwash or some other innocuous substance containing alcohol.

Other countries with lower drinking limits for young people include some states in Australia, most of the US and New Zealand. In Ontario, Canada, Donaldson said, there was a 19% reduction in crashes in which the driver was aged 16 to 19 when a zero limit for new drivers was introduced in 1995.

Justifying his call for zero alcohol for 17 to 20-year-olds, Donaldson said they were six times more likely to have a car crash if they had been drinking. A young person who had been drinking was 2.5 times more likely to have a crash than an older person who had been drinking. "I'm aware it is a controversial recommendation, but I believe it would save lives," he said. Guardian

Alcohol field station for Camden

A special patrol of paramedics will treat drunken revellers in the streets of Camden Town in a bid to relieve pressure on hospitals. The pilot scheme to station a specific ambulance team in the area comes amid concerns there are too many alcohol-related admissions to Accident and Emergency from the area on Friday and Saturday nights.

Under the plans being developed by Camden’s Primary Care Trust and the London Ambulance Service, a team of paramedics in an ambulance will be based in the streets around Camden Town Tube station. They will be looking for drinkers who “appear to be intoxicated by alcohol”.

The aim is to treat them before they have to be taken to hospital accident and emergency departments, easing the pressure on the Royal Free and University College hospitals at peak times. The scheme is due to be operating by August, although the specific hours of cover are still being worked out.  Camden New Journal

See also previous posts about alcohol field stations

Glasgow tops the table for alcohol-related hospital admissions in Scotland

Glasgow has Scotland's highest rate of alcohol-related hospital admissions, new figures have shown. The NHS statistics said an average of 860 people per 100,000 were admitted between 2004 and 2006 in Scotland. But in the east end of Glasgow that rose to 1,505, compared to a regional low of 501 in East Renfrewshire.

Alcohol misuse is estimated to cost Scotland £2.25bn every year, with related deaths more than doubling in the past decade. The statistics showed wide variation across Scotland in the number of people admitted to hospital as a result of alcohol-related illness.

East and south east Glasgow and south east Highland were among the worst areas nationally, parts of which had 3% of the population admitted to hospital at least once because of alcohol. But in areas such as Dumfries and Galloway, East Dunbartonshire and Edinburgh, the admission rate was just 0.2%. BBC News

Download Health and Wellbeing Profiles 2008 report

New report links homelessness to early relationships

The Salvation Army in the UK has produced its fourth report , The Seeds of Exclusion, that works to understand the indicators in early life which can lead to future problems of social exclusion, including mental health, addictions and relationship breakdown. The report aims to understand the nature, complexity and severity of problems for those suffering from social exclusion. Findings show early relationships to be at the heart these issues.

Commissioner John Matear introduces the report:

Press release and background information here
Download The Seeds of Exclusion (2008)