Alcohol Policy UK

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.

Lansley speaks out against minimum pricing ahead of new national alcohol strategy

The Health Secretary Andrew Lansley has spoken firmly against minimum pricing as he prepares to deliver a new national alcohol strategy early next year. Speaking for a feature in the Independent on Sunday, Lansley said there were "big problems" with minimum pricing, backing arguments commonly cited by minimum pricing critics and sections of the alcohol industry.

Top doctors and academics had recently written to the Daily Telegraph calling for minimum pricing as sought in Scotland, claiming a 50p minimum price per unit of alcohol could save nearly 10,000 lives a year. In response, David Cameron said he had "no doubt" that very low cost alcohol is part of the problem. However Coalition policy has set out taxation and 'below cost ban' approaches, but calls for minimum pricing remain because neither are expected to significantly affect the cheapest prices at point of sale.

The Health Secretary however stands opposed to minimum pricing, believing it will would fall foul of EU law - a debate raging in Scotland. Whilst Lansley conceded that higher prices can reduce consumption, he said minimum pricing would penalise the poor and hit responsible drinkers - a claim often made by opponents but disputed by academics who say it will target heavy drinkers most, not the poorest.

Lansley told The Independent on Sunday: "Are we really saying that because a bottle of vodka isn't £8 but £12.50 they are not going to preload with a bottle of vodka for a night out when they are in clubs where they pay £5 for a drink?". Supporters of minimum pricing tend to cite misunderstandings about the effects of the policy; that it is not about affecting significant changes in individuals, but about achieving a smaller change in a larger group, akin to the well known public health prevention paradox.

Lansley however also highlighted findings from the IFS which suggest minimum pricing would transfer larger revenues to drinks firms and retailers. The IFS suggest EU law should be changed to allow a taxation restructuring to achieve a minimum price effect. Lansley though highlighted that pricing alone was itself going to solve all the problems on its own.

Early next year a new national alcohol strategy will be released. It is expected to include a further emphasis on measures such as Community Alcohol Partnerships (CAPs) supported by industry or retailers. Alcohol messages will also be mainstreamed into wider Change for Life campaigns and more may be announced through the controversial Responsibility Deal. Investment in treatment and prevention approaches will also be closely watched within the changing context of NHS reform and public health transitions.

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.

MoD urged to review "subtantially higher" alcohol misuse in armed forces

A defence select committee report has called for the Ministry of Defence to conduct an urgent study into the issue of alcohol misuse within the armed forces. The report suggests 13% of military personnel have alcohol dependency compared to 6% in the general population.

However a General submitting evidence appeared to refute there was a higher prevalence of alcohol dependence, but accepted there was a significant issue of alcohol misuse.

General Berragan, Director General Personnel, said misuse of alcohol in personnel under 35 years old was about twice as high as in the broader society with an even higher difference for women. He explained that the Armed Forces recruited risks-takers, put them in a stressful situation and then returned them home with money and free time when they drank excessively.

The committee said the MoD was "yet to recognise the seriousness of the alcohol problem and must review its policy in this area". It also said "It is unclear to us whether the MoD regards the misuse of alcohol and other dangerous risk-taking behaviour as part of a pattern of reprehensible behaviour which requires punishment or discouragement, or a manifestation of stress which requires treatment, or indeed a combination of both."

See a report in the Guardian or the full chapter on alcohol in the Defence Committee Seventh Report.

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.

Findings brief interventions bulletins: all Primary Care staff can deliver; dependent drinkers respond to extended brief interventions in A&E

Recent research bulletins from the drug and alcohol Bank:

Alcohol brief interventions: doing without the Doctor

It works when the doctor does it, but what if the nurse or other primary care staff briefly counsel risky drinking patients? According to this synthesis of the research, it still works - maybe not as well, but perhaps more patients can be reached more cheaply. Modest impacts and imperfect methodologies mean it remains an open question whether meaningful drinking reductions would be found in usual practice.

Even dependent drinkers respond well to alcohol brief interventions

In the north of England just a few (and often just one) counselling sessions by a specialist alcohol nurse had a remarkable impact on drinkers seeking medical care at an accident and emergency department. What made it remarkable was the fact that these patients were not just heavy drinkers, but dependent and drinking as much as patients at alcohol clinics.

Brief interventions, also know as 'Identification and Brief Advice' (IBA) are a key part of alcohol harm reduction approaches as identified in NICE alcohol prevention guidance. However the difference between simple IBA, extended brief interventions and brief treatment approaches has been much debated, as explored in the briefing 'Clarifying brief interventions'.

See here for a recent briefing paper on mainstreaming brief interventions, or here for resources, e-learning or the INEBRIA webpage.

A forthcoming SIPS conference will release the results of the largest brief intervention pilot study conducted in the UK in March next year.

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.