Alcohol Policy UK

Guidance published to support the roles of doctors in drug and alcohol treatment

The National Treatment Agency (NTA) has highlighted new guidance on the roles and competencies of doctors in drug and alcohol treatment. It highlights the need for services to employ teams with the right mix of skills and clinical expertise to support recovery from drug and alcohol problems. 

Delivering quality care for drug and alcohol users: the roles and competencies of doctors provides a clear analysis of the medical competencies involved in working with drug and alcohol users. The report has been published  by the Royal College of General Practitioners and the Royal College of Psychiatrists. It is also intended to support the transition towards new commissioning arrangements for drug and alcohol services next year. 

The guidance aims to help commissioners, employers and others to meet their legal and regulatory requirements and provide a high quality service. It will also help doctors working in the sector to ensure that they are meeting General Medical Council requirements on revalidation.

The Substance Misuse Management in General Practice (SMMGP) is a network to support GPs and other primary health practitioners who work with substance misuse in the UK.

NICE alcohol guidance is available covering a range of treatment and prevention areas, including quality standards, alcohol pathways and further tools.

Government publishes response to the Health Select Committee Alcohol Strategy inquiry

The Government has published its response to the Health Select Committee inquiry on the Government’s Alcohol Strategy.

Download the Government Response to the House of Commons Health Select Committee Report of Session 2012-13: Government’s Alcohol Strategy

The Government's response answers the Health Select Committee's extensive inquiry which gave a mixed if not critical view of the strategy. In particular, the inquiry and other responses questioned an excessive focus on binge drinking over health issues. The response answers this in part by highlighting Department of Health guidance and resources for treatment and interventions found on the Alcohol Learning Centre.

One other key concern outlined by the Health Select Committee was that "an Alcohol Strategy should be seen as part of a wider public health strategy, and should contain some key quantified, alcohol-specific objectives... Public Health England should devise the national measures against which the strategy can be tested."

The Government's response states:

It is for the Government rather than Public Health England, to set national objectives for public health, together with the Public Health Outcomes Framework.

It is important to note that, while not framed as ‘targets’ or ‘quantified objectives’, the ambitions set out at the start of the strategy are challenging, and cover all the main domains of harm. Achieving them would mean reversing the long term rise in alcohol-related harms of all types. They provide clear objectives and a framework to allow success to be judged at national level.

The Government agrees that Local Authorities should consider the need for a local alcohol strategy. Public Health England will have a vital role in advising local areas on their own strategies.

Health groups support for the strategy was clear however on the decision to introduce a minimum unit price for alcohol. The Government will consult on the level of minimum unit price and on other proposals set out in the Strategy during the autumn.

Scotland update Sep 2012: test purchasing key to Licensing Act; alcohol sales data

An evaluation of the implementation of the objectives of the Scottish Licensing Act has been released by NHS Health Scotland. It reviews the effectiveness of various interventions including test purchasing, Challenge 25 and proof of age schemes. The report finds that test purchasing is seen as the most useful way to influence licensed trade staff practice, especially when combined with robust proof of age schemes.

A recent Scotland MESAS update analysing alcohol sales, revealed that the amount of pure alcohol drunk by Scottish adults has risen from an average of 10.2L per adult in 1994 to 11.2L per adult in 2011. However, since 2005 sales of pure alcohol show a fall from 2010-2011 of 4%. This equates to 21.6 units per week on average. This remains significantly higher than approximately 20% higher than current sales in England and Wales of 2.3L per adult (equating to 17.9 units per week).

Reacting to the report, the former Health Secretary Nicola Sturgeon admitted there was no single answer to the Scottish relationship with alcohol, and that the current Scottish Government Alcohol Framework included 40 separate measures to tackle alcohol harms. The BBC reported that Alcohol Focus Scotland have estimated that alcohol harms cost the 32 Local Authorities in Scotland £2bn each year. Dr Evelyn Gillan, CE of Alcohol Focus Scotland stated that Scotland needs to "shift the focus of licencing away from individual on-sales premises to managing the overall availability of alcohol".

The new Scottish Health Secretary Alex Neil agreed that more needs to be done to tackle Scotland's problems with alcohol misuse, which currently cost the country £3.6bn per annum. He warned of a "nightmare problem with booze" that threatens to overwhelm the NHS. Scotland plan to bring in minimum pricing following the passing of a new bill this year.

See here for other earlier news from Scotland on hospital statistics, lowering of the drink drive limit and alcohol retail and pricing reports.

Events & dates Sept 2012: IBA; PbR; City Health; INEBRIA; Social Care

A Nottingham IBA event takes place on Monday 24th September in Mansfield. The event aims to explore and develop opportunities for the further deliver of Identification and Brief Advice (IBA) and is free to attend for alcohol leads, commissioners and practitioners. For more information and booking details see the event flyer here or email [email protected].

An alcohol Payment by Results (PbR) event takes place on the 28th September in London. The event will explore PbR issues with commissioners and providers of specialist alcohol treatment services and review of the National Alcohol Payment by Results (PbR) projects due to complete in the autumn of 2012. The event costs £85+vat and is being organised by Alcohol Concern in partnership with Improving Health & Wellbeing UK and partners. Click here for further information and to book a place.

The City Health 2012 conference takes place in the City of London’s Guildhall on 22nd and 23rd October 2012. City Health 2012, delivered in partnership with the London Drug and Alcohol Policy Forum, will examine policy and practice in relation to public health in cities, with a special focus on health behaviours – including on diet, alcohol, sex, drugs, smoking, nightlife and entertainment venues. The 2 day full delegate rates costs £295 - download the City Health Flyer here.

The 9th INEBRIA conference on brief interventions will take place on 27- 28 September 2012 in Barcelona, Spain. The INEBRIA conference will explore From Clinical practice to Public Health: The two dimensions of Brief Interventions'. INEBRIA - the International Network on Brief Interventions for Alcohol Problems - brings together those working to develop brief interventions, also known as IBA in England, to share learning and practice.

An event for social workers, Alcohol and Drug use across the Life-course, will take place in Manchester on 21st November - details here. The BASW Special Interest Group in Drugs and Alcohol are hosting this event which is for social work and other social and health care professionals costing only £15 for non-members. 

Alcohol Awareness Week (AAW) 2012 will take place from 19-25 November - see details here. The aim of the the week, organised by Alcohol Concern, is to address the theme of "It’s time to talk about drinking". in order to help trigger  conversations about the health risks, social problems, stigmas and taboos associated with talking about the dangers of alcohol. A set of conversation starter cards are available to download.

Willing consumers? Alcohol Concern Cyrmu 2012 marketing conference presentations

Presentations from Alcohol Concern Cymru's annual conference on 6 September 2012 have been made available. The event explored 'how alcohol marketing promotes a positive image of drinking, and how we can effectively challenge it' and received coverage on Wales Online and the BBC.

Presentations included:

• Andrew Misell, Alcohol Concern Cymru Manager: Alcohol marketing in Wales
• Maran Waran, London School of Marketing: Marketing fundamentals
• Gerard Hastings, Stirling School of Management: Alcohol marketing
• Alan Tapp and Katie Collins, Bristol Social Marketing Centre: Social marketing techniques to achieve social good
• Tom Smith, Alcohol Concern Youth Policy Project: Young people challenging alcohol marketing
• Colin Shevills, Balance North-East: Sam's snaps: Hitting them where it hurts
• Conference agenda

Alcohol Concern Cymru have previously published a number of reports relating to Wales and alcohol.

A blog post 'The drip feed' by James Nicholls was recently published exploring alcohol marketing and it's history.

More action to tackle alcohol duty fraud needed say MPs

HM Revenue and Customs (HMRC) has come under fire for failing to tackle alcohol tax fraud in a report from the Commons Public Accounts Committee. It is estimated that as much as £1.2 billion is lost each year from alcohol duty evasion.

The main source of tax evasion reportedly comes from beer intended for oversees export, but ends up illegally diverted to the UK or re-imported without duty paid. The committee's report says three times as much beer is exported to Europe than is actually sold there. But no figures were available for the lost duty on wine.

Total tax revenue from excise duties on alcohol in 2010-11 was £9.5 billion, so the £1.2 billion tax gap is sizeable. Last year it was reported alcohol fraud was rising, with illicit beer accounting for up to 14% of total UK sales. HMRC has a 'tackling alcohol fraud strategy' and a Smuggling hotline (0800 59 5000).

The MP's report also warns of the low numbers of successful prosecutions for alcohol duty fraud. In the four years from 2006-07 to 2009-10 the highest number of successful prosecutions in any one year was six, with only 20 in total over the four year period. The report warned that HMRC "does not take enough account of the deterrent effect of successful prosecutions."

HMRC are considering a range of measures to reduce alcohol duty fraud, including a proposal to introduce fiscal stamps for beer, which appears to have been successful in reducing duty evasion on spirits. A British Beer & Pub Association (BBPA) press release opposed the stamps due to the cost impact on businesses but supported the call for tougher enfrocement.

See reports from the BBC, Morning Advertiser and Telegraph.

Could minimum pricing "backfire" as claimed?

Earlier this year a new Government Alcohol Strategy won praise from health groups for its intention to introduce minimum pricing, now planned for 2014. However the strategy received mixed reviews overall, with concerns extensively explored in a recent Health Select Committee report. Critics said the strategy was too focused on the crime and disorder aspects of alcohol misuse, neglecting the importance of health and treatment issues. 

A month or so later, The Telegraph ran a story headlined 'Plans to outlaw cheap alcohol will backfire, says watchdog', suggesting minimum pricing will lead to supermarkets selling "more, not less" cheap alcohol. The story, based on written evidence from the Office of Fair Trading (OFT), also appeared in the Daily Mail and the Financial Times.

Does the claim the minimum pricing could "backfire" stack up? Certainly the true impact - and indeed its questioned legal status - will be unknown until it is implemented. However, whether resulting supermarket actions could actually result in more, not less cheap alcohol being sold seems a somewhat mis-leading conclusion to draw from the OFT submission. If this did happen, the public health community would surely regard its campaigning for minimum pricing as the biggest own goal in it's history.

The basis for the argument is that minimum pricing will generate increased profits to retailers which could in turn incentivise supermarkets to sell more, for example via increased promotional activity on those products. Whilst this may be feasible there are many complex factors to consider, and no evidence as yet to suggest increased promotional activity will be applied. The OFT clearly states "At worst, such an incentive [to sell more] could dull the effectiveness of the minimum price in reducing alcohol sales."

Nonetheless, the assumption that minimum pricing would increase revenue to retailers is a logical argument, and one that the Institute of Fiscal Studies (IFS) has previously warned of. It is estimated that a 10% price rise results in an average 4.4% reduction in consumption - so although sales are reduced it is not proportionate to the price rise, leaving retailers with extra profit. It is worth noting that in the background, alcohol duty changes have been continued as part of the Treasury's role in the alcohol strategy to 'tackle problem drinking'.

There are of course multiple factors at play, and it could be argued that if raising alcohol prices were to bring such net benefits to retailers there is nothing to stop them having done so already. The perceived success of the responsibility deal - which committs to "foster a culture of responsible drinking" and take further action on marketing - has already caused contention. However we know little about strategies such as "loss leading" - heavily discounted products designed to bring people in store, but with losses reportedly made up on other items.

It may be worth considering at this point the way that minimum pricing would be expected to work. It will not suddenly stop specific individuals from problematic drinking, as much of the public seem to misunderstand it. Although minimum pricing will disproportionately effect heavier drinkers, it is a small reduction across this significant minority that would collectively result in overall benefits to crime and public health. If each heavy drinker drank one or two percent less as a result, the combined impact could be significant - as modelling has estimated.

The OFT in fact state they have less issue about the impact of minimum pricing itself, but are more concerned about the longer term implications of "legitimising intervention to control prices in a competitive market". Of course it is the OFT's role to protect and promote an open and competitive consumer market.

The legality is also commonly raised. The OFT states that although minimum pricing could inadvertently lead to retailers holding discussions that could breach competition law, their view is that "UK competition law does not prevent legislation to set a statutory minimum price for alcohol." The Scotch Whisky Association (SWA) are hoping it will prove otherwise.

Whilst no one can be sure how retailers or consumers will respond to minimum pricing, it seems unlikely to result in activity that would overall counteract the expected small reductions in consumption brought about by a raised floor price. Minimum pricing alone won't solve the UK's current culture of alcohol misuse, but amongst many academics and health bodies, it is both hoped and expected to play a significant role.