Alcohol Policy UK

NTA survey seeks to establish national picture of alcohol services in hospital settings

Commissioners in England are being asked to partake in a survey of alcohol services in hospital settings in England by the National Treatment Agency (NTA). The NTA are to be part of Public Health England (PHE) as of 1st April.

Investment in a variety of models of hospital based alcohol services has increased in recent years, particularly since 2009 Department of Health alcohol guidance identified 'Appoint an Alcohol Health Worker' as a 'High Impact Change'. However the extent, nature and sustainability of these services is unknown.

The survey will provide the first ever national picture of the number and nature of the alcohol services in England’s hospitals and PHE will go on to develop guidance and materials to support the continued development and delivery of such services. Iain Armstrong of the NTA has indicated around half of the key Local Authority areas have completed the survey to date, with the survey remaining open to commissioners until 5th April 2013.

An NHS Evidence QIPP case study is available on Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care. In 2010 Alcohol Concern published Alcohol Health Workers - description and review of the AHW posts

Further alcohol hospital resources are available here on the Alcohol Learning Centre, including on hospital based Alcohol Health Work. See here for NICE alcohol commissioning guidance.

London level alcohol action continues through LHIB: IBA in sexual health settings briefing; the economic case for action; leadership summit report

The shadow London Health Improvement Board (LHIB) alcohol programme has been continuing to push regional level action to address alcohol misuse on a number of priority areas, delivering a series of events, briefings and other projects. 

Through the Vision and Partnership strand, a series of workshops are being hosted to support local roles in effective partnership and advocacy action (places available to London roles on 25 & 27 March). Through the Licensing and Enforcement strand, a second Licensing Network event took place on the 15th March supporting effective partnership action and the development of public health approaches. Through the Early Intervention strand, the IBA Practitioners' Network has continued to support the objective of Identification and Brief Advice (IBA) delivered effectively across a range of settings.

IBA in sexual health settings - LHIB briefing

Also produced is a briefing note on the delivery of Identification and Brief Advice (IBA) in sexual health settings (pdf). The development of the briefing was supported by the London Sexual Health Programme, UCL, Chelsea and Westminster hospital, and Alcohol Concern.

Economic Case for Alcohol - LHIB briefing

A briefing paper which outlines the economic case for taking action on alcohol in London has also been developed. Download 'Taking Action on Alcohol in London: the case for action' (pdf).

IBA leadership summit - presentations and event report

The IBA leadership summit in January brought together over 130 senior decision makers and leaders and included presentations and workshops from a range of IBA experts. See here for the London IBA leadership summit 2013 write up (pdf) including presentations from the day.

A range of other initiatives are also underway, including an IBA scratchcard initiative to facilitate IBA delivery in Pharmacy settings, and the development of a London 'minimum standard' to ensure and support effective IBA delivery. Previously summary reviews of IBA across London and IBA across London Criminal Justice Settings were published.

Budget 2013: Beer duty sees small drop but wine and spirit duty esacalator remains

As of Sunday the price of a pint will be 1p less, ending the beer duty escalator that would have added 3p to a pint, as announced in the 2013 Budget. However the 2% above inflation duty rise continues for other drinks, adding 10p to a bottle of wine and 53p to a litre bottle of spirits. 

Pub and beer groups heralded the news as a welcome boost to the flagging pub industry, which has seen 10,000 pubs closed in the last 10 years. Last year the Campaign for Real Ale (CAMRA) led on a petition calling for a freeze on duty, which achieved over 100,000k signatures and a parliamentary debate.

However other sections of the industry including Diageo and the Wine and Spirit Trade Association (WTSA) were heavily critical of the singling out of beer and questioned the legality under EU law.

No news came on Minimum Unit Pricing (MUP), a Government decision now much anticipated after further speculation that the Prime Minister may give in to pressure to back down. He has however vowed to "tackle" the issue of cheap alcohol. The IFS have consistently argued for increased taxation as preferable to MUP, though some health academics argue both are required together. A VAT cut for pubs has also been argued.

See Budget 2013 alcohol duty comments and reports including:

• Is cheaper beer a sign of muddled thinking? BBC
• Cut in beer duty is welcome tonic for Britain's suffering pub - The Independent
• Cheers? Chancellor cuts beer duty but wine and spirits are still tapped - The Guardian

News and updates Mar 2013: minimum pricing plans in doubt; UK health bodies support 'statement of concern' over industry; other news

The Government has emphasised it is yet to confirm its decision on minimum unit pricing (MUP) as Home Office minister Jeremy Brown said the Government were listening to "powerfull arguments on both sides" following the recent consultation. The Home Office website still states it "will introduce a minimum unit price for alcohol" - but for how long?

Last week fresh reports that the Prime Minister had u-turned on minimum unit pricing emerged, suggesting he had given in to pressure from a number of cabinet ministers. However speaking in the House of Commons, David Cameron insisted he was "determined" to deal with cheap alcohol. Health bodies urged the Government to stand firm on MUP.

Global 'Statement of Concern' against alcohol producers involvement in policy

Last month a number of UK organisations backed a  Statement of Concern' (pdf) sent to the World Health Organization (WHO) after thirteen of world’s largest alcohol producers announced commitments to support the WHO’s Global Strategy.

However the statement said that based on alcohol producer's "lack of support for effective alcohol policies... and their lobbying against effective public health measures" a united public health response against industry involvement was needed. The Global Alcohol Policy Alliance (GAPA) are calling for individuals to endorse the statement by sending a name, title, affiliation and country to [email protected].

Other news

A selection of other recent news is highlighted below. For full round ups of media and news reports follow Drugscope Daily or the LAPE alcohol e-shot.

The Department of Health are 'working' with drinks industry to add calorie information to labels - Guardian report. The controversial 'Responsibility Deal' said in 2011 it would "provide simple and consistent information as appropriate in the off-trade" including calorie content.

Can politicians save Britain's pubs? asks a BBC report. It explores a range of challenges facing the decline of the pub, including the smoking ban and imbalanced beer taxes compared with the off-trade.

'Beer googles' are a myth, but the dis-inhibitor effect is key says a scientist according to a Telegraph report. "Alcohol switches off the rational and decision making areas of the brain while leaving the areas to do with sexual desire relatively intact, and so this explains beer goggles."

Brighton and Hove Council are considering whether to ask parents to sign contracts pledging not to give their children alcohol - BBC. Alcohol Concern said parents were often the main source of alcohol for underage drinkers and alcohol posed significant health as well as safety risks to young people, urging parents to support alcohol-free childhoods in line with CMO guidance.

Plans to film binge drinkers  in Cardiff and show them footage of their drunken behaviour to help them change their ways will go ahead - BBC report.

Doctors call for pregnant women to be tested for alcohol intake - Channel 4 news. The news was in response to the FASD Trust publishing recommendations for medical staff to tackle foetal alcohol disorder caused by drinking alcohol during pregnancy - BBC.

Britain sobers up as drinkers cut back on wine and spirits according to projections that suggest the country will drink millions fewer bottles of wine and spirits over the next few years - Telegraph. The news contrasts with recent media coverage of research on adults under-estimating their consumption - see our recent guest post.

Under-reporting: media, myths, and policy implications?

Sadie Boniface, who is currently writing up her PhD in UCL’s Department of Epidemiology & Public Health, has contributed the following guest post. It explores some of the key issues that were neglected in recent media reports of this paper about under-reporting of alcohol consumption, the NHS Choices Behind the Headlines summary of which appears here.

Under-reporting is persistent and global

We know that the way our work was reported in the media was not really ‘news’ to those working in the field. Epidemiologists and public health researchers with even a vague interest in alcohol will be familiar with the fact that what participants say they drink amounts to a lot less than what is actually sold. This sort of ‘favourable’ reporting is also known for other health behaviours such as energy intake, and also for seemingly more objective measures such as height and weight. For Britain, where self-reported consumption in the General Lifestyle Survey is compared with alcohol sales from HM Revenue and Customs, reported consumption has amounted to between 50% and 60% of alcohol sales since 1992.

Low alcohol sales coverage is something that has been known for a long time, and is certainly not peculiar to the UK, with international studies consistently finding alcohol sales coverage of 40-60%. There has been a huge amount of research done internationally on under-reporting of alcohol consumption, and in particular the extent to which this can be mitigated with improved survey design has been investigated. In contrast, the demographic, social, and alcohol-related factors that may be associated with under-reporting have been explored to a far lesser extent (and that’s what this PhD research is mainly about).

‘It’s all in my cellar’

General Lifestyle Survey 2011 confirms drop in risky drinking - but causes and long term trend unclear

The 2011 General Lifestyle Survey has been released, including Chapter 2: drinking (pdf). The GLS 2011 explores trends in reported alcohol consumption since 2005 and confirms a fall in frequency of drinking above the guidelines amongst men and women. However health groups are keen to emphasise a significant longer trend rise in alcohol misuse and harms since the 1950s. 

Respondents to the 2011 GLF were asked questions relating to average weekly alcohol consumption and the maximum amount drunk on any day in the last week. Key findings included:

• The proportion of men drinking on five or more days a week fell from 23% in 1998 to 16% in 2011, and for women from 13% to 9%.
• The proportion reporting drinking alcohol in the last seven days fell from 72% in 2005 to 66% in 2011 for men, and from 57% to 54% for women.
• The proportion of men exceeding four units (daily guideline) on their heaviest drinking day was 41% in 2005 and 34% in 2011. The proportion of women exceeding three units was 34% in 2005 and 28% in 2011.

It is unclear to what extent various factors account for falls in reported consumption. Lower disposable income since the recession; national and local action to reduce alcohol misuse; or a general 'peaking' of consumption in 2004 may all play significant roles.

Clare Gerada, chair of the Royal College of GPs, suggested "It may be linked to income – as we have less disposable income, we drink less," she said. Others have previously warned that consumption and harms may begin to rise again as or when the economy picks up, as heavier drinker's income are disproportionately squeezed in harder times.

Extensive media coverage was recently given to the issue of 'under-reporting' following a UCL study. However media reports generated some particularly sensationalised interpretations, as explored in this behind the headlines report. More to come on this.

Earlier this year findings from the the Health Survey for England (HSE) 2011 were released, comprehensively exploring consumption patterns. See the HSE chapter 6: drinking patterns and chapter 7: drink diary. Also earlier this year the ONS released the latest Statistical bulletin for alcohol-related deaths in the UK (2011).

See here for the NHS Statistics on Alcohol 2012 report.

ONS alcohol-related deaths bulletin (2011): rates remain steady

Earlier this year the ONS released the latest Statistical bulletin for alcohol-related deaths in the UK (2011). In 2011 there were 8,748 alcohol-related deaths in the UK, a small decrease of 42 fewer than 2010.

The trend remains relatively stable over the last 10 years, though with some fluctuations amongst males and significant regional variations. However overall rates are still significantly higher than 20 years ago following rising rates during the 1990s, and a Lancet piece last year predicted a longer term rise. Alcohol-related hospital admissions are also continuing to rise despite a fall in consumption since 2004.

Figure 2: Alcohol-related death rates are highest amongst males in the 55-64 year age range:

See here for further alcohol related information and reports, the NHS Statistics on Alcohol 2012 report and fact-sheets from the Institute of Alcohol Studies.

'Independent' alcohol strategy released by coalition of health bodies

An "independent" alcohol strategy has been released by a coalition of over 70 health organisations from across the UK, led by the University of Stirling. 

Health First: An evidence-based alcohol strategy for the UK calls for a 50 pence Minimum Unit Price (MUP) and a series of other measures including a ban on alcohol advertising and a third of label space to be taken up by health warnings.

Last year a Government alcohol strategy was released, which announced plans for MUP and measures to "re-balance" licensing laws. A Home Office led consultation recently closed which had proposed a 45 pence MUP, despite Scotland seeking to implement MUP at a 50 pence level.

Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said: “Governments across the UK have begun to take action to reduce the harm that alcohol can cause. This action is very welcome but needs to go further. In developing this strategy, we considered the best available evidence about appropriate policies and interventions that are needed both to reduce drinking levels in individuals and reduce the damage to families and communities that alcohol can cause. The report provides a blueprint for action, now and in the future.”

However Henry Ashworth, chief executive of the alcohol industry-led Portman Group, said the vast majority of people drink within recommended guidelines and highlighted progress made through the controversial responsibility deal. Ashworth said "we must focus on finding local solutions to tackle specific alcohol-related problems, not penalising those who are drinking sensibly."

See the independent strategy's press release, a BBC and Guardian report.