Alcohol Policy UK

Public Health England publishes 2013/14 priorities - much space for alcohol?

Public Health England (PHE), the new national body set up to lead on the promotion of health and wellbeing, has published its 2013/14 priorities.

PHE now includes national remit for drug and alcohol policy having now integrated the former National Treatment Agency and alcohol policy team. However local Health and Wellbeing Boards (HWBs) and Directors of Public Health (DPH) are able to set the local prioritisation of public health budgets.

PHE's priorities for 2013/14 do not explicitly focus on alcohol misuse, but the document does state "the most significant factors that lead to poor health [are]: smoking; high blood pressure; obesity; poor diet; lack of exercise; and excessive alcohol consumption."

PHE has 5 key priorities including a first priority of reducing preventable deaths and ill health through addressing key factors including alcohol misuse:

1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol
2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency
3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics
4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme
5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

Indeed alcohol misuse can be seen as significant to priorities 2, 4 and 5 given alcohol's cross-cutting impact on disease, disability, problems within families and workplace health. Additionally priority 1 includes the roll out of the NHS Health Checks programme, which now includes alcohol IBA as part of the lifestyle intervention to be offered to up to 15 million 40-74 year olds over coming years. But with a Government strategy with little attention to treatment and prevention, should it say more on alcohol?

Briefing warns of sharp rise in admissions of older people with alcohol-related mental health problems

An Alcohol Concern briefing has warned of a 150% rise in hospital admissions for over 60’s with alcohol related mental health problems in the last decade. The briefing 'Trends in alcohol related admissions for older people with mental health problems: 2002 to 2012' finds a disproportionate rise amongst older adults, despite an overall rise in all adults and accounting for a growing older population. 

The analysis looks at hospital data for those admitted to hospitals in England with mental and behavioural disorders associated with alcohol use. Dr Tony Rao, an alcohol and older people mental health specialist and author of the report, warned that “increasing numbers of older people are living with alcohol related dementia, anxiety and depression – and it’s their loved ones, carers and the rest of society who are left picking up the pieces."

The report also found a 140% increase over the last decade in the number of over 60’s being admitted to hospital with Wernicke Korsakoff syndrome – a form of brain damage caused by alcohol use.

Recently an Alcohol Insight found a significant and growing number of older people are at risk of alcohol-related harm, and that alcohol problems are less likely to be detected in older people. Barriers to identification included complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help.

A 2012 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.

See here for an Alcohol Concern Wales briefing paper and presentations from an alcohol and older people event. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

See here for the latest annual statistics on alcohol for England 2012.

What's the future for the Late Night Levy & EMRO?

Since October 2012, Local Authorities have had the power to introduce a Late Night Levy (LNL) on premises opening after midnight under the PRSA 2011. The Levy is intended as a means of raising a contribution towards police and council accrued costs of the late-night economy.

However likely use of the Levy looks uncertain. Similarly no areas appear to have yet committed to use of Early Morning Restriction Orders (EMROs) to restrict the sale of alcohol between midnight and 6am.

According to a report in the Morning Advertiser, just 1% of councils say they plan to introduce either a LNL or EMRO, with over three quarters reportedly ruling them outaccording to a survey of 363 councils. A number of Local Authorities are however consulting on the use of the powers, such as Newcastle City Council and Milton Keynes. Blackpool and Hartlepool are understood to be considering EMROs.

A number of reasons for reluctance over the use of the powers seem apparent, ranging from insufficient expected revenue from the LNL, to legal concerns over being the first to implement new legislation. The Association of Licensed Multiple Retailers (ALMR) have reportedly set up a 'fighting fund' to cover the cost of legal challenges against EMROs or the levy. In a BBC radio discussion, Brigid Simmonds of the BBPA argued that pubs would suffer if the on trade are further targeted, pointing out 70% of alcohol is now sold off-trade.

Cllr Brad Smith, Chairman of Bexley Council's Licensing Committee said "There are not a significant number of licensed premises which would be affected [in Bexley]... as little as only £1,000 per year would be raised". He emphasised the council had a strong process of using robust licence reviews on individual premises causing problems. In Great Yarmouth an EMRO was reportedly avoided when premises agreed to earlier voluntary closure of 4am from 6am.

History repeats?

In 2008 powers came in under the 2006 Violent Crime Reduction Act allowing Local Authorities to implement 'Alcohol Disorder Zones' (ADZs). ADZs were introduced to allow local authorities to impose charges on licensed premises to pay for the costs of addressing alcohol-related problems, but warnings proved true and none were ever implemented, though other powers within the 2006 act were more widely utilized. Will the LNL and EMRO be the new ADZ , or with the integration of public health within Local Authorities, is a "re-balancing" of the licensing act underway?

See www.gov.uk/alcohol-licensing or www.alcoholpolicy.net/licensing/ for licensing guidance and information.

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Latest Findings alcohol bulletins: Public Health framework reviewed; alcohol counsellor skills; text advice can work & more

Recent bulletins from the drug and alcohol bank:

Public health objectives for England including drugs and alcohol

Sets out the structure and objectives of the public health system for England effective from April 2013 and how progress against these objectives will be measured, including addiction treatment completions, alcohol-related hospital admissions, and prisoners identified as needing treatment for alcohol/drug problems.

Seminal studies of the impact of alcohol counsellor skills and support

In the alcohol treatment world, arguably studies don’t get more important than these landmarks in the relatively scarce literature about what makes some alcohol counsellors, therapists and treatment services more effective than others

'Treatment-resistant' skid-row alcoholics react to organised empathy

Later to become founding director of the US National Institute on Alcohol Abuse and Alcoholism, in the late 1950s Dr Morris Chafetz of Massachusetts General Hospital conducted a remarkable series of studies which proved that an alcohol clinic's intake and performance can be transformed by the simple application of empathy and organisation.

Post-emergency visit text message advice moderates drinking

For the first time this US study tried mobile phone text messaging as a way to monitor and moderate the hazardous drinking of young adults screened at emergency departments. Compared to merely monitoring, text-based advice did cut drinking – but why did monitoring-only patients actually start to drink more?

Nurse-led hepatitis education cost-effective way to curb drinking in methadone patients

At Californian methadone clinics, group education sessions led by a nurse and focused on the risks of aggravating hepatitis infection led to the same substantial reductions in drinking as one-to-one or group motivational interviewing conducted by highly trained counsellors, offering a cost-effective means to reduce alcohol-related risks.

Alcohol Research UK 2013 annual conference: health inequalities, prevention in schools and online approaches reviewed

The Alcohol Research UK annual conference recently took place at the Wellcome Conference Centre in London on 12th March, exploring Alcohol and British Society. Some of the key talks and presentations are available and highlighted below.

Professor Mark Bellis: Health and Inequalities

Professor Bellis from Liverpool John Moores University, examined some of the possible reasons behind the “alcohol harm paradox” - how the poorest 20% of people in Britain suffered twice the levels of alcohol related harm as the most affluent 20% – despite reporting similar levels of alcohol consumption.

Professor Bellis said, “There are a number of possible explanations... These include differences in drinking patterns, hidden alcohol consumption and a cumulative health impact from poor diet, housing and other health challenges that leave people more vulnerable to the damages alcohol causes.”

Dr David Foxcroft: Developmental Epidemiology and Prevention

Dr David Foxcroft discuss some of the latest research into alcohol education and prevention in schools, in particular the impact of programmes such as the Good Behaviour Game and the Strengthening Families programme.

Developmental Epidemiology and Prevention (PPT) David Foxcroft

Professor Jonathan Chick and Dr Jan Gill – A Tale of Two Cities

Professor Jonathan Chick and Dr Jan Gill discuss findings from their ongoing research into drinking behaviours in Glasgow and Edinburgh. Their research supports the evidence that those drinking at the most harmful levels purchase the cheapest alcohol – particularly white cider and cheap vodka.

A Tale of Two Cities (PPT) Jonathan Chick and Jan Gill

Paul Wallace and Stuart Linke: Ten Years Experience with Down Your Drink (DYD)

Professor Paul Wallace and Stuart Linke give an overview of the Down Your Drink online screening and brief advice website. The presentation describes how the intervention has been amended over time, and presents feedback from a number of people who have used the site.

Digital Approaches to Alcohol Problems: Ten Years Experience with Down Your Drink (PPT) Paul Wallace and Stuart Linke

FEAD (the Film Exchange on Alcohol and Drugs) will shortly be putting up videos from the day.

An Alcohol Research UK symposium on alcohol policy will be taking place at the forthcoming New Directions in the Study of Alcohol Group conference ‘Alcohol Spills Over' on 25th to 28th April 2013.

Licensing information pack: toolkit supports data collection and decision making

The shadow London Health Improvement Board (LHIB) has co-ordinated the development of a Licensing Information Pack to support local licensing activity.

Download Licensing Information Pack: resources to inform local action on alcohol misuse (pdf)

Section One covers 'Information, Guidance & Tools', which outlines a range of local and national data sources; the organisations that collect them; and how to access the data.

Section Two presents four London case studies giving real-life examples of how the evidence base has been used to inform local area decision-making and licensing policy.

The development of the Information Pack followed feedback from delegates at the recent London Licensing Network Events. Delegates, who included licensing officers, trading standards officers, and the police, highlighted that issues around inter-agency information-sharing impeded the development of strategies to combat the negative impact of alcohol.

The Local Government Association (LGA) recently published guidance on Public health and alcohol licensing in England and other resources. The National Institute for Clinical Excellence (NICE) recently released an alcohol public health briefing for local authorities. See here for an e-learning course on A&E data sharing and data sharing guidance.

All Home Office licensing guidance can be accessed here, including revised guidance issued under section 182 of the Licensing Act 2003 and amended guidance on the late night levy [pdf].