Alcohol Policy UK

Alcohol Concern report asks questions over local funding for alcohol services under new commissioning systems

A new Alcohol Concern report looking at the impact of the public health transfer suggests the local strategic prioritisation of alcohol may not be being matched by investment in services. It found that although most local authorities say they expect alcohol funding to stay the same or increase, many treatment providers were concerned or had recently experienced cuts.

The report, 'A measure of change: an evaluation of the impact of the public health transfer to local authorities on alcohol', documents findings from a first wave survey sent out to 30 of the 152 upper tier local authorities. The findings aim to explore the levels of prioritisation and funding of alcohol across areas with various levels of harm. The survey was also sent to Clinical Commissioning Groups (CCGs) and treatment providers in the same areas.

Tom Smith Policy Programme Manager at Alcohol Concern said:

“As may have been expected, spending on alcohol services remained unchanged in many areas in the first year after the public health transfer to local authorities but there are anxieties, certainly from treatment providers, about the future.

“It is a real concern for the future that those local authority areas battling against the worst levels of alcohol-related harm are the least likely to expect increased funding for alcohol.

“Alcohol misuse has a huge impact on local communities so it’s vital that local authorities recognise this and create joined up strategies to address all the issues. Both treatment and prevention services need to be given clear prioritisation and responsibility must not be allowed to fall between the gaps of local bodies and service’s remits.”

The report follows a recent survey by Alcohol Concern that found that although most key local needs assessment documents recognised alcohol, most did not go far enough to address the full impact of alcohol misuse.

Indeed it seems that whilst many areas identify the need to address alcohol harms as a priority, a mixed local picture looks set to remain the norm. Issues such as funding constraints, the recently uprooted commissioning landscape, and arguably no central pressure or targets may be considered the current key challenges - many others have been previously identified in this 2009 research on the Orientation and Integration of Alcohol Policy.

Last year Alcohol Concern also published a Guide to Alcohol for Councillors to help them address alcohol harm within the new landscape. NICE has a comprehensive set of alcohol guidance and quality standards, including alcohol pathways and further tools. NICE have also released Public Health alcohol guidance for local authorities.

Updated 'LAPE' local alcohol profiles include new hospital admissions indicator

Public Health England (PHE) last month announced the latest update to the Local Alcohol Profiles for England (LAPE) data tool, which includes the revised measure of alcohol-related harm. 

The LAPE profiles allow each local authority area in England to look at data on 26 alcohol-related indicators and how they compare with other areas and national averages. The latest data includes the new revised 'narrow' measure for alcohol-related hospital admissions, as well as modelled estimates across a range of alcohol-related health and crime indicators.

Before reporting the updated LAPE figures we were keen to find out whether the annual National Statistics on Alcohol for England reports (2013 here) were still going to be produced, as these have previously been released around May. Last year it was announced that some national statistics reports, including on alcohol, could be axed following a consultation in order to make significant savings. Thankfully we have been assured that National Statistics on Alcohol for England 2014 are to be released shortly!

LAPE and the National Statistics alcohol reports use slightly different methodologies to calculate overall hospital admissions. Nonetheless both indicate a continuing upward trend in alcohol-related admissions, although the PHE press release described these as remaining at "similar levels" to the previous year. The release also highlighted drops in 5 year mortality rates, although an ONS release earlier this year highlighted some areas of concern for alcohol-related deaths.

The PHE release does also emphasise the mixed picture across the country, with 145 of the 326 local authorities showing an increase in alcohol-related deaths among men, and 154 showing an increase among women. Reports such as the Guardian highlighted the areas showing increasing deaths as typically those with higher levels of deprivation.

Report calls for more action in prisons to break alcohol re-offending cycle

A report released by the drugs charity Addaction has called for more to be done in prisons to address alcohol misuse, particularly amongst non-dependent drinkers. The report found that 70 per cent of prisoners surveyed said they had been drinking when they committed the offence they were imprisoned for. However only half of those prisoners recognised their drinking as a problem. 

The report was produced by the Alcohol and Crime Commission, a partnership set up by Addaction including representatives of the prison system, Parliament, the treatment sector and also the drinks industry (Heineken). An event also took place at London's RSA - the audio including panel Q&A is available here.

Addaction’s Chief Executive, Simon Antrobus, said:

"A staggering number of prisoners committed a crime while drinking, but unless they’re alcohol dependent the system doesn’t properly recognise them as problem drinkers. This means that people are leaving prison without the support they need. Add to that the fact that after-care is almost non-existent and we end up with a situation where we’re asking people to reintegrate into society, but without any of the right tools they need to do so."

Recommendations from the report include:

• That alcohol-treatment services for prisoners should form a key part of any prison rehabilitation, and that this must include continuing support for prisoners as they reintegrate into the community.
• That all frontline staff in UK prisons – from offender managers to peer support workers and mentors – receive expert alcohol awareness training and be able to identify problematic behaviour relating to someone’s drinking.
• Support services specifically designed for women prisoners should be developed as a matter of urgency.
• That the true extent of this problem is properly researched. A thorough and alcohol-specific needs analysis should be carried out into alcohol misuse among the prison population. This needs analysis should then inform the commissioning of services both in prison and on release and be integral to the contracts drawn up for the new Community Rehabilitation Companies (CRCs).
• That all through-the-gate services should prioritise community-based treatment that help people recover fully in their own communities as well as working to reduce the stigma faced by ex-prisoners and people who have beaten alcohol problems.

In 2011 NHS Scotland released the Alcohol and Offenders Criminal Justice Research Programme which included a prison health needs assessment and pilot report on brief interventions within prisons. This Findings bulletin reviewed unmet alcohol needs in prisons in 2010 and this matrix cell explores IBA within the criminal justice system. Last year the World Health Organization (WHO) also released a report on the link between alcohol and offending and the missed opportunities within prisons in particular.

Nonetheless some prisons in England have invested in improving alcohol treatment pathways and delivering Identification and Brief Advice (IBA) for non-dependent drinkers, with criminal justice healthcare now being commissioned by NHS England.

Labour would introduce minimum pricing and end alcohol sports sponsorship according to leaked document

A Labour Government elected in 2015 would implement key public health favoured measures to address alcohol misuse, including minimum unit pricing and ending sports sponsorship by alcohol companies, according to leaked documents obtained by The Mail on Sunday. See also Guardian and Telegraph reports.

Minimum pricing is favoured by most public health groups and bodies such as Alcohol Concern, given the link between price and consumption. However the policy is seen as risky political territory given around half of the public are thought to oppose it, in part due to a misunderstanding of the policy, according to research.

The Coalition Government of course controversially u-turned on minimum pricing amid claims of significant industry influence. The replacement policy of a below cost ban has been derided as comparably ineffective, and the Government have also been under fire for scrapping the alcohol duty escalator.

Ending sports sponsorship by alcohol companies is favoured by many health groups largely due to the reach and influence sports advertising has on children and young people. However an 'independent' alcohol strategy - 'Health first'- released by a coalition of over 70 health organisations in 2013, called for a ban on all alcohol advertising. Alcohol Concern have recently called for a major shake up of alcohol advertising, based on France’s Loi Evin which has much tighter controls including prohibiting sponsorship of sporting and cultural events.

Alcohol sports sponsorship spend is currently thought to be £300m a year, including 11 Premiership football teams and the big branding of major sporting events such as the FA Cup (Budweiser), Rugby World Cup (Heineken) and the Grand National (Crabbies).

Public health bodies may therefore be rooting for a Labour victory in 2015 - the document also proposed harder measures to reduce the harms caused by smoking and excessive sugar consumption. However the likelihood or not of a Labour victory aside, it is worth noting Manifesto pledges on alcohol aren't exactly binding, and the ongoing legal battle for Scotland's minimum pricing ambition could last years.

Forthcoming events: policy, licensing, minimum pricing, IBA & more

Some selected events that may be of note to the alcohol field:

Policy events

An Alcohol Policy in Practice CPD course run by UKCTAS, the UK Centre for Tobacco and Alcohol Studies will take place in Edinburgh from 22nd to 25th September 2014. The course covers key issues for alcohol policy and practice led by some of the leading academics and policy-makers. Further info here including the flyer or programme.

An event exploring alcohol minimum pricing will be held by the Cambridge University Science and Policy Exchange (CUPSE), for the Annual Policy Review at the Royal Society in London at 6pm on 10th June. The event page states 'members of the Civil Service, Government, academia, and think tanks are all invited to attend' - see here for more details.

Alcohol Concern Cymru (Wales) 2014 Conference on licensing takes place in Newport, Gwent, on 16 September 2014. The event, 'Under control? Alcohol licensing and creating safer communities', will explore 'key issues in alcohol licensing', including the late-night levy and 'the emerging challenge of alcohol home delivery services'. Early bird rate of £60 - further details here.

The Skills Consortium 3rd annual conference on Alcohol... Medicines, are we competent? will take place on 25th June, London. The question posed is: ‘are we competent?’. Speakers are asked to consider workforce development issues in delivering services for these client groups. Further details here.

Drugs and Alcohol Today's 2014 conference takes place on 19th June 2014 in Brighton. Prices from £35+VAT - see here for more details and booking.

Regional

DrinkWise North West are holding a number of  alcohol events in Manchester, topics including Voluntary Agreements – the ‘Ipswich model’ (5th June), Cumulative Impact Policies (11th July, Foetal Alcohol Spectrum Disorder (11th September) and more. See the flyer here for full details [pdf].

Brief intervention / IBA 

The 11th INEBRIA Conference on 'brief interventions - recent advances and new applications' takes place in Warsaw on 18th & 19th of September 2014, in Warsaw, Poland. INEBRIA is the International Network for Brief Interventions on Alcohol and other Drugs. See here for the conference website - last chance for the discount registration fee of 200 € before the 15th of May.

Also..

Down under, the The 1st International Energy Drinks Conference will take place in Australia on 6-7th November 2014 - perhaps of relevance given warnings over mixing energy drinks and alcohol.

'Big Alcohol, Big Tobacco, Big Influence': second event presentations

The Public Policy Team at the University of Southampton have released videos from a second event recently held in Westminster on the theme of 'Big Alcohol, Big Tobacco, Big Influence: New vectors for global diseases', following an initial event earlier this year.

Guest speakers and their presentations included:

• Dr Nick Sheron, Head of Clinical Hepatology, University of Southampton Professor - on Alcohol policy and vested interests: different methods, or different goals...

• Dr Sarah Wollaston MP, Member of the Health Select Committee and MP for Totnes - on Evidence and strategy in alcohol politics

• Eric Appleby, Chief Executive of Alcohol Concern - on The verdict on progress so far

• Eric Carlin, Director of Scottish Health Action on Alcohol Problems - on The Scottish Experience

Also available is the panel Q&A and discussion

MP and Dr Sarah Wollaston on Evidence and strategy in alcohol politics

  

Videos from the first event can be found here, including talks from Professor Gerard Hastings, Dr Geof Rayner, Linda Bauld and more.

Final Findings bank alcohol 'matrix bites': containing crime, protecting families

The fifth series of 'matrix bites' from the Drug and Alcohol Effectiveness Bank looks at 'treatment intended to safeguard the community':

A common theme is the contradiction between treatment centred on the patient’s welfare, yet offered within a system which prioritises the wider community, and sees the patient essentially as a threat. That divide is regularly and productively bridged, but not without difficulty, and sometimes not well enough for research to discern the intended benefits.

Cell A5. Treatment interventions to safeguard the community
What seems a core contradiction is illustrated by the cover of WHO guidance on treating problem-drinking prisoners. Subtitle, “An opportunity for intervention”, is belied by the barbed wire-topped wall. How could such an environment host productive intervention? Yet those same walls create the ‘dry space’ in which intervention seems possible.

Cell B5. Are relationships overshadowed by coercion – or even more important?
Asks whether lack of research on the practitioner’s influence in criminal justice contexts means that when coercion is driving treatment, therapeutic relationships are unimportant. Some evidence and expert opinion argues the contrary, because in a coercive context, “genuinely adopting and communicating [motivational] qualities is much trickier”.

Cell C5. Is this the most difficult management task in the addictions field?
Asked of managing ‘wet’ centres where street drinkers can continue to drink, the title question could have been asked generally of managing treatment within criminal justice and allied systems.

Cell D5. When it comes to treatment for offenders, is small beautiful?
About the influence of an organisation’s structures and processes on how well it delivers treatment for drinking problems in criminal justice settings. Context for the title question is a market which drives service providers to grow ever bigger, perhaps in the process losing innovative impetus.

Cell E5. Have we got the right ingredients for criminal justice/health collaboration?
Last cell explores systems of screening, brief interventions and treatment for problem-drinkers at various stages of the criminal justice system. We invite you to benchmark your own systems against the key ingredients for partnership working, and to ponder why drinking is prominent in sending thousands to prison, yet not in services provided in prison.

These 'bites' form the fifth and final row of the Alcohol Matrix. Round ups of the previous rows below:

• Row 1: brief interventions 
• Row 2: fundamental issues to treatment.
• Row 3: treatment in a medical context
• Row 4: psychosocial or 'talking' therapies

See here for NICE guidance, standards and tools for alcohol treatment.

Serious violence in decline since 2001 - alcohol-related?

Cardiff University's Violence and Society Research Group last month published Violence in England and Wales in 2013: An Accident and Emergency Perspective which showed that numbers of people injured in serious violence dropped by 12% in 2013 compared to 2012.

The data, gathered from 117 EDs, MIUs and Walk-in Centres, show another significant year on year fall in serious violence across England and Wales. Apart from a 7% increase in 2008, levels of serious violence have fallen every year since 2001. Lead author of the study, Professor Jonathan Shepherd said:

"Violence is falling in many Western countries and we don’t know all the reasons why. In England and Wales, the growth of multi-agency violence prevention involving police, the NHS and local authorities may well be a factor; violence has fallen more in regions where this is best organised.

Another probable explanation is changes in alcohol habits. Binge drinking has become less frequent, and the proportion of youth who don’t drink alcohol at all has risen sharply. Also, after decades in which alcohol has become more affordable, since 2008 it has become less affordable. For people most prone to involvement in violence, those aged 18-30, falls in disposable income are probably an important factor."

Reports in the mainstream media were quick to emphasize the link between the affordability of alcohol and violence - e.g. "Violence drops 12% as alcohol prices rise" from the Daily Mail, and "A decline in binge drinking and the rising price of alcohol is behind a dramatic 12% fall in the number of people injured in serious violence" from the Guardian.

On the other hand, Portman Group Chief Executive Henry Ashworth highlighted the impact of local partnership-working and pointed towards cultural change in our drinking habits, saying:

"It seems that we as a society no longer accept drunk and disorderly behaviour. It is important that we continue to engage partnership working to ensure these positive trends continue in the right direction."

So, as Dr Shepherd highlights, the exact role of alcohol trends and activities is hard to establish. A FullFact analysis of the claims suggests a correlation, but is also cautious against clear links. However it may be worth noting the evaluation of the 3 year £22 million the Alcohol Improvement Programme (AIP) that ran from 2008-2011. It indicated the AIP was not found to have impacted on national level hospital admissions, though it did help improve the prioritisation and delivery of local action, particularly around identified 'High Impact Changes' such as IBA and hospital liaison. Alcohol now seems a priority for many local authorities, so it would be understandable to expect some significant impact. However it is also speculated that consumption may start to increase again if affordability begins to rise again.

News & updates April 2014: consumption 2% down, cancer ad not in breach, alcohol and obesity links, 'Palcohol', Pound Pubs & more

Some stories from the media since the March round-up:

Per capita alcohol consumption down 18% since 2004

UK alcohol consumption per head fell again in 2013 by 2.1%, says the British Beer & Pub Association, which compiles data every year based on HMRC alcohol tax returns. This is the seventh year in the past nine that there has been a fall. In total, Britons drank over seven billion fewer units of alcohol in 2013, compared with 2004 when the downward trend began. However consumption rose steadily over several decades prior.

Alcohol cancer ad not in breach

The Advertising Standards Authority rejected complaints from the alcohol industry about a TV advert linking alcohol to cancer after being presented with some of the large body of evidence about alcohol and cancer risk, reports the Guardian. The ad, produced by Balance North East, shows a tumour in a glass of beer.  

Alcohol and obesity

Drinking more than three large glasses of wine can push people over a "tipping point", meaning they consume about 6,300 extra calories in the following 24 hours, according to Slimmming World research, as reported by the BBC.

A study carried out for the Telegraph found that many alcoholic drinks contain significant amounts of sugar. A single pint of cider contained almost as much sugar as the World Health Organisation (WHO) recommends should be an average person’s daily limit. A tin of gin and tonic contains about half that.

Powdered alcohol - confusion over legality

A product called "Palcohol" gained widespread attention (see for example this story from the Independent) after it was reported that the US Alcohol and Tobacco Tax and Trade Bureau approved the powdered alcohol, including vodka and rum varieties. However, according to The Associated Press, the approvals were issued in error.

Alcohol and celebrity

Alcohol Concern has criticised the former England football captain David Beckham for his decision to promote a whisky brand in partnership with the drinks company Diageo and TV producer Simon Fuller, says Third Sector.

Trade & industry news

Drinkaware has called on all glasses in pubs to have unit lines marked on them so drinkers can better understand how many units of alcohol they are consuming. See the Drinkaware press release or Morning Advertiser report.

The City of London Corporation’s licensing committee has unanimously agreed to introduce a late-night levy, after the authority consulted on the fee for the second time in five months reports the Morning Advertiser.

Plans to open a chain of discount pubs selling beer for just £1 have sparked a furious reaction from drink awareness campaigners says the Mirror. The first of the 'PoundPubs' has already opened in Manchester, bringing customers 'more round for your pound'. A second is about to open in Stockton on Tees, with an application for a special licence to sell beer from 8am.

If successful, the 'PoundPubs' chain has pledged to bring the brand nationwide, with a range of beers, ciders, bitters and cask ales on offer for £1.50-a-pint, or £1 for a half. Mike Wardell, a director at Here for Your Hospitality Ltd, said the latest PoundPub to open in Stockton-on-Tees would bring a traditional local to the High Street. But alcohol campaigner Colin Shevells, director of Balance, said: "Drink is already too affordable, too available and too heavily promoted".

Tackling street drinking

From 5th April, supermarkets across Gloucester are banned from selling cut price alcohol reports the Gloucester Citizen. Strict new tariffs will see cans of lager sold for a minimum of 50p, bottles of wine will cost at least £2.24 and spirits cannot be sold for less than £10.16. Dr Allan Harris, a GP who runs a drop-in health clinic welcomed the initiative, saying:

"Clearly alcohol poses a major and enduring threat to life and health for the homeless population. As has been seen when other drugs become less available, they switch to whatever else is around. Mephedrone is a particular problem in Gloucester at the moment. Those of us providing health care to the homeless need to be on our toes to step in and help homeless people who are reducing alcohol use, to intervene to prevent the complications of acute alcohol withdrawal, including seizures and delerium tremens.”

Meanwhile, street drinkers are being driven from Spalding town centre, bringing a new “sense of well-being” says Spalding Guardian, with the number of incidents dealt with by police almost halved, and the number of calls from the public falling by more than 50 per cent. The measures adopted in the town centre include:

• Adopting a single can policy – an agreement with local off-licences not to sell single cans. Street drinkers were buying one can at a time to minimise their loss when police made seizures.
• Litter removal – the council made an undertaking to remove all litter, including discarded cans and bottles, within the Designated Public Place Order area every 24 hours
• Rough sleepers – many of the street drinkers were also rough sleepers. Joint patrols with the Framework Street Outreach Team took place to break the cycle.
• Foreign nationals – the majority of street drinkers are from central and eastern European backgrounds. Joint working with UK Border Agency removed some of the most prolific street drinkers as the council could evidence that they were not exercising their treaty rights.

'Sobriety orders' to be tested in London pilot to curb alcohol-related re-offending

The Mayor of London's ambition to see 'sobriety orders' imposed on certain alcohol-related offenders comes a step closer next month as four London boroughs will implement a new pilot.

Alcohol Abstinence Monitoring Requirements (AAMRs) will allow courts in the pilot boroughs to require an offender abstain from alcohol for a fixed time period (recommended to be between 90-120 days) as part of any community sentence order. If alcohol is detected by a 'transdermal tag' a prompt reappearance at the magistrate’s court and an immediate sanction should follow.

Transdermal tags are an ankle bracelet that detect whether alcohol has been consumed by taking a regular reading which detects any alcohol naturally secreted from the drinker's sweat. The tags have been used in Scotland as part of research looking at the impact on students who volunteered to stop drinking. Those that wore the tags were significantly more likely to stick to abstinence than those who were not being monitored.

Of course the question of whether the tags can reduce alcohol-related offending is yet to be answered. In fact the Home Office piloted a similar 'Sobriety Conditional Cautioning' scheme in 2012 across five areas, but only ten offenders took part. Six of the ten completed the scheme without breaching. However the Home Office report released last year stated a 'general lack of understanding of the process' was apparent in the areas taking part, and offenders were required to report for breathalyser testing rather than wear tags.

A briefing from the Mayor's Office of Policing and Crime (MOPAC) states the London pilot will be 'aimed at a specific cohort of offenders; those convicted of alcohol-related offences stemming from the night time economy; repeat drink driving offenders and those convicted of alcohol-related violence offences'. It will run in four South London Boroughs of Croydon, Sutton, Southwark and Lambeth.

The pilot was first mooted in 2010 and drew attention when Kit Malthouse spoke on a BBC radio 4 feature saying London faced a "disproportionate" problem with alcohol-related crime - a claim accepted by a fullfact.org exploration. The scheme then drew sharp criticism from the Guardian but later recieved a "cautious welcome" from Alcohol Concern, who stated that the pilot should offer sobriety testing as part of a "wider regime" of support rather than punishment. Watch this space.