Alcohol Policy UK

Health Survey for England 2013 - current consumption trends stable?

Figures from the Health Survey for England (HSE) 2013 have been released, though do not indicate any significant changes in reported alcohol consumption patterns over the last year.

The report states 'a stable picture over the last three years for both men and women' based on average weekly consumption. However for heaviest drinking day in the last week, a gradual year on year decline since 2009 is reported. In 2013, 37% of men drank more than the daily guideline of 4 units on their heaviest drinking day in the last week, compared to 41% in 2006. Similarly for women, 27% of women consumed more than 3 units on their heaviest drinking day in the last week, compared to 33% in 2006.

Overall consumption has declined since 2004 based on HMRC data, but it is unclear to what extent various factors account for these falls. 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. Also changes within groups needing accounting for, especially considering an increasing population of non-drinkers; the HSE indicates that 15% of men and 20% of women did not drink during 2013.

Of course some warn that consumption may begin to rise again as the economy picks up, since heavier drinker's incomes are disproportionately squeezed in harder times. Consumption is still significantly higher as a longer term trend, and no indication of a halt to rising alcohol-related hospital admissions as yet.

In 2013, based on weekly consumption the HSE indicates:

• just under two thirds of adults drank at lower risk levels 63% of men drank up to 21 units per week for men and 64% of women drank up to 14 units per week.

• 18% of men drank at an increased risk of harm (between 21 and 50 units per week), and 5% drank at higher risk levels (more than 50 units per week).

• 13% of women drank at increased risk levels (between 14 and 35 units per week), and 3% drank at higher risk levels (more than 35 units per week).

Last year a more detailed HSE report reflected known general consumption patterns, as well as findings reported in the General Lifestyle Survey. See here for the Statistics on Alcohol for England 2014, although less comprehensive than previous versions.

Wales and Northern Ireland plan for minimum pricing as Scotland's MUP delay approaches third year

The Governments of Wales and Northern Ireland have both recently set out their intentions to introduce minimum pricing, following further research by the University of Sheffield.

The Welsh Health and Social Services Minister Mark Drakeford said they would "continue to develop our proposals with a view to introducing legislation" following publication of the Sheffield Alcohol Policy Model's Welsh findings. The report says that a 50 pence minimum unit price (MUP) could reduce Welsh alcohol-related hospital admissions by more than 1,400 and save 53 lives each year.

The announcement in Wales earlier this month came shortly after the Northern Ireland Executive also said it would proceed with minimum pricing. For Northern Ireland, a 50 pence MUP would be expected to reduce alcohol related deaths by 63 per year and save healthcare services £1.8 million within the first year.

Previously this year the Sheffield Alcohol Research Group published work which is said shows MUP is a targeted measure and would not 'punish responsible drinkers', a common charge fired by opponents. Further work by Sheffield also suggested supermarkets subsidise tax increases on the cheapest drinks to keep customers attracted in store.

MUP: not so fast... 

Of course Governments announcing MUP plans and actually implementing it are not quite the same - Scotland are in the midst of a EU legal battle spearheaded by sections of the alcohol industry. Scotland first passed legislation to implement MUP in 2012, but cannot be sure it will even come into force in 2015.

SHAAP (Scottish Health Action on Alcohol Problems) are campaigning for people to sign in support for Scotland's MUP plans following a briefing on Alcohol Policy in Scotland: Proceedings from Brussles event [pdf].

In England, plans announced in 2012 for a minimum pricing were shelved were followed by accusations of industry lobbying. As an alternative, a 'below cost ban' has since been implemented, but its effect has been suggested to be minimal, if any. However Public Health England have committed to "continue to set out the evidence base for the introduction of a minimum unit price for alcohol".

Young people’s hospital alcohol pathways: PHE support pack for A&E departments

New guidance to improve support for young people in A&E with alcohol related problems has been published by Public Health England (PHE).

The support pack is aimed at A&E clinicians, hospital managers, substance misuse and young people’s commissioners to help them develop care pathways within A&E and into other services for young people.

It says A&E attendance provides a 'teachable moment' in which a planned response can have a significant impact on the current and future health and wellbeing of the young person. 'Brief interventions' (IBA), clear alcohol care pathways and pathways into wider (non-alcohol-related) children’s services and support should be ensured where appropriate.

The guidance includes a model care pathway for alcohol misusing adolescents (see right) and also covers: 

• Understanding levels of unmet need
• Initial screening and referral process
• Information and data sharing 
• Safeguarding
• Interventions 

The report recommends that AUDIT-C, a short 3 item assessment tool, should be used to assess young people for alcohol misuse in A&Es. Based on AUDIT-C is states:

The threshold for brief intervention for young people aged 10-16 years should be a score of 3+ (adult score should not be used). The threshold for referral to substance misuse specialist services should be a score of 6+. However, screening results should not replace clinical assessment and judgement and patient preferences.

The pack builds on a 2011 Alcohol Concern briefing which outlined steps A&E departments could take to provide harm reduction to young people who attend hospital as a result of their drinking. See all Young People tagged posts here.

Alcohol Concern call for statutory marketing regulation as alcohol industry efforts "can't be trusted"

Alcohol Concern are calling for statutory regulation of alcohol marketing as a new report from Alcohol Concern Wales says "big alcohol companies cannot be trusted to promote moderate drinking".

Download Creating Customers: finding new ways and places to sell alcohol, and new people to buy it [pdf]

The report says major alcohol producers are constantly seeking new ways and places to sell alcohol, and new people to sell it to. It says the industry undermines its own pledges to encourage the safe use of alcohol, highlighting marketing and sales tactics at odds with claimed 'responsible drinking' intentions.

The report also explores how alcohol is marketed to different groups, employing a range of strategies. For instance marketing to women may portray alcohol as a calorie-laden indulgence and as an aid to weight loss, whilst retailers are encouraged to maximise sales in various ways. It also says big drinks companies are working to drive up consumption in parts of Africa, Asia and Latin America where levels of drinking have traditionally been lower than in the West.

Alcohol Concern Wales Director, Andrew Misell said:

“Given the number of different ways the alcohol industry can now sell their products, the big question is whether the people who make more profits the more alcohol we drink are really the best people to advise us on how to use it safely and healthily.

“Given the obvious conflict between the alcohol industry’s need to sell more alcohol and the need to promote moderate drinking, alcohol producers should have no role in drawing up information or policy on safe drinking.”

Currently alcohol marketing regulation falls within the Portman Group’s Code of Practice of the Naming, Packaging and Promotion of Alcoholic Drinks, which exists 'to ensure that alcohol is marketed responsibly and only at adults'. With overall responsibility for marketing adherence, the Advertising Standards Authority (ASA) recently defended the current set-up following calls for tighter restrictions to protect children. However public opinion may be on the side of health groups given a recent survey which found most people believed alcohol advertising regulation to be inadequate.

A recent Cochrane review though did not find a clear answer as to whether banning or restricting alcohol sales would reduce consumption, although one subsequent study has found otherwise. However the general effects of advertising may be more indirect - for instance by changing social norms or associating alcohol with certain imagery or lifestyles, which may in turn influence overall consumption. These questions and other significant issues are explored in insightful look at alcohol marketing in this ADHS blog 'The drip feed'.

Alcohol and the Developing Adolescent Brain: Evidence Review released by SHAAP

Earlier this year Scottish Health Action on Alcohol Problems (SHAAP) published a report compiling a number of expert insights into the impact of alcohol on the adolescent brain. The issue is of particular relevance to alcohol policy given evidence that early onset drinking is linked to later life alcohol problems.

Download Alcohol and the Developing Adolescent Brain: Evidence Review [pdf].

The review looks at key areas including how the brain develops during adolescence, what alcohol does to the developing brain, the role of genetics, and further clinical, psychological and cognitive implications of adolescent alcohol use. Many of the articles address the limitations and challenges facing research in the area, but identify a number of serious effects adolescent alcohol use can have on short term brain functioning and for later life.

Based on the themes of the report and round-table discussions, SHAAP make a number of policy recommendations:

• Protecting young people from alcohol-related harm has to be within the context of a 'whole population' approach to reduce overall alcohol consumption.
• Protecting young people from alcohol-related harm should be embedded in national and local policy.
• Emerging evidence that the adolescent brain may be especially vulnerable to alcohol harms should inform all health-promoting activities.
• Emerging evidence that the adolescent brain may be especially vulnerable to alcohol harms should prompt investment in further exploratory research.

Last year an event took place exploring 'Alcohol consumption in adolescence and early adult life: What are the consequences?', organised by the Cohorts and Longitudinal Studies Enhancement Resources (CLOSER).

A presentation at this year's Drinkaware conference also looked at the subject with a presentation on 'The effects of alcohol on the adolescent brain', by Sarah-Hayne Blakmore, Professor in Cognitive Neuroscience at UCL. View the factsheet here.

GP 'brief intervention' incentive for new patients to end - a blow for IBA?

General Practice will no longer be incentivised to deliver 'Identification and Brief Advice' (IBA) for new patients from April next year following changes announced to the General Medical Services (GMS) contract.

Instead of the alcohol Direct Enhanced Service (DES) funding, NHS Employers states 'the associated funding will be reinvested in global sum' - the total amount paid to Primary Care. It will then be a 'contractual requirement for all practices to identify newly registered patients drinking alcohol at increased or higher risk levels'.

On the one hand, this means all practices will be obliged to identify at-risk drinkers when new patients join a practice. On the other, removing the requirement to record 'identification' to generate the payment will presumably not help focus attention on IBA. Nor will the changes help address questions over whether 'identification' of at-risk drinkers actually results in patients receiving 'brief advice', although the current DES guidance states it is for local commissioners to quality check.

NHS England have committed to monitoring recorded activity via the General Practice Extraction Service (GPES), so will be able to assess the impact of the change.

The alcohol DES: 2008-2015

Since 2008, practices have been able to take part in the alcohol 'Direct Enhanced Service' (DES) and claim a payment (currently £2.38) for each new patient screened using a validated initial 'identification' tool such as the FAST or AUDIT-C. Originally only planned for two years, the alcohol DES was then extended each year. However its value has been much debated with questions over whether the scheme has actually resulted in sufficient quality IBA, or led to a 'box ticking' exercise to generate a payment.

One often raised issue is that the DES payment is collected when a patient completes FAST or AUDIT-C and recorded by the practice, regardless of the score or 'brief advice' being delivered. The original guidance only stated that practices 'should' subsequently complete a full AUDIT and offer brief advice to at-risk drinkers, or referral for those indicating dependency. Not surprising then that recording of 'brief advice' or 'referral' activity on the same systems usually appear significantly lower.

In 2011 Haringey's local alcohol service HAGA produced a comprehensive DES report after finding 75% of local practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice. Informal mystery shopping accounts also indicate a very mixed picture - some practices may simply hand out screening tools without any follow up, whereas some might ensure staff are suitably trained and appropriate pathways are in place.

In fairness to the limitations of the DES, wider pressures on Primary Care roles, as well as broader attitudinal barriers around alcohol are also likely to be significant. Meanwhile IBA has been integrated as part of the NHS Health Checks programme and is increasingly being delivered by Community Pharmacies.

Where next? 

Clearly there is some way to go before we are likely to see a picture of quality IBA being routinely delivered in Primary Care. Research points to the importance of incentives, but it is also clear that more than incentives alone are required - training, pathways and organisational and other factors also crucial. Little has been done to really explore what would further motivate belief in the value of IBA by busy frontline roles.

Meanwhile the role of IBA in local alcohol strategies seems increasingly popular as it continues to be sought in a range of further settings where the evidence is less clear. Also under question is whether more minimal or 'lite' versions, online approaches or other channels of engaging at-risk drinkers can be considered as 'evidence based' approaches to 'brief intervention'...

For more see the IBA blog, Alcohol Learning Centre, INEBRIA, or the 2013 'Clarifying Brief Interventions' briefing.

Dry January impacts drinking through the year & Alcohol Awareness Week 2014 round-up

Alcohol Concern recently announced research shows many drinkers attempting a 'Dry January' make lasting changes to their drinking, even those who do not successfully complete the whole month off.

Released during the recent 2014 Alcohol Awareness Week, the figures indicated that six months after completing a 'Dry January', participants were drinking less frequently and drinking less per drinking occasion.

Figures complied by the University of Sussex showed:

• 72% of participants had sustained reduced levels of harmful drinking six months after completing Dry January
• The 23% of people who had “harmful” alcohol consumption when they started Dry January are now in the “low risk” category
• 4% of participants were still dry six months on

With the growing popularity of Dry January and other 'month off' campaigns, increasing attention was inevitably focusing on the issue of how helpful such approaches really are for the drinker. The British Liver Trust's Andrew Langford had previously warned against the appeal of a "quick fix in January" and instead called on people to follow a 3 step liver plan including two or three alcohol free days in every week of the year. Others had queried whether a month of might lead to drinking more in subsequent months.

Varying periods of abstinence play a role in many people's consumption patterns as shifting life circumstances, cues or interventions may trigger 'contemplation' or unconscious change. Alcohol Concern highlight 9.6 million adults in England drink above the guidelines, most of whom are not dependent but might experience alcohol-related health or social problems. A range of benefits were highlighted by Dry January participants including improved sleep, energy, weight loss and saving money.

See here for a presentation on the Dry January results [PPT]. Public Health England (PHE) have teamed up with Alcohol Concern to promote the 2015 campaign.

Alcohol Awareness Week 2014 

The findings were released during this years Alcohol Awareness Week (AAW) which ran from 17-23 November. Alcohol Concern promote AAW to encourage local areas and organisations to increase awareness and activities such as Identification and Brief Advice (IBA).

Many areas and organisations carried out local or regional activities including encouraging sign ups to Dry January, or making use of social media. Like Dry January, AAW seems to be gaining momentum - see the #AAW14 hashtag for some of the activtity this year, or here for a round up or last year's AAW.

Download alcohol impacts poster here [pdf]

BHF 'alcohol at work' guide encourages workplace policies

The British Heart Foundation (BHF) have produced a 'Health at work guide to alcohol', which encourages organisations to assess alcohol-related need and develop policy and awareness raising activities.

The guide highlights figures that suggest businesses in the UK lose £7.3bn every year as a result of alcohol-related ill-health, time off work and lost productivity. Referencing the Institute of Alcohol Studies factsheet on alcohol in the workplace, it also highlights the 17 million working days per year are lost to alcohol-related absenteeism, and that alcohol is responsible for an estimated 40% of all workplace accidents.

To address this the guide encourages employers to set up a team to lead on the development of a programme that includes securing cross-organisation support, development of workplace policies, and the delivery and evaluation of staff training and workplace alcohol awareness initiatives.

In 2012 former Alcohol Concern Chief Exec Don Shenker set up the Alcohol Health Network to improve alcohol-related health in the workplace. A 2011 research project into the feasibility of alcohol brief interventions (or 'IBA') in the workplace has shown that opportunities to deliver IBA do exist - though may have limitations and are not without barriers. The project concluded with a briefing paper on alcohol & the workplace which also made similar recommendations.

Other organisations, including Alcohol Concern, have also sought to develop alcohol workplace programmes, whilst an NHS Workplace Wellbeing Charter includes alcohol components. Indeed the workplace may be considered one significant area where real progress is yet to be made.

News & updates November 2014: 95% ABV vodka under fire, older women's drinking, sobriety tags, trade news & more

Selected media reports since the October roundup:

Amazon has halted sales of the 95%-alcohol vodka, Spirytus Rektyfikowany, that killed a girl at her 18th birthday party. The Polish liquor is still being sold in the UK through scores of internet shopping sites, along with other super-strength spirits, reports the Mirror.

Soaring numbers of older women are having treatment for alcohol dependency, reports the Daily Mail and Guardian, with over-60s now making up nearly one in ten of all women undergoing formal treatment programmes.

Severe damage inflicted on an unborn baby by her mother’s heavy drinking during pregnancy was equivalent to an attempt at manslaughter, the court of appeal has been told, reports the Guardian, whilst campaigners and doctors call for stronger warnings about drinking during pregnancy, says BBC News.

Lib Dem MP Norman Baker has said that the country should be "worried more about alcohol" than cannabis and policy should do more to tackle irresponsible sales, according to the Independent. Baker, who recently resigned from his role as Home Office lead on drugs, said "I’m in favour of evidence-based policy, and we underplay the dangers of alcohol."

A Tory Government will allow judges across the country to use alcohol abstinence orders or 'sobriety bracelets', if the party is returned to government next year, according to the Guardian. The scheme is currently being piloted in London and several other areas.

Trade news 

As the on-trade diversifies pubs are now 'not all about alcohol' says the owner of All Bar One, reports The Telegraph. In some of its other chains, soft drinks now outsell alcohol as reaching out to non-drinking and business crowds becomes increasingly important.

Publicans with personal licences that expire early next year will need to complete an application form to renew their licence, the Home Office has confirmed. The Deregulation Bill, which removes the requirement for personal licences, won't be approved until Spring 2015 at the earliest, so the new application form is a stop-gap, reports the Morning Advertiser.

The Daily Mail picked up on recent research by the Royal Society for Public Health calling for calorie-content labelling on alcoholic drinks - a proposal criticised by the drinks trade, according to the Morning Advertiser.

The Government has promised to amend its Business Improvement District (BID) guidance to local councils to encourage areas with the scheme to be exempt from introducing a late-night levy, reports the Morning Advertiser.

Non-alcoholic beer is set to grow by 26% from 2013 to 2018, partly driven by health-conscious Western Europeans who want the beer but not the belly, reports the Daily Telegraph, despite, says the Mirror, its 'terrible taste'.

And finally, Snuffle, alcohol-free Belgian beer for dogs, has been launched in the UK.

 

Consultation on relaxing low level alcohol sales: Community and Ancillary Sellers Notice (CAN) - a controversial move?

The Government published a consultation last month on the Community and Ancillary Sellers Notice (CAN) as part of its Deregulation Bill, which is currently being considered by Parliament.

The CAN intends to allow particular low-risk businesses and community groups to sell small amounts of alcohol, while providing appropriate, light-touch controls. Currently licences can cost between £100 and £1900, plus a £75 application fee, which some smaller businesses argue is excessive.

The CAN consultation proposes for a low, one-off fee, a CAN user would for three years be able to sell a limited amount alcohol between 7am and 11pm. Community groups would be able to name up to three premises at which they will sell alcohol at organised events, with a maximum of 300 attendees.

However controversy over the move was triggered by Labour peer Lord Brooke who said the proposal was in response to alcohol industry pressures which are "seeking to extend the areas in which it is selling alcohol in other forms". Lord Brooke also asked why health bodies had not been consulted. It was suggested the proposal poses a risk to children as it would repeal the offence of selling liqueur confectionery to those under the age of 16. Home Office spokeswoman Baroness Williams responded that "The rules are that 0.2 litres per kilogram is the limit and that is to stop vast quantities of alcohol being put into food."

The consultation closes on 9 December - see the factsheet, impact assessment, and respond online here. The factsheet says areas still to be decided are: 'exact limits on the amount of alcohol that can be served and any exceptions; eligible business types (including the maximum size); the definition of qualifying community groups; the frequency of permitted events and details on the fee'.

Introducing the consultation, Lynn Featherstone, Crime Prevention Minister, said: 

"Under existing arrangements small accommodation providers such as bed and breakfasts and community groups are subject to the same licensing regime and scrutiny as businesses which sell much higher quantities of alcohol including large hotels and off-licences. These groups have told us that these requirements are heavy handed for those who want to sell small amounts of alcohol as part of a wider service.

The Coalition government is committed to reducing the unnecessary burdens on responsible businesses, but not at the expense of undermining safeguards against crime and disorder or public nuisance and we want to get this balance right."

The CAN will be a new authorisation under the Licensing Act 2003. See here for Home Office licensing guidance, including revised guidance issued under section 182 of the Licensing Act 2003.