Alcohol Policy UK

Regional consumption explored in new study correlating consumption and harm

A new study details regional variations in alcohol consumption and provides "support for the ecological relationship between alcohol-related mortality and alcohol consumption".

The NHS Scotland commissioned research was published in the open access journal BMC Public Health. The study is the first to combine alcohol retail sales with other research and survey data to analyse regional alcohol consumption and its relationship to alcohol-related mortality.

Central Scotland was shown to have the highest levels of alcohol consumption, largely due to high off-trade spirit sales, and highest mortality rates. The South West, North East, North West and Yorkshire also ranked above average for Great Britain. In contrast, there were lower average per adult sales in London, Central England and the East of England. See a Daily Mail report here which includes info-graphics.

Key findings included:

• Per adult consumption in northern England was above the GB average and characterised by high beer sales.
• A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales.
• Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade.
• London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types.
• Alcohol-related mortality was generally higher in regions with higher per adult consumption.

The study found a 'a general pattern of higher alcohol-related mortality in regions with higher population alcohol consumption', but two outliers existed with Central Scotland and South West England showing conversely disproportionate mortality rates. 

See here for the Local Alcohol Profiles for England (LAPE) data tool or Alcohol Concern alcohol harm map also based largely on alcohol-related hospital admissions.

Last year PHE released new liver disease profiles to highlight alcohol's role in premature deaths across England.

Local and National Alcohol Policy: how do they interact?

A briefing exploring the relationship between local and national alcohol policy has been released by the Centre for History in Public Health, part of the London School of Hygiene and Tropical Medicine (LSHTM).

Download Local and National Alcohol Policy: how do they interact? [pdf]

The briefing captures presentations and debate at seminar held last year attended by a range of historians, policy roles and alcohol leads. Over-arching themes from the briefing may not be of surprise; alcohol policy at national and local level is a complex area, interacting on many levels, and often influenced by wider social, economic or cultural changes.

Despite this, lessons from history provide many interesting parallels, particularly in regard to licensing. In the first presentation, Dr James Nicholls explored how concerns over drinking in the late 18th century and 19th century led to measures to address outlet density and improve pubs - both contemporary themes of alcohol policy. Modern examples of policy failings (such as EMROs) show us, as history does, that alcohol policy is 'clumpy' and involves many tensions. It also shows that where policy threatens industry business interests, it will 'almost always use its economic influence to resist legislation'.

In the second talk, Professor Betsy Thom explored how knowledge within the alcohol policy field exists and the various challenges to seeing it implemented. In particular, the example of 'partnership working' has been shown to be typically challenging and still without conclusive evidence of its effectiveness. Despite this, various forms of partnership working have been considered central to national, regional and local attempts at implementing alcohol policy over recent decades.

Finally Public Health England's Don Lavoie presented on the last decade of national policy related to health harms following the first national Alcohol Harm Reduction Strategy for England in 2004. Since then, two further national strategies followed; new Labour's extensive 'Safe.Sensible. Social', and the current Government Alcohol Strategy. Surrounding these has been an ever broadening policy base of documents, including full NICE guidance, and various initiatives such as the Alcohol Improvement Programme.

Further discussion captured in the briefing identifies a range of other issues currently found within national and local alcohol policy. Differences between England and Scotland proved interesting discussion points, whilst challenges to implementing local action and the role of 'data' versus personal testimonies in policy advocacy also captured attention.

Download the full briefing here for more of the discussion and conclusions. See here for a FEAD video of a James Nicholls talk on 'Alcohol Policy - can we learn from history?'.

In 2009 a research project along similar lines explored 'The Orientation and Integration of Local and National Alcohol Policy in England and Wales'.

LGA call for alcohol tax to resource further local level action

The Local Government Association (LGA) have called for the Government to divert a fifth of the current total annual duty on alcohol to councils.

The LGA say £2 billion of alcohol duty should be directly invested in alcohol harm reduction activities that will help save money in return.

Download ‘Tackling the causes and effects of alcohol misuse' [pdf].

The call is part of a wider LGA campaign calling on the next Government to invest heavily in key local authority issues such as housing, schooling and unemployment 'by radically devolving power to local areas'. The report outlines the key ways in which local authorities can act to address alcohol misuse, but argues more resources are needed, particularly for preventative measures. 

The report states that "local councils’ responsibilities for health and wellbeing boards, social care, planning and housing strategy as well as public health, environmental health, licensing and trading standards put them at the heart of the web of influences needed to tackle this complex issue".

As such, the report outlines key "activities we could develop, expand and strengthen with additional resources" to address alcohol misuse. Of course many of the activities are already undertaken through local alcohol strategies, though certainly levels of investment and coverage of alcohol services varies greatly.

The report identifies trading standards and licensing teams as key areas where more work can be done to tackle the black market, which currently costs the Treasury £1.3 billion each year. It also highlights opportunities for improving prevention including further investment in Health Checks, further services for people with inter-dependent needs, and further work with the criminal justice system to improve outcomes for offenders.

Overall the report can be seen as a call for any future Government not to forget the role that local authorities play in addressing key areas where local 'invest to save' measures can be taken. This comes at a time where significant further cuts to local government are expected, but the likelihood of seeing any mainstream manifestos commit to ring-fencing a portion of alcohol tax may be slim. As such, the future position for local authorities seeking to resource alcohol strategies may remain the same; find whatever funding from wherever you can, and hope it lasts...

Responsibility deal pledge to remove 1 billion alcohol units by 2015 achieved early

The Department of Health have announced a second report detailing findings on the Public Health Responsibility Deal (PHRD) Alcohol Network pledge to remove 1 billion units of alcohol from the market by the end of 2015.

The report states that 1.3 billion units have already been removed from the market during 2011-2013, hitting the voluntary target well ahead of schedule. Although alcohol sales volume fell slightly (0.8%) during the period, an overall reduction in the average strength (ABV) of drinks removed 1.3 billion of the total 1.9 billion reduction. Reduced ABV beer and ciders accounted for the vast majority of units removed.

The report states that just over 52 billion units of alcohol were released for UK consumption in 2011, so removing 1 billion units would equate to a drop in consumption of around 2% which "should have significant public health benefits". However it may be noted that significant tax savings to producers may have been key to the agreement. In 2012 it was reported AB InBev would save up to £8.6 million a year in duty on off-trade sales alone by reducing Stella Artois, Budweiser and Becks from 5% to 4.8% ABV.

In 2011 the alcohol pledges committed to “foster a culture of responsible drinking which will help people drink within guidelines” in which removing a billion units would be done "principally through improving consumer choice of lower alcohol products.” Whilst the market for lower strength drinks has grown, most of the units are more likely to have been cut via drinkers unaware of a small reduction in the ABV of popular beers and ciders.

Assuming that the reduction will not be undermined by increased consumption or ABV in 2014 and 2015, the pledge is likely to be hailed as a key success for the Responsibility Deal and proponents of voluntary action over legislation. It was announced last year the labelling pledge was met, but other aspects have not been so successful. In 2013 Asda pulled its pledge to stop promoting alcohol in its foyers after other supermarkets had not followed suit.

Of most significance to opponents of the Responsibility Deal are claims that it has been a smokescreen for avoiding policies such as Minimum Unit Pricing (MUP). When it was first announced, six health groups walked out of the deal in protest of the pledges and process, with more reportedly quitting after the Government's MUP u-turn.

Despite this, new alcohol pledges were announced last year. The new pledges included agreements for some producers to stop super-strength drinks being available in large cans, and further actions on responsible display and promotion of alcohol for off-sales. For the on-trade, some pubs and bars will agree to have house wines below 12.5% ABV on offer and actively promote lower-alcohol products to customers.

Blue Light Project: Alcohol Concern release manual for 'Working with Change Resistant Drinkers'

The Blue Light project is Alcohol Concern’s national initiative to develop alternative approaches and care pathways for treatment resistant drinkers who place a burden on public services.

The project aims to challenge the belief that nothing can be done with resistant drinkers who 'do not want to change'. It aims to challenge this by showing there are a range of positive strategies that can be used to manage risk, reduce harm and promote change.

Download the first version of the Blue Light Project manual: working with change resistant drinkers [pdf]

The manual includes:   

• Tools for understanding why clients may not engage
• Risk assessment tools which are appropriate for drinkers
• Harm reduction techniques workers can use
• Advice on crucial nutritional approaches which can reduce alcohol harms
• Questions to help non-clinicians identify potential serious health problems and deliver enhanced personalised education
• Management frameworks
• Guidance on legal frameworks
• Above all it offers a message that positive intervention is possible

Alcohol Concern will be developing the project and manual which has been made available as a first version, with an updated version to follow in the spring.

A number of dissemination events and smaller workshops to review and develop the materials will be held over the coming months, supported by Public Health England. The aim is to start an ongoing national dialogue about how best to work with this client group.

To express an interest in attending one of the events contact [email protected].

Events & dates: New Directions 2015; Where next for IBA; GAPA 2015 & studentships

New Directions 2015 conference  

The New Directions in the Study of Alcohol Group (NDSAG) has announced its 39th Annual Conference 2015 [pdf] which will take place in London on 21st and 22nd of May.

The conference will explore a range of areas, including the headline theme 'Addicted to Recovery?', looking at the latest research on alcohol addiction in the context of the recovery agenda, related addictions, policy, and practice.

Confirmed speakers are to include: Prof. Keith Humphreys (Stanford University, USA), Prof. Anne Lingford Hughes (Imperial College, London), Prof. Marc Lewis (Radboud University, Nijmegen, Netherlands), Prof. David Best (Sheffield Hallam University and Monash University, Australia), Prof. Colin Drummond (National Addiction Centre, Kings College London), Dr Henrietta Bowden-Jones (National Problem Gambling Clinic, UK), Tim Leighton (Action on Addiction, UK), Alistair Sinclair (UK Recovery Federation), Clive Henn (Alcohol Policy Team, Public Health England), Dr Niamh Fitzgerald (University of Stirling, Scotland) and more. 

See the New Directions website for more details and future announcements including the annual Ron McKechnie prize which offers a full conference bursary.

Alcohol brief intervention: where next for IBA?  

The Alcohol Academy are organising a national conference to explore key issues facing the delivery and implementation of 'Identification and Brief Advice' (IBA) in the UK. The event will take place on Monday 20th April in Birmingham. Formal registration will open shortly but you can register your interest by contacting [email protected] or see the event flyer [pdf] for more information. 

Global Alcohol Policy Conference 2015 

The Global Alcohol Policy Alliance (GAPA) and Alcohol Focus Scotland are to co-host the next Global Alcohol Policy Conference which will be held in Edinburgh from 7-9 October 2015.

'Momentum for change: research and advocacy reducing alcohol harm' will look at key themes including: Implementing Effective Alcohol Policies; Barriers to Implementing Effective Alcohol Policies; Building Support for Protecting Children’s Right to Grow Up Free from Alcohol Marketing & Building a Global Network.

Prospective presenters are encouraged to submit abstracts in relation to new research, effective advocacy approaches and national or global policy. The abstract submission deadline is 6 March 2015. For more information and booking (from late January) visit the conference website: www.gapc2015.com.

BSA alcohol research methods event 

The British Sociological Association (BSA) are holding Alcohol Explorations: A Research Methods Workshop which will take place at in London on Friday February 27 2015. The event is aimed at academics interested in alcohol research methods, exploring issues such as 'how can sociological research help us to understand the complex subjective, embodied and sensory experiences of drunkenness and intoxication?'. See the flyer here or contact Dr. Thomas Thurnell-Read for more details.

Research & studentships

Alcohol Research UK are inviting universities to apply for one of three jointly-funded research studentships for studies commencing in the academic year 2015/16. Each studentship will offer £7,000 per year match funding for three years, to enable a student to undertake research in the alcohol field leading to a PhD. Please see the prospectus for full details. The deadline for receipt of applications is 26th January 2015.

The Centre for Public Health at the Faculty of Education, Health and Community, Liverpool John Moores University, is organising its first Public Heath PhD Symposium and doctoral students are currently invited to submit abstracts.

Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS): fourth annual report summarises impact to date

The fourth annual report that provides an update on the monitoring and evaluation of Scotland’s alcohol strategy has been released by NHS Health Scotland. The report summarises the impact various elements of the national strategy are thought to have had on alcohol-related harm.

Overall, consumption and most alcohol harm measures have been continuing to fall over recent years. However according to the report, 'a substantial proportion' of the improvements in alcohol-related harms are associated with 'declining affordability of alcohol due to the economic downturn'. Nonetheless, the ban on quantity discounting of alcohol and increased Alcohol Brief Intervention activity (or 'IBA' in England) were thought to be contributing to the improvements seen in Scotland.

Although some increased awareness of the harm caused by alcohol was evident amongst the population, there had been little notable change to attitudes or other knowledge around alcohol. Whilst significant investment and access to alcohol treatment services had been made, more understanding was needed to assess the potential contribution this made. Other licensing work actions were not shown to have played a significant role as yet, and the strategy aim of minimum pricing has not yet been achieved owing to an EU legal battle led by sections of the alcohol industry.

For further analysis read the full MESAS report here [pdf], or see a recent Findings Bank entry.

Dry January looks set for strong 2015 - here to stay?

Dry January appears to be continuing to gain momentum as significant media attention and Twitter activity continues. Dry January 2015 has been backed by Public Health England (PHE) with a significant digital, press and radio campaign fund, whilst a number of local areas are adopting the campaign.

Alcohol Concern first officially launched Dry January in 2013, followed by significant growth last year. A big boost for the campaign came with PHE's involvement and recent research indicating sustained reductions in many participant's drinking.

It has been suggested that a quarter of Britons now make some attempt to give up alcohol for January, though most would not be officially signing up. The Dry January campaign may however have threats to its present popularity. For one, it might be considered that the increasing number of other 'month off' campaigns might dilute the novelty or acceptability of an occasional sober month.

Sections of the alcohol industry might also be looking to counter the trend; the Morning Advertiser have launched a 'Try January' campaign which aims to 'unite the industry' to support January as a month for 'discovering new food and drink'.

Others may be put off, and perhaps some inspired, by various the various popular figures opting in - the usually proud drinker Nigel Farage's participation attracted significant interest. A selection of other media articles during the month also looks likely to continue - this 'how to do Dry January' piece one example from the Independent.  

Dry January - what for?

More research may be underway as to why people attempt a 'month off', but the significant shift to more regular 'home drinking' may play a role in why many drinkers might decide to take time off booze. Whilst some might simply believe a break could be a 'detox' for the body, increasing awareness over the risks of regular 'risky' consumption may be contributing to the campaign's popularity. Indeed its main promotional messages are centred around potential benefits of improved sleep, mood or calories cut out.

Overall, health groups are likely to view growing popularity of 'Dry January' as a positive. No single policy or campaign is likely to be successful in reducing population level harmful drinking on its own, but Dry January might be seen to contribute to a broader change in attitudes and habits, as well as the possible benefits to individuals. Overall consumption may have dropped over the last decade, but health groups are set to continue to argue minimum pricing and other controls regarded as central policy levers for securing a sustainable impact on alcohol harms.

Licensing figures 2014: premises down slightly, but reviews still falling and questions over 're-balancing' measures

The Home Office recently released 2014 statistics on alcohol and late night refreshment licensing in England and Wales. Broadly the figures show little change in the number of premises licensed to sell alcohol, though the figures for new powers introduced under the Licensing Act raise questions over their effectiveness.

In particular, no Early Morning Restriction Orders (EMROs) have been implemented and only one area has managed to get a Late Night Levy through, despite several other areas attempting to.

Also questionable is the number of applications or variations being granted where 'Cumulative Impact Policies' (CIPs) are in place. CIPs are designated areas where it is deemed any further premises would be likely to have a negative ‘cumulative impact’ owing to a saturation of premises. Despite this, 86% of applications or variations in the 208 CIP areas were still granted [N.B we are currently checking these figures].

Whilst the figure is still lower than non-CIP areas (91%), the majority of applications being approved in CIP areas seems counter to the intention of the policy. Whilst it could be highlighted that some applications are not made as a result of a CIP being in place, the numbers of applications suggest this is not likely to be significant.

Total premise figures

Licensed premises permitted to sell alcohol dropped by just under 2% as of March 2014 to 168,600. However including premises licenses which were 'not permitted to sell or supply alcohol or had alcohol permissions which were not reported', there were 204,300 premises licences, a slight increase of 0.1% (300) compared with 2013. In 2014 there were 15,400 club premises certificates, a 2% drop (-300).

24 hour licenses

There were 8,200 premises with 24-hour alcohol licences in England and Wales in March 2014, a slight decrease of 2% (-200) from the previous year, but an increase of 8% (600) compared with 2009. 24-hour alcohol licences in 2014 equated to 4% of the total number of premises licences.

Licensing reviews

A licensing authority can be asked to review a licence on the grounds of it having an adverse impact. 800 reviews were completed in the year to 31 March 2014, down 11% (-100) fewer than the previous year and 27% (-300) than in 2009.

653 reviews were for crime and disorder, 314 were for protection of children, 258 were for public nuisance, and 193 were for public safety. Police and Trading Standards instigating 79% of all reviews. Most reviews (689) resulted in conditions being added to the licence or modified, 198 resulted in a licence being revoked. The remainder resulted in either suspensions, removal of the designated supervisor or no being action taken.

Re-balancing the licensing act?

In 2010 the Government consulted on proposals to 'overhaul' the licensing act in order to 'give local authorities and the police much stronger powers to remove licences from, or refuse to grant licences to premises that are causing problems'. However given the overal figures and number of ERMOs, levies or refusals in CIP areas, it is perhaps hard to argue that any real 're-balancing' has occurred. 

Also set out following the 're-balancing' consultation was reform of the temporary event notices (TENs) system, which was then abandoned following a further consultation. However the original consultation did also set out to 'enable more involvement of local health bodies in licensing decisions' which has happened to some degree (see guidance here). It also set out the intention of the 'below cost ban' which is now in effect, via of course the brief interruption of a minimum pricing announcement and subsequent u-turn.

At the recent ALcohol Concern conference, shadow public health minister, Luciana Berger, said Labour would seek to introduce public health as a licensing objective and were "committed to reviewing the licensing system with a view to enhancing the voice of local communities in licensing decisions".

The Home Office announced it would not be publishing the figures for 2015 in order 'to reduce the administrative burden both on LAs and the Home Office statistics team'.

Findings alcohol bulletins: health benefits lost from minimum pricing reversal; England & Scotland's alcohol treatment capacity checked

Recent bulletins and hot topics from the drug and alcohol bank:

Health benefits lost by reversal in English alcohol price policy

When for England the UK government reverted from a proposed minimum price per unit of alcohol to a ban on pricing below duty plus VAT, they abandoned a policy that would probably have had 40–50 times the impact on consumption and reaped correspondingly greater health gains.

Record alcohol treatment numbers in England still not enough

In England a record 114,920 adults were in specialist alcohol treatment in 2013/14 and nearly 4 in 10 left as planned free of dependence. A good record, but probably still most dependent drinkers who might have benefited from treatment did without it, partly because relatively few found their ways there via GPs and emergency departments – a sign of the shortfalls in England’s screening and brief intervention provision.

Scottish alcohol treatment system has three times the capacity of the English

Evidence that in 2012 Scotland’s treatment caseload equated to 1 in 4 of the country’s alcohol-dependent adults, over three times the 1 in 14 ratio in England, partly a consequence of extra funding accompanying the 2009 national alcohol strategy. Can it really be that proportionate to need, Scotland’s treatment system has three times the capacity of the English?

Also, Findings hot topics for November/December 2014:

• What is a harm reduction service for?
• Reintegration and recovery objectives stretch UK treatment services
• Should dependent drinkers always try for abstinence?
• Cycle of change model: change promoter or benevolent fiction?