UK Alcohol Policy Whither now? Dr Jane Marshall SSA Symposium 9 November 2012

The Government’s Alcohol Strategy Presented to Parliament by the Secretary of State for the Home Department by Command of Her Majesty March 2012

Alcohol Consumption by Country

Cafe culture? Our streets are more like Dodge City (Daily Mail 12 September 2009)

Britain: “open 24/7” Public drunkenness has become more acceptable over the past decade 2010/2011 – Almost 1 million alcohol- related violent crimes (Home Office 2011) – 1.2 million alcohol-related hospital admissions

Alcohol-related hospital admissions These have more than doubled in less than a decade 2002/3: 501, /9: 945, /10: 1,057, /11: 1,200,000 – Alcohol-related falls and accidents – Cirrhosis, heart disease – Mental health disorders linked to alcohol NHS Information Centre, 2011

Level of dependencePrevalence in people aged 16 and over (%) Number of people Mild3.201,325,8000 Moderate ,000 Severe , 600 Total3.801,578,400 Estimated number of people aged 16 and over in England with alcohol dependence NICE, 2011

Why? Cheap alcohol is too readily available Industry needs have been prioritised over community concerns Increasing numbers of people are drinking at home (and “pre-loading”) Previous governments have failed to tackle the problem Lack of challenge to this behaviour Government’s Alcohol Strategy, 2011 (p3-4)

The Strategy Take firm and fast action where immediate and universal change is needed: – End availability of cheap alcohol and irresponsible promotions – Minimum unit price Ensure that local areas are able to tackle local problems, reduce alcohol-fuelled violent crime and tackle health inequalities Recognise the role of industry in changing individual drinking behaviour Support individuals to make informed choices about healthier and responsible drinking

Outcomes Required A change in behaviour so that people think it is not acceptable to drink in ways that could cause harm to themselves or others A reduction in alcohol-fuelled violent crime A reduction in the number of adults drinking above NHS guidelines A reduction in the number of people “binge-drinking” A reduction in the number of alcohol-related deaths A sustained reduction in the numbers of year olds drinking alcohol and the amounts consumed

1. Turning the Tide Reducing availability – Minimum unit price (MUP) – Ban on multi-buy promotions (off- trade) Alcohol advertising – Work with relevant agencies to increase public awareness (Ofcom; ASA; the Portman Group) Responding to emerging issues – Alcohol duty fraud – Liver disease in young people

Mortality

Alcohol-related liver disease : 25% increase in alcoholic liver disease Alcoholic liver disease accounts for ⅓ (37%) of all liver disease deaths Predicted cost: £1 billion per annum by 2015 [Liver disease strategy]

2. Taking the right action locally Changing behaviour at the local level Challenge and enforcement Rights and responsibilities Working across boundaries Evidence based action on health harms

Structure of the New NHS in England

New Commissioning Structures Health and wellbeing boards The NHS Commissioning Board Clinical networks and clinical senates Clinical commissioning groups Commissioning support organisations NHSCB sectors and local area teams Local authorities Health Watch

Police and Crime Commissioners

Public Health England

Joint Strategic Needs Assessment

2. Taking the right action locally Changing behaviour at the local level Challenge and enforcement Rights and responsibilities Working across boundaries Evidence based action on health harms

Changing behaviour at the local level Local areas being given powers to address harms from alcohol Stronger powers to control density of licensed premises Cumulative Impact Policies (CIPs) apply to on- and off-trade Greater community involvement in local alcohol licensing applications Information on crime near local alcohol hotspots

Challenge and enforcement Police and local authorities will take action to punish premises acting irresponsibly Proactive visible policing Managing the night-time economy: late night levy Max fine for persistently selling alcohol to <18 doubled to £20,000

Rights and Responsibilities Zero tolerance of violence in hospitals e.g. A&E Departments Support Trusts to work with local police Local powers to tackle drunken behaviour Health bodies to input into decisions on licensing Conditional Caution scheme

Evidence based action on health harms Needs identified in JSNA to be met Funding through Public Health Grant to allow local authorities to commission Identification and Brief Advice Specialist treatment for those with greater need Alcohol Liaison Nurses Integration across clinical pathways

3. Shared responsibility with industry Industry has a responsibility to change behaviour – Build on the Responsibility Deal – Make available a wider choice of lower strength products Supporting growth and responsible businesses – E.g. Best Bar None scheme Cutting red tape – Simpler processes for issuing a Temporary Event Notice (TEN)

4. Supporting individuals to change Understanding the risks Treatment and recovery Mental health Offenders

Understanding the risks Support people to make choices about healthier and responsible drinking. Particular focus on – young people – troubled families (£448 m) – schools and universities – A&E Departments Changes4Life Campaign launched in Feb 2012 CMO to oversee a review of the alcohol guidelines for adults Raise awareness of FASD and effects of alcohol in pregnancy Identification and Brief Advice in A&E and Primary Care NHS Health Check Alcohol Liaison Nurses Alcohol and domestic violence

Treatment and Recovery Family intervention projects Recovery beyond medical or mental health issues

Mental Health Promoting good mental health in children and adults to prevent alcohol misuse No Health Without Mental Health

Offenders Local investment in alcohol interventions and treatment services for offenders (8 pilot areas) Alcohol interventions pathway and outcome framework in four prisons