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Alcohol Strategy

The Alcohol Harm Reduction Strategy for England was finally published on 15th March 2004. Joy that the Strategy, eagerly awaited since 1998 was finally appearing soon gave way to dismay when it became obvious that the wait had not been worthwhile. As expected, the Strategy focuses strongly, - some argue disproportionately – on youthful `binge drinking’.

Launching the Strategy, Public health minister Melanie Johnson said:

“The measures in this strategy will help us tackle problems at source - for example, around 70 per cent of weekend accident and emergency admissions are alcohol-related. This document is an important contribution to the government’s wider debate on public health - Choosing Health? - that will lead to a white paper later this year. We will further develop the approach to alcohol treatment and support services as part of the consultation on this white paper.”

Hazel Blears, minister for crime reduction, policing and community safety said:

“We have consulted widely on this strategy and identified that a lot of good practice already exists. In many areas the police, local councils and the drinks industry are working together to combat underage drinking, antisocial behaviour and drink-fuelled violence. Our strategy will widen this approach so that people are more aware of the dangers of excessive drinking, that advertising doesn’t promote irresponsible drinking, and violent behaviour in our city centres is reduced.”

Predictably, immediate reactions to the Strategy were mixed but generally guarded.

The BMA’s Head of Science and Ethics, Dr Vivienne Nathanson said:

“It is very good news that the Government is taking the issue of alcohol abuse seriously. What we need now is concrete action to tackle the crisis. The BMA would like to see clear warnings and labelling on alcohol products as well as a ban on alcohol advertising.

“It is a tragedy”, she continued, “that doctors are starting to see serious liver disease in young people because of alcohol. It is also very expensive for the NHS. Young people must be made aware that having fun does not have to mean getting drunk three or four times a week. Alcohol is a poison. Too much in one go can be lethal, too much week after week kills you more slowly.”

Professor Ian Gilmore of the Royal College of Physicians also gave a less than wholehearted response.

“I am pleased the strategy has been published,” Professor Gilmore said, “but there is some disappointment that it appears to be much stronger on issues of law and order than on health.”

Professor Gilmore also criticised the report’s emphasis on further research rather than action.

“The report talks about audits and pilots but we believe there is already more than enough evidence for action. It is stronger on cleaning up the streets than on preventing physical harm.”

Eric Appleby, chief executive of Alcohol Concern said that ministers deserved praise for tackling an issue that had proved too hot to handle for past governments, and he also welcomed the review of alcohol advertising and the promise of targeted campaigns. “But”, he continued, “we must boost treatment and counselling services for people experiencing drink problems now. The recent Commission on Alcohol Services said these services needed urgent help to cope. We also expect the drinks trade to live up to their obligations on drinks promotions.”

Lord Adebowale, chief executive of social care charity Turning Point:

“We welcome measures around education, preventative work and requirements on the drinks industry. But these are just part of the puzzle, and the biggest piece is missing; tackling the lack of treatment services for the 3.8 million people who are dependent drinkers. The document gives little hope of speedier, effective treatment for people with alcohol dependence, and is small comfort for the families of the 13 people who will die today, as every day, as a direct result of alcohol misuse.”

Others were even less generous in their appraisal. Professor Christine Godfrey, one of the country’s leading health economists and who was an adviser to the Strategy Unit which prepared the analysis on which the Strategy is supposedly based, described it as a huge disappointment and little more than a sop to the alcohol industry.

It was hardly surprising therefore that industry bodies welcomed the Strategy rather more enthusiastically than did the alcohol abuse agencies. Sources connected to the alcohol industry confirmed to Alert that the industry’s main reaction was one of relief that it had got away so lightly, particularly as it emerged that the Home Secretary had been pressing for far tougher measures than any to be found in the Strategy. However, the possibility that tougher measures will be introduced at some point in the future cannot be entirely discounted.

Speaking for public consumption, Rob Hayward, chief executive of the British Beer & Pub Association said:

“The government has laid down a challenge to the industry to promote responsible drinking. We are determined to build on good practice that exists. At the heart of this strategy is recognition that 90 per cent of the population enjoy alcohol as part of their social lives without harm, but we recognise the need for action to tackle a minority who misuse alcohol and cause anti-social behaviour. This strategy is a key cornerstone in that campaign.”

Jean Coussins, chief executive of the alcohol industry’s Portman Group said:

“There are serious and growing problems of alcohol misuse and the industry must continue to play its part in tackling these. I am pleased that the government has recognised that it can build on the good practice already in place amongst leading companies within the industry. The industry must do even more to deliver against the tough targets set out in the strategy, or face government action.”
The frequent references to a crackdown on binge drinking in the media at the time of the announcement of the Alcohol Harm Reduction Strategy was either the result of cynical spin or lazy journalism. The only real crackdown was on the Home Secretary who wanted measures which other ministers had already ruled out during the passage through Parliament of the Licensing Act 2003 – a measure which many believe will in itself exacerbate the problems of binge drinking.

The day before the launch of the Strategy, the Sunday Times reported that in a private letter sent on February 6, Home Secretary David Blunkett warned the Prime Minister that the “situation at night in our town and city centres raises serious concerns about the control of alcohol-related crime and disorder”.

The newspaper reported that research commissioned by the Home Office had uncovered a sharp rise in violent assaults linked to drink and a significant increase in people being attacked by drunken strangers. Moreover, a senior Home Office official was quoted as saying that it was now “more or less impossible” for the police to enforce the law in city centres. Leaked minutes of a meeting record Leigh Lewis, a permanent secretary at the Home Office, saying that alcohol-related violence was no longer confined to the larger city centres but was now evident in smaller towns. He also explained that it now started earlier in the week. The meeting was told the surge in violent crime followed the alcohol industry changing its approach to marketing with “irresponsible sales promotions”.

The consequences for the police were disclosed at a meeting on February 9, chaired by Ellie Roy, director of crime reduction.

Roy warned: “The high number of licensed premises in city centres makes it more or less impossible for the police to effectively enforce the licensing laws, especially given their other crime and terrorism priorities.”

Those who followed the passage through Parliament of the new Licensing Act will recall that such arguments were put forward by various opposition spokesmen and were repeatedly dismissed by Government ministers, particularly the principal Government spokesman in the House of Lords, Baroness Blackstone. In one notable exchange with Lord Avebury who had asked her to comment on the statistics of violent crime in areas with a concentration of late night drinking establishments, Baroness Blackstone explained: “All my training as a social scientist would lead me to be extremely cautious about making such a deduction. There are many causes of violent crime and you cannot necessarily assume that because there is a late night entertainment culture, and the drinking associated with it, that is the cause of violent crime.”

Baroness Blackstone’s expertise as a social scientist was perhaps less evident in her reply to Lord Avebury than was her obligation to follow the official line, however implausible, of the Department of Culture, Media and Sport, a Department which appears to believe that its responsibilities to the public weal are best discharged by acting as the agent of the alcohol industry lobby which has been campaigning for de-regulation of the liquor licensing system.

The Sunday Times reported that Mr Blunkett wants to see:

  • Powers to fix the prices of alcoholic drinks in city centres to help to curb excessive drinking.
  • A compulsory annual levy on pubs and clubs of an average £10,000 a year each to pay for up to 30,000 extra police officers.
  • Local councils to be instructed to refuse all new licences to premises unless the applicants can prove that they will not increase antisocial behaviour.

The newspaper suggested that these measures were blocked by the Treasury, the Department for Culture, Media and Sport and the Prime Minister as being anti-business. However, their most significant feature is that they are explicitly ruled out by the Department of Culture, Media and Sport’s new Licensing Act.

It is understood that the Home Secretary fought to delay the introduction of the Licensing Act. However, a week after the Alcohol Strategy appeared, the Government published the guidance on the Act, completing the next major stage in bringing it into life. (see page 20)

Commenting to Alcohol Alert on the Sunday Times allegations, Lord Avebury, one of the main protagonists in the licensing bill debates, recalled the apparent impossibility of convincing Government Ministers that there was any connection at all between the growth in the number of premises licensed for late night drinking and the increasing problems of crime and disorder, said: “While there is joy at any sinner who repenteth, I’m afraid it’s too late. There is no possibility of another Licensing Act being introduced before the last one has even come into force .”

24-hour drinking ‘will fuel crime’

Allowing pubs and clubs to open all hours could lead to a rise in violent crime, disorder and nuisance, according to a report produced by the Metropolitan Police. The report, the Preliminary Assessment Of The Impact Of The Licensing Act 2003 On The Metropolitan Police Service, produced by the Clubs and Vice Operational Command Unit, flatly contradicts the claims made by the Department of Culture, Media and Sport for the new Licensing Act.

The Police report forecasts more drink-driving because of the lack of public transport late at night, a boom in illegal cabs and taxi touts, a growth in street vendors operating in the black economy and greater disturbance to residents.

Varied closing hours, it says, will encourage people to go out later and force the police to patrol trouble spots throughout the night.

However, while the Home Office is emphasising the need to contain excessive drinking, the Department for Culture, Media and Sport is pressing ahead with its plans for 24 hour licensing.

The Met’s report is concerned with London, especially the West End, but police chiefs across the country are thought to share its misgivings about the Licensing Act 2003.

The report says: “The Government’s assertion that closing time and binge drinking are linked is valid, but closing time is not the only causal factor.”

It predicts a rise in pub crawls through the night.

“A further complication will be that, with premises remaining open longer, transient drinking will take place. This will increase the numbers of persons on the street.

“Whilst it is accepted that staggered closing may induce a gradual drift away from premises, it is unlikely to reduce the numbers that use premises. The flashpoints that traditionally occur between 11pm and 5am may be reduced in intensity but occur with increased frequency.”

With more drunks on the streets for longer, the police fear a rise in fights, rape, robberies, domestic violence and assaults on officers.

The report cites the experience of several European cities, including Dublin where flexible hours were introduced four years ago.

It says: “With the drinking culture that is firmly entrenched in the country, the relaxations in permitted hours will for the foreseeable future fuel this culture.”

David Davis, the shadow home secretary, said the Government should ensure that existing laws against under-age drinking are properly enforced before extending the opportunity for bingeing.

The Strategy

The Strategy, which appeared after its six years gestation to have co-operation with the alcohol industry at its heart, consists mainly of promises to encourage more use of existing controls combined with promises to keep the situation under review. There will, for example, be a review of the ‘sensible drinking’ message. There will be a review of the issue of alcohol advertising, and a review of treatment needs and services. The drink driving figures are also to be kept under review, but neither in relation to drink driving nor anything else is there a promise to introduce any of the measures that the large and growing international research evidence suggests can be expected to make a real difference.

The polices rejected by the Government include those related to taxation and physical availability, both of which are shown by the body of research evidence to be the most effective. Of course, the Government’s own Licensing Act produces the contrary effect as far as availability is concerned. One of the absurdities of the whole process which Alert has repeatedly pointed out was the order of events: the Licensing Act preceding the Strategy and in so doing greatly limiting its options, given the presumed imperative of not making the Government look foolish. The table below, reproduced from the recently published Alcohol: no ordinary commodity (reviewed on page 22), the work of the leading international experts in the field, indicates the range of effectiveness of the various alcohol policies. It should be noted that another top scorer for effectiveness is the range of drink driving measures which the Government has signally failed to bring in, despite its promises in opposition. It is also striking that the very measures proposed most enthusiastically in the Strategy are shown to be of little or no effect.

The principal initiative contained in the Strategy is a three- part voluntary social responsibility scheme for alcohol retailers. This seems to consist mainly of agreements to behave as any reasonable person would expect them to be behaving anyway. The three parts are:

Promotion of good practices in product development, branding, advertising and packaging. This will cover aspects such as observing the existing advertising codes and not targeting under-age drinkers.

A donation to an independent fund

This is an innovation. A fund will be set up with contributions from the industry which will be used to fund local and national level projects designed to tackle alcohol-related harm.

Promotion of Good practice down the supply chain

As far as implementation of the Strategy is concerned, there is to be no alcohol czar. For all the understandable mockery which greets the proliferation of czars, the failure to appoint one in this case sends out the strong message that the alcohol problem is nowhere near as important as that posed by illicit drugs. Instead of a czar, the two junior Ministers, one from the Home Office, the other from the Department of Health will assume joint responsibility for delivery of the Strategy in what looks to be a low key version of the short-lived Inter-departmental Committee on Alcohol Misuse set up by the Conservative government in 1988. There is also to be an external stakeholder group to bring an outside perspective and serve as a sounding board for initiatives. All the indications are that this too will be dominated by the alcohol industry.

The lack of significant content of the Strategy is hardly a surprise in view of the biased editing of the Interim Analysis produced by the Strategy Unit. As reported in Alert (Issue 3, 2003), research findings suggesting policy choices at variance with those favoured by the alcohol industry were removed from an earlier draft of the Analysis.

Prompted by these earlier goings on, the Academy of Medical Sciences convened its own group under Professor Sir Michael Marmot to `put the alcohol back into alcohol policy’ by examining the importance of the overall national consumption of alcohol. In a report published prior to the launch of the Government’s Strategy, the Academy concluded that “The scientific evidence indicates that, for the health of the public, action is required to reduce the consumption of alcohol at a population level.”

If the Academy entertained the hope that a careful examination and presentation of the relevant evidence would influence the Government it was mistaken. While the Strategy concedes that national consumption is rising and that if present trends continue, England will be one of heaviest drinking nations in Europe within the next ten years, it then proceeds to ignore completely the implications of that fact for the level of harm and what needs to be done to reduce it. Instead, beginning in the Prime Minister’s foreword, the Strategy prefers to promote the myth of the two populations – the great majority of sensible drinkers who never have any problems, and the small minority of deviant drinkers who cause all of the problems. Predictably, the Strategy also emphasises how moderate drinking is good for health, and how very good indeed the alcohol industry is for the nation’s economy.

This latter claim is of particular interest as it directly contradicts the Strategy Unit’s analysis on which the Strategy is supposedly based..

An early paragraph of the Strategy reads:

“While it is outside the scope of this report to quantify the economic benefits in detail, alcohol plays a key role within the leisure and tourist industry. It accounts for a substantial section of the UK economy: the value of the alcoholic drinks market is more than £30bn per annum and it is estimated that around one million jobs are linked to it.”

However, the Strategy Unit report ‘Alcohol Misuse: How much does it cost?’ devotes a section to explaining why the output, income and employment generated by the alcohol industry should not be represented as benefits the community receives from the production of alcohol. This is because the claim rests on the false assumptions that in the hypothetical absence of alcohol, the money spent on it by consumers would not be used in any form of expenditure on any other products or services and, likewise, that the resources used in producing alcohol products and services would have no alternative uses. The point made by the Strategy Unit was that neither of these assumptions is true, and the other uses to which the expenditure and the resources would in reality be put could provide similar benefits but without the burden of costs that the alcohol market inflicts on the wider society.

The Strategy

Better education and communication

The strategy includes a series of measures aimed at achieving a long term change in attitudes to irresponsible drinking and behaviour, including:

  • making the “sensible drinking” message easier to understand and apply;
  • targeting messages at those most at risk, including binge- and chronic drinkers
  • providing better information for consumers, both on products and at the point of sale;
  • providing alcohol education in schools that can change attitudes and behaviour;
  • providing more support and advice for employers; and
  • reviewing the code of practice for TV advertising to ensure that it does not target young drinkers or glamorise irresponsible behaviour.

Improving health and treatment services
The strategy proposes a number of measures to improve early identification and treatment of alcohol problems. These measures include:

  • improved training of staff to increase awareness of likely signs of alcohol misuse;
  • piloting schemes to find out whether earlier identification and treatment of those with alcohol problems can improve health and lead to longer-term savings;
  • carrying out a national audit of the demand for and provision of alcohol treatment services, to identify any gaps between demand and provision; and
  • better help for the most vulnerable – such as homeless people, drug addicts, the mentally ill, and young people. They often have multiple problems and need clear pathways for treatment from a variety of sources.

Combating alcohol-related crime and disorder
The strategy proposes a series of measures to address the problems of those town and city centres that are blighted by alcohol misuse at weekends. These include:

  • greater use of exclusion orders to ban those causing trouble from pubs and clubs or entire town centres;
  • greater use of the new fixed-penalty fines for anti-social behaviour;
  • working with licensees to ensure better enforcement of existing rules on under-age drinking and serving people who are already drunk. We will also work in partnership with the industry to reduce anti-social behaviours – issues to be addressed may include layout of pubs and availability of seating, managing crime and disorder in city centres and improved information on safe drinking in pubs; and
  • In addition to local initiatives, the Security Industry Authority (SIA) will begin the licensing of door supervisors with effect from March 2004.

Working with the alcohol industry
The strategy will build on the good practice of some existing initiatives (such as the Manchester Citysafe Scheme) and involve the alcohol industry in new initiatives at both national level (drinks producers) and at local level (retailers, pubs and clubs).

  • At national level, a social responsibility charter for drinks producers, will strongly encourage drinks companies to:
    • pledge not to manufacture products irresponsibly – for example, no products that appeal to under-age drinkers or that encourage people to drink well over recommended limits;
    • ensure that advertising does not promote or condone irresponsible or excessive drinking;
    • put the sensible drinking message clearly on bottles alongside information about unit content;
    • move to packaging products in safer materials – for example, alternatives to glass bottles; and
    • make a financial contribution to a fund that pays for new schemes to address alcohol misuse at national and local levels, such as providing information and alternative facilities for young people.
  • At local level, there will be new “code of good conduct” schemes for retailers, pubs and clubs, run locally by a partnership of the industry, police, and licensing panels, and led by the local authority. These will ensure that industry works alongside local communities on issues which really matter such as under-age drinking and making town centres safer and more welcoming at night.

Participation in these schemes will be voluntary. The success of the voluntary approach will be reviewed early in the next parliament. If industry actions are not beginning to make an impact in reducing harms, Government will assess the case for additional steps, including possibly legislation.

Making it all happen
Making it happen will be a shared responsibility across Government. Ministers at the Home Office and the Department of Health will take the lead. We will measure progress regularly against clearly defined indicators and will take stock in 2007.