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Issue 2 2008

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Alcohol tax increases 'will save thousands of lives' - Department of Health

The increases in excise duty and VAT on alcohol announced in the Budget in March will save 3,250 lives in England alone by the end of March 2013, according to the Department of Health.

This assessment of the likely impact of the tax increases was given by public health Minister Dawn Primarolo in a speech to the British Medical Association’s Public Health Conference. Curiously, the Chancellor of the Exchequer himself made no reference in his Budget speech to the lifesaving benefits of the tax increases, saying only that they allowed him to provide ‘additional support for families and lift more children out of poverty’. The briefings provided by Treasury officials also seemed to suggest that the taxes on alcohol had been increased purely to raise revenue.

However, it was clear from Dawn Primarolo’s speech that the Department of Health had been pressing the health case for tax increases, and the speech represents the most direct and explicit acknowledgement by the present Government that alcohol taxation is a powerful means of tackling alcohol-related harm. Previously, the Government had been very reluctant to concede this point despite the many representations made by the public health lobby over the years, arguing that the scientific evidence shows clearly that alcohol taxation is one of, if not the, key weapons available to Government to reduce health and social harm related to alcohol. Ironically, the previous Health Secretary, Patricia Hewitt, had also argued for alcohol tax increases at each Budget, especially on alcopops, but had been publicly slapped down by the Treasury for doing so. In its National Alcohol Harm Reduction Strategy first issued in 2004 the Government explicitly rejected alcohol taxation as a means of controlling alcohol harm.

The increases

The Chancellor announced that alcohol duties would increase by 6 per cent above the rate of inflation. Beer would rise by 4p a pint, cider by 3p a litre, wine by 14p a bottle and spirits by 55p a bottle. Alcohol duties would continue to increase by 2 per cent above the rate of inflation in each of the next four years. When these year-on-year increases are compounded over this period, they represent a nominal 31 per cent increase in duty by 2012. Commenting on the tax issue, Ms Primarolo said:

“In current market conditions, and we have to recognise this, the tax increases announced by the Chancellor may not feed through fully to price and it is price which we know reduces consumption. Our estimates suggest that higher taxes, if they do feed through to price, will mainly affect the 7 per cent of the population who drink one third of all alcohol consumed in Great Britain. And that, in England alone, the total number of lives saved up to the end of March 2013 – when Budget 2012, the last Budget with a 2% above inflation increase has taken effect – will save 3,250 lives by the Department’s calculations.”

The obvious significance of this statement is not only that it recognises price and tax as key determinants of the level of alcohol consumption and harm, it also clearly rejects the counterargument put forward by the alcohol industry and others that tax rises fail to have any impact on alcohol harm, merely ‘punishing’ the responsible drinking majority, while the minority of `alcohol abusers’ carry on drinking at the same level.

There was more bad news for the industry later on in the speech when Ms Primarolo confirmed the Government’s preparedness to bring in – to the industry - very unwelcome legislation. She said:

“We share the concerns that have been expressed about the practice of deep discounting promotions, often as loss leaders, and below cost price, of alcohol. But as we move forward to challenge this, we have to make sure that any action we take is based on evidence. That is why the Department of Health has commissioned a research team from the University of Sheffield to carry out an independent review of the evidence on the relationship between the pricing and promotion of alcohol and harm. We expect the results of the review to be published in August.

We have stated that, depending on the review’s findings, that we are prepared to consult on the need to regulate change, including legislation, if this proves to be necessary. And we have informed the alcohol industry that we shall not shrink from doing so.

The same holds true pending the results later this year on monitoring the outcome of the industry’s implementation of the alcohol labelling regime that was announced last May. We have the powers now that we need to regulate in this area, if it is not delivered, and we will if necessary.”

Ms Primarolo also took the opportunity of summarising current initiatives in regard to the NHS response to alcohol, including providing specific training in alcohol problems to identify and treat excessive drinkers. (see page 14)

Reactions to the Tax Increases

Predictably, the public health community supported the Chancellor’s tax increases while alcohol industry spokesmen condemned them, speaking of `betrayal’ and ‘the worst Budget for the industry in living memory’.

Prior to the Budget, sections of the Industry had been running a campaign against alcohol tax increases, a campaign which they presumably thought had succeeded, when in an interview in the Daily Telegraph a few days before the Budget, Alistair Darling ‘made it clear he (was) not planning a big rise in alcohol duty to discourage bingedrinking’. “I don’t take the view that the best way to deal with this is to punish everybody for the sins of a minority” he said.

Reacting to the increases, Jeremy Beadles, for the Wine and Spirit Trade Association, said: "That the Government should commit itself and future Governments to an above inflation rate increase for alcohol for the next four years is hitting all drinkers for the sins of a minority even before it has received the results of its own report on Pricing, Promotions and Harm. A policy of commit now, hurt consumers now, study the issue later."

For the British Beer & Pub Association (BBPA) Rob Hayward said:

“Government is punishing all beer drinkers rather than tackling the minority of drunken hooligans. But Government tax policy is fuelling Britain’s binge drink problem by driving people away from beer, out of the pub into the arms of the deep discounting supermarkets. They don’t pay beer duty and don’t allow brewers to pass it on, so their rock bottom prices will remain unaffected by this tax hike.”

Following the Budget, an internet campaign was started by an Edinburgh licensee, with the aim of banning Alistair Darling from any pub in the country. (Mr Darling represents an Edinburgh constituency.) Asked about the campaign to ban him from all pubs, a spokesman for Mr Darling again avoided referring to the health benefits and said:

“The Chancellor made itclear at the time of the budget that his priorities were alleviating child poverty and helping pensioners. It’s a small price to pay for doing that.”

Public Health Support

Professor Ian Gilmore, President of the Royal College of Physicians and Chair of the UK Alcohol Health Alliance, said:

“We welcome the Chancellor’s decision to increase tax on alcohol. The international evidence suggests that even moderate taxation rises will reduce alcohol related deaths and this move, although modest, shows that the Government finally recognises the importance of taxation in reducing alcohol-related harm in the UK….”

The Institute of Alcohol Studies also welcomed the tax rises, saying that the rises would go some way towards addressing the increase in the affordability of alcohol that has occurred over the past twenty years. However, the IAS warned that the tax rise would not of itself address the growing discrepancy between the cost of alcohol in pubs and the cost of alcohol bought from supermarkets. Such pricing discrepancies continued to have worrying public health implications. The IAS called upon the government to continue pressure upon supermarkets to halt the sale of alcohol at below cost prices.

The British Medical Association and Alcohol Concern made similar comments.

Political Reactions

Conservative Party
Prior to the Budget, the Conservative Party launched its own proposals for targeted tax increases on drinks which were defined as problematic and which were claimed to contribute to binge drinking. The Conservatives attacked the Government for unfairly penalizing the responsible drinking majority because of the sins of the few, and said that what the Chancellor of the Exchequer should have done was introduce a revenue neutral alcohol taxation package that increased tax on problem drinks such as alcopops and super-strength beers and ciders, and used all the additional revenues raised to cut tax on low alcohol beers and ciders.

The Conservatives said that this approach had been highly successful in other countries; in Australia, low alcohol beers now make up 20% of the beer market, while in Germany the consumption of alcopops had fallen by half. They claimed that this policy had received support from alcohol charities and medical experts.

For example, Christopher Day, Professor of Liver Medicine at the University of Newcastle, had said: "I strongly support this targeted tax package. The strongest evidence-based approach is to increase the price of problem drinks and reduce their availability. This has worked in countries across the world - and I'm in no doubt that it will work here in the UK too."

Liberal Democrats
The Liberal Democrats also favoured targeting high strength alcoholic drinks.

Shadow Chancellor, Vince Cable, said that “taxes should be used to discourage binge drinking. Raising the tax on drinks with high alcohol content would raise £225 million, an amount that could be used to cut VAT on healthy, 100% fruit juice from 17.5% to 5%."

This, Mr Cable said, would complete the transformation of the Liberal Democrat Party from the "party of beards and sandals to the party of smoothies".

The Government dismissed the Conservatives’ and the Liberal Democrats’ plans for placing additional tax on high strength drinks as contrary to European Union law.

From the alcohol industry’s perspective,however, the disagreements between the Government and the opposition parties on tax policy are probably less significant than the fact that all three major political parties have now accepted the principle that alcohol taxation is a legitimate and effective means of tackling alcohol related harm.

Bargain Booze

Ms Primarolo’s uncertainty as to whether the tax increase would feed through fully to the price paid by the consumer proved to be well founded. Immediately following the Budget, Bargain Booze, a company with a range of off-icensed outlets, informed its suppliers that the company would not accept any price rises consequent upon the tax increases and that the suppliers would have to absorb the costs themselves. The letter read:

“As you know, the aggressive market that we’re all trading in continues to place massive pressure on our industry, and our retail outlets - like everyone else - are feeling the pinch. Given the discount pricing strategies adopted in the past few years by the multiple grocers we are not confident that the Budget will result in material increases in retail prices.

 

 

 

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Supermarkets step up pricing debate

“In other words we believe based on past evidence that this tax is unlikely to be passed on to the consumer in any meaningful way. Given our position in the market with our fascias Bargain Booze, Bargain Booze Plus, Bargain Booze Select Convenience, Thorougoods and Thorougoods Select Convenience price is obviously a key focus for us and we will have to review the position of any brands where the retail ticket is increased in our business.

As you know, Bargain Booze is built on high volume turnover so a reduction in demand and sales would be disastrous (as would the drop in margin, were we to ask our retailers to swallow the increase).

“As a result we regret to say that we cannot absorb the increases in costs that the budget would seem to demand. We accept that these increases have not originated from yourselves but we would ask your help by joining with other major brand-owners in supporting the take-home drinks market by absorbing these increases within your own company.”

Denunciations of the role of the supermarkets in promoting alcohol problems, principally by selling alcohol at heavily discounted prices and in some cases below cost, continued apace. At one point Sir Terry Leahy, Chief Executive of Tesco, was accused of being the `godfather of binge drinking’ by John Grogan MP, Chairman of the Parliamentary Beer Group.

The accusation, described as inaccurate and offensive by a Tesco spokesman, indicates the depth of hostility that now sector and the supermarkets. The latter often sell alcohol for less than the on-trade can buy it. Some supermarkets are reported to have been selling lager more cheaply than water or cola, and indeed to have been selling alcohol at below cost price. Ten supermarket firms - Aldi, Asda, the Co-op, Lidl, Morrisons, Netto, Sainsbury’s, Somerfield, Tesco and Waitrose – all reported to a Competition Commission inquiry in 2007 that they used alcohol as a loss leader.

These practices have been condemned as antisocial by politicians and the public health lobby as well as spokesmen for the on-trade. They have given rise, amongst other things, to what is referred to as ‘pre-loading’ whereby customers, mainly young, consume cheap alcohol from supermarkets before going out for the night and are thus at least partially drunk when they arrive at the pubs and the bars. An academic study has provided confirmation that pre-loaders do indeed tend to drink more than others who wait until they get to the bars and that they are also more likely to get into street disturbances and other sorts of trouble. This is, of course, occurring in the context of a long-term trend towards home consumption and the relative decline of the on sector as the principal location of purchase and consumption.

While the supermarket bosses have consistently denied any responsibility for fuelling the binge drinking problem with their pricing policies, their protestations of innocence appear to be regarded with growing impatience and the climate of opinion has clearly shifted against them. The Government has commissioned research specifically into the impact of price discounting in relation to alcohol consumption and harm and supermarket sales of alcohol were on the agenda of the Downing Street summit on binge drinking called by Prime Minister Gordon Brown. In an interview in The Publican, Conservative Party leader David Cameron also supported moves to end irresponsible supermarket sales practices. “One of the things we’ve said is if we want to stop the practice of heavily discounted alcohol in supermarkets, we need to change the law,” he explained.

The pressure on the supermarkets became so intense that Tesco was finally driven to announce that it wished to work with the government on possible legislation to limit its own ability to sell cut price alcohol. Lucy Neville-Rolfe, Tesco's Executive Director for Corporate and Legal Affairs, said government would have to take the lead because competition laws stop retailers from artificially raising prices. Moreover, she said, it would be commercial suicide and pointless for Tesco to act alone, as shoppers would simply go elsewhere.

Another indication of the supermarkets’ wish to improve their image was provided by Asda which announced that it intended to phase out sales of "shooter" alcopops, popular with young teenagers as part of a drive to stamp out underage drinking. In addition, from April, the chain's 100 town-centre 24-hour stores ceased selling alcohol between midnight and 6am to stop people buying alcohol late at night when leaving bars and clubs. However, not everyone found the supermarkets’ claims to be mending their ways convincing. The Institute of Alcohol Studies commented that despite the rhetoric about social responsibility the supermarkets were still heavily discounting alcohol for bulk purchase in the run up to St Patrick’s Day and a major rugby tournament. Speaking for IAS, Russell Bennetts said:

“The Institute of Alcohol Studies strongly condemns supermarkets for continuing to sell and promote alcohol in an irresponsible manner. As we enter a weekend of major sporting events and St. Patrick’s Day celebrations, supermarkets have been promoting cut-price alcohol that encourages binge drinking.

He added: “Supermarkets claim that cut-price alcohol bought from their stores is consumed over a long period of time and in a responsible manner. However, they are hypocritical to say this while they continue to advertise cheap alcohol in relation to specific events.

“The Competition Commission have found that five leading grocery retailers sold £38.6 million worth of alcohol at below cost during the 2006 World Cup. Supermarkets know full well that drinks promotions linked to such events entice consumers to buy more alcohol and to drink more alcohol. To claim otherwise is disingenuous.

“Supermarkets are not truly interested in saving the consumer money or in ensuring their customers remain healthy. They are aware that alcohol is a more price responsive product than milk. This is why they choose to use alcohol as a loss-leader. In fact, the Office of Fair Trading has claimed that the leading four supermarkets colluded to keep the prices of milk, cheese and butter artificially high.

“A Sainsbury’s radio advertisement offered cut price Guinness in the lead up to a weekend of rugby matches and St. Patrick’s Day celebrations. This appears to be part of a continuing trend for supermarkets claiming sporting and other events as a reason to drink at home. Tesco have continued to advertise cut-price alcohol even after claiming that they wish to halt such behaviour.”

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Stronger Government action needed to tackle the epidemic of alcohol misuse, says new BMA report

A new hard-hitting report ‘Alcohol misuse: tackling the UK epidemic’ issued by the British Medical Association (BMA) calls on the government to show leadership and implement a full range of effective control policies that will reduce the burden of alcohol misuse.

“Recent governments have worked too closely with the alcohol industry and have pursued policies of deregulation and liberalisation regarding alcohol control” said BMA Head of Science and Ethics, Dr Vivienne Nathanson. She added: “As doctors we see first hand how alcohol misuse destroys lives. It causes family breakdowns, is a major factor in domestic violence, ruins job prospects, is often related to crime and disorderly behaviour and it kills. Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The government approach has led to increased consumption levels and alcohol-related problems and demonstrates a failure in the political drive to improve public health and order.

“Alcohol misuse not only costs lives it also costs the country many millions of pounds. The NHS spends millions every year on treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences. The BMA is very worried about alcohol consumption among young people, particularly young girls. It is shocking that in Europe, the UK’s teenagers are most likely to be heavy drinkers.”

Key recommendations from the report include (a full list can be found on page seven of the report):

Higher taxes on alcoholic drinks and this increase should be proportionate to the amount of alcohol in the product.

An end to irresponsible promotional activities like happy hours and two-for-one offers.

Standard labels should be displayed on all alcoholic products that clearly state alcohol units, recommended guidelines for consumption and a warning message advising that exceeding these guidelines may cause the individual and others harm.

The legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100 ml throughout the UK.

Mass public awareness campaigns may be politically attractive and increase knowledge about alcohol misuse but they are very expensive and ultimately ineffective if unsupported by broad based policy, says the BMA report. Targeted approaches are vital, including measures to reduce alcohol availability and thus consumption by young people and children.

BMA Chairman of Council, Dr Hamish Meldrum, said: “Our report is making some tough recommendations but if the government is serious about tackling this issue this is what is needed. Since 1997, taxes on wine and beer in the UK have only increased in line with inflation while taxes on spirits have not increased at all. There is strong and consistent evidence that price increases result in reduced consumption and that increased opening hours are associated with increased alcohol consumption and alcohol related problems. The government needs to act on this evidence.” The Licensing Act 2003 now permits 24-hour opening in England and Wales and the BMA is dismayed that public health was not considered as one of the licensing objectives in the Act.

While most people in the UK drink sensibly and do not put their health at risk, there are significant numbers of men and women, across all ages, who are drinking significantly above the recommended guidelines. Although there has been a slight downward trend in recent years, the UK is still one of the heaviest alcohol consuming countries in Europe.

Alcohol consumption in the UK is not equally divided between genders and ethnic groups. Men in the UK are more likely to drink heavily compared to women although the upward trend of alcohol consumption among young women between the ages of 16 and 24 is now the highest in Europe. Only 9 per cent of the White British population are non-drinkers compared to 90 per cent among those of Pakistani and Bangladeshi origin or 48 per cent of those of Black African origin.

Preventing alcohol-related harm requires the accurate identification of individuals who misuse alcohol, but there is currently no system for routine screening and management of alcohol misuse in primary or secondary care settings in the UK. The BMA report is calling for a more comprehensive system to identify patients at risk of alcohol misuse – this could be done via screening questionnaires when individuals visit their GP, or attend for a general hospital appointment or when they go to A&E. The report is also calling for new ring-fenced funding for specialist alcohol treatment services so that patients can be seen as soon as possible.

Dr Meldrum, who is also a family doctor in Yorkshire, believes it is necessary that more is done to help people with alcohol problems: “We need to identify patients who are misusing alcohol much earlier, but it doesn’t end there. There must be enough funding in place to refer patients who are at risk to specialist centres. As a GP it is disheartening to refer someone who has an alcohol problem for help but know that they’ll be waiting months to be seen by the appropriate specialised agency. In that time not only does their health worsen but the effects on their family and work life can be catastrophic.”

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Gary Newlove - the true price of binge drinking?

The kicking to death of father-of-three Gary Newlove in Warrington, Cheshire by a gang of teenage boys led by Adam Swellings, gave a powerful further prompt to the national debate on binge drinking and its link to crime and anti-social behaviour, who is to blame and what should be done. The teenagers were drunk on cheap, strong cider and high on cannabis at the time of the murder.

Before the killers were sentenced, the Chief Constable of Cheshire, Peter Fahy, spoke of a hard core of young men not in work, education or training but characterised by poor or non-existent parenting combined with ready access to cheap alcohol. He called for schools and other local agencies to develop a joint strategy to target this hard core. He wanted the parents concerned to be called to account, and he also demanded action at national level – higher taxes on alcohol, especially high strength lager and cider, for it to be made easier for a whole town centre to be made an alcohol-free zone, and the legal age for buying alcohol raised to 21.

However, Cheshire Constabulary were themselves criticized for failing to take action against the Swellings gang. One of their earlier victims, ironically the teenage daughter of a Cheshire police officer, described how she and her friends were threatened and attacked by Swellings on several occasions. She said:

“I think the police should feel ashamed of themselves. They could have prevented all of this. It’s so sad that someone has to lose his life because people didn’t do anything about (Swellings) and his gang. It’s taken someone to be murdered for them to sit up and do something.”

Helen Newlove, Gary’s widow, condemned the magistrates for releasing Adam Swellings from court on bail only hours before he and his friends murdered her husband. Swellings had pleaded guilty to assaulting another man who had complained about him and his friends causing trouble around his house. The Crown Prosecution Service had advised against releasing Swellings on the grounds that he had breached previous bail conditions but the Warrington magistrates disregarded the advice.

Mrs Newlove said:

“We knew he (Swellings) had previous convictions, but it was a shock to hear he had been released that day. I’m absolutely disgusted. These magistrates, it’s unbelievable. They let him out and walk the streets…. He’s gone out, got drunk and taken drugs and my husband has been left dead.”

In an unusual move, Cheshire police in the person of Gary Finchett, then Acting Chief Superintendent for Warrington, wrote an open letter to the people of the town via the local newspaper, the Warrington Guardian, calling for the community to pull together to solve the problems of anti-social behaviour. Mr Finchett explained that while crimes such as the murder of Gary Newlove were rare and that the level of crime and anti-social behaviour in Warrington was declining, as it was in the whole of Cheshire, it was still too high. He wrote:

"No one can be anything but appalled by the tragic death of Gary Newlove and the devastating impact that this has had on his family, friends and the community of Warrington. The police have a vital role in tackling the scourge of alcohol related crime and antisocial behaviour in our society. However, crime and anti-social behaviour is not the sole responsibility of the police and we cannot do this alone.

“The fact is that society, responsible authorities, parents/carers and the licensing trade all need to do a lot more. Alcohol and substance misuse, drinking in public, the absence of parental control, a lack of responsible citizenship, the abdication of responsibility by a small hard-core of young people and their parents/carers and the ready availability of strong, cheap alcohol sometimes purchased by adults for young people are significant contributory factors to crime and antisocial behaviour in our neighbourhoods.

“Society's promotion of an alcohol culture and a tendency to find humour in drunkenness, along with outlets irresponsibly selling cheap strong alcohol, and parents who condone such consumption lie at the heart of this problem. Tackling this complex and deep-seated problem cannot be the sole responsibility of the police. A modern and committed society must see that we must address these issues together.

“My Neighbourhood Policing Units spend a huge amount of time dealing with the impact of alcohol abuse, particularly the impact on young people. Over Christmas and New Year every available police officer and CSO in Warrington was allotted duties to tackle alcohol related crime as well as underage drinking. If society wants the police to deal with anti-social behaviour all of the time, it must ask itself what it doesn't want us to do……. There is an alcohol culture in this country which is not repeated in other countries where alcohol is enjoyed more responsibly. The police and local authority are key stakeholders in the debate around strong, cheap alcohol which is too readily available. We are also jointly responsible with Trading Standards and other responsible authorities for enforcing the licensing laws which is why, despite a successful Pubwatch and Challenge 21 Scheme, we have proactively targeted off-licenses and other licensed premises suspected of directly or indirectly supplying alcohol to children. Alcohol misuse by young people is a grave concern of mine. Warrington has one of the highest admission rates to Accident and Emergency Departments of females under 16 years for alcohol related illness in the Country. I have also received a letter from a Consultant in Emergency Care expressing his concern about seriously intoxicated underage drinkers. Responsible members of the licensing trade are also working with us to tackle this problem.

“Gary Newlove's death was fuelled by alcohol. We will continue to lobby the licensing trade to stop cheap drinks promotions, to limit the alcohol content of strong beer and to consider raising the legal drinking age to 21. Ultimately, parents and young people must act responsibly and respect the communities they live in.

“The high density of bars, pubs and clubs and fast food outlets in Warrington Town Centre is a particular concern of mine. We have the highest density of licensed premises outside Blackpool. Too many of my resources are being dragged in from our neighbourhoods to police the town centre at night. My officers are taking quick and decisive action yet still being overrun by the spill-out of drunks from licensed premises who offer no alternative to an environment which encourages and facilitates drinking to excess, premises which offer cheap booze deals just in order to stay competitive, and an environment that speaks loudly to all who look in upon it as if to suggest that there is nothing wrong with their behaviour.

“We are dealing with too many people who arrive in the town centre late at night, often already having consumed cheap, strong alcohol elsewhere, getting more and more intoxicated as the night progresses, hanging around fast food outlets until the early hours of the morning and then become either the victims or perpetrators of crimes such as criminal damage and assault. We are committed to working with Warrington Borough Council to address this issue once and for all. We expect all other partners including the licensing trade to match our commitment. Society needs moral integrity to set and police its own values and standards to prevent such incidents occurring in the future. Mr Newlove's tragic death was caused by the criminal actions of youths who had consumed alcohol. It only took a few seconds of alcohol-fuelled violence to destroy a life. The police cannot always be there in those moments. It is a credit to my police officers and staff that the offenders were arrested and brought to justice so swiftly.”

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Addiction as a mitigating factor

Alcohol and other forms of dependence may be regarded as mitigating factors in sentencing people convicted of some criminal offences, allowing burglars and thieves to escape the jail sentence they would otherwise be given.

This is one of the proposals contained in a new consultation exercise by the Sentencing Guidelines Council, which is chaired by Lord Phillips, the Lord Chief Justice.

The consultation document discusses the question of how the seriousness of offences should be assessed, and in considering aggravating and mitigating factors the document states:

‘Many offenders convicted of acquisitive crimes are motivated by an addiction, often to drugs, alcohol or gambling. This does not mitigate the seriousness of the offence, but an offender’s dependency may properly influence the type of sentence imposed. In particular, it may sometimes be appropriate to impose a drug rehabilitation requirement or an alcohol treatment requirement as part of a community order or a suspended sentence order in an attempt to break the cycle of addiction and offending, even if an immediate custodial sentence would otherwise be warranted.’

The document also states that `the fact that an offence has been committed in desperation or need arising from particular hardship’ may also count as personal mitigation in exceptional circumstances’.

Critics were quick to attack the proposal. The Conservatives said the guidelines were an indication that the courts were being pressed into issuing non-custodial sentences in order to keep offenders out of overcrowded jails. Nick Herbert, the Shadow Justice Secretary, said: "People will be uncomfortable with the idea that professional thieves who prey on the vulnerable may only receive community service. Punishments should fit the crime, not prison capacity."

Patrick Mercer, a Conservative member of the Home Affairs Select Committee, said: "Whatever the background of the criminal they should be made to serve the sentence. Rehabilitation can go on in prison. I don't see why these are mitigating factors."

Sentencing Guidelines Council: Theft and Burglary (Non-Dwelling) Consultation Guideline. March 2008. Responses to the consultation should be received no later than 28 May 2008.

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Alcohol Harm Reduction Toolkit published

A guide to implementing alcohol harm reduction strategies at local level has been published jointly by the Department of Health, the Home Office and the Department of Children, Schools, and Families.

The toolkit is intended as a resource to help local teams develop strategies to address alcohol-related crime, ill health and other harm in line with Safe. Sensible. Social. The next steps in the National Alcohol Strategy. It is written specifically to help alcohol leads and others within local authorities, primary care trusts (PCTs), children’s services and delivery partnerships such as Crime and Disorder Reduction Partnerships (CDRPs) and Drug and Alcohol Action Teams (DAATs) – the people most likely to be responsible for developing and delivering alcohol strategies locally. It will also be useful to individual agencies tackling alcohol misuse.

The toolkit is based on the Local Alcohol Strategy Toolkit produced by London Drug and Alcohol Network and Alcohol Concern in 2004. It provides a step-by-step process on how to develop a local alcohol strategy, and suggests a range of activities to help with the three key strategic areas of health, community safety and children and young people.

The strategy is available on the Home Office website 

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More money for alcohol screening in Scotland

The Scottish Government has announced that funding for alcohol screening, prevention and treatment services will more than double to £25 million for the year 2008/2009. This compares to £10.13 million in 2007/08.

The package forms part of an additional £85 million funding commitment to tackle alcohol misuse over the next three years. Minister for Public Health Shona Robison said:

"The record funding I am announcing demonstrates the Scottish Government's clear commitment to address Scotland's complex relationship with alcohol. Far too many Scots are drinking above the recommended amounts on a regular basis - often without realising that they are doing so, and without understanding the impact it is having on their health.

Today's funding will ensure that people across Scotland have access to advice and support about their drinking and to treatment services where necessary.

But Scottish Government action does not stop there. We are currently developing a long term strategic approach to tackling alcohol misuse. We plan to publish our proposals for action before the summer."

NHS BOARD FUNDING ALLOCATION
Ayrshire & Arran - £1,775,085
Borders - £700,915
Dumfries & Galloway - £897,971
Fife - £1,636,844
Forth Valley - £1,275,324
Grampian - £2,014,386
Greater Glasgow - £6,325,293
Highland - £1,496,320
Lanarkshire - £2,455,698
Lothian - £3,401,218
Orkney - £333,164
Shetland - £345,022
Tayside - £1,816,885
Western Isles - £390,621

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Young people at risk from energy drinks

Young people who mix energy drinks with alcohol are twice as likely to end up harmed than those who just drink alcohol, a study has found. US researchers surveyed over 4,000 students about their drinking habits and found that people who drank energy drink cocktails were more likely to suffer injuries, require medical help or get into problems related to sex. The researchers concluded it was because the energy drinks masked feelings of drunkenness. Energy drinks typically contain high levels of caffeine as well as other stimulants such as ginseng. It has become popular among young people to mix them with alcohol, particularly vodka.

Independently of this study, there was already concern and controversy in the US about prepackaged energy alcohol mixes, critics arguing that not only were there particular health issues attached to them but also that the appearance and packaging of the drinks appeal to the under-aged as well as adding to the confusion as to which drinks are alcoholic and which not.

The new study, presented at an annual meeting of the American Public Health Association, found that a quarter of those who had drunk alcohol in the previous 30 days had consumed energy drink cocktails. Compared with students who did not mix alcohol with energy drinks, they were twice as likely to be hurt or injured, to require medical attention, and to travel with a drinking driver. They were also more than twice as likely to take sexual advantage of someone else, and had almost double the risk of being taken advantage of sexually. In a typical drinking session, they drank up to 36% more than the other students, and they also reported twice as many episodes of weekly drunkenness.

'Serious consequences'
Lead researcher Dr Mary Claire O'Brien said: "We were surprised that the risk of serious and potentially deadly consequences is so much higher for those who mixed energy drinks with alcohol." She said the problem was that students did not realise they were as drunk as they were when they mixed alcohol and energy drinks.

"Students whose motor skills, visual reaction times, and judgment are impaired by alcohol may not perceive that they are intoxicated as readily when they're also ingesting a stimulant. Only the symptoms of drunkenness are reduced - but not the drunkenness. They can't tell if they're drunk, they can't tell if someone else is drunk.

"So they get hurt, or they hurt someone else."

Pre-packaged EnergyAlcohol Drinks
In the US, public health and safety officials were already campaigning against pre-packaged alcoholic energy drinks containing caffeine and other stimulants as well as alcohol. In 2007, 29 State Attorneys General signed a letter to Anheuser-Busch expressing their concern about Spykes, an alcoholic energy drink packaged in colourful 2- ounce bottles which, they said, had obvious appeal to youth. The objections of law enforcement officials as well as parents and leading public health organizations caused Anheuser-Busch to withdraw Spykes from the shelves but many other alcoholic energy drinks remain on the market.

In the US, The Marin Institute produced a report `Alcohol, Energy Drinks, and Youth: A Dangerous Mix’. The report reviews the limited amount of evidence available about the health issues connected with alcohol energy mixes and examines the alcohol industry’s marketing practices promoting the consumption of alcoholic energy drinks. The Marin Institute says that the results, while preliminary, are unsettling.


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New report focuses on teenage drinking

A detailed picture of teenage drinking in the North West of England is provided by a survey carried out by the Centre for Public Health at John Moores University. The survey found that while there was a small decrease in the number of 15 and 16 year olds who drank alcohol compared with 2005, among drinkers there was an increase in the percentage drinking in public places (e.g. bars, parks) and in the frequency of consumption.

The research team calculated that of the 189,731 15 and 16 year olds in the North West, around 56,900 (30.0%) binge drink at least weekly (i.e. drink five or more drinks in one session).

For the first time, estimates of total alcohol consumption by 15 and 16 year olds in the North West were made. The researchers calculated that 65.9% of 15 and 16 year olds in the region drink at least monthly and that their total annual consumption was 83,943,726 units. This is equivalent to 44.2 bottles of wine (177.0 pints of beer) per year for every 15 and 16 year old in the region, or 67.2 bottles of wine (268.7 pints of beer) per year for each 15 and 16 year old that drinks at least once a month.

Other main findings were:

Substantial levels of binge drinking, frequent drinking and drinking in public places were seen in all demographics. However, binge drinking in particular was more frequent amongst those living in more deprived areas (31.1% of drinkers binged rank at least once a week in the most affluent areas compared to 39.1% in the least affluent [quintiles]).

Among drinkers, 34.1% stated that they bought their own alcohol. These individuals were more likely to engage in a risky drinking behaviour (e.g. three times more likely to binge drink once or more a week).

Consistent with findings in 2005, those who had alcohol provided to them by parents (48.5% of drinkers) were 1.64 times less likely to binge drink each week and 1.28 times less likely to drink in public places.

Having a hobby or being involved in sports was protective against most risky drinking behaviours with, for instance, those having a hobby or sports pastime being 1.59 times less likely to binge drink.

Among those that drank once a week or more, 39.7% of females and 42.0% of males had been involved in violence following alcohol use. Those from the two poorest deprivation quintiles of residence were around 50% more likely to have been involved in alcohol-related violence than those in the most affluent quintile.

Engaging in binge drinking, drinking more frequently, and drinking greater amounts of alcohol each week, were also associated with alcohol-related violence.Thus, those binge drinking three or more times per week were over five times more likely to have been involved in alcohol-related violence (than those who drank each week but did not binge drink).

Among those that drank once a week or more, 20.7% of females and 15.4% of males reported regretted sex following alcohol. Females; those aged 16; those binge drinking more frequently; and those drinking at greater volumes per week were more likely to have had regretted sex following alcohol consumption. For instance, those drinking over 40 units per week were two and a half times more likely to have had sex they later regretted following alcohol (than those who drank each week but consumed up to five units per week).

Heavy drinking patterns were associated with higher levels of smoking. While only 2.1% of those that drink at least once a week but never binge drink smoked more than five cigarettes per day, this rises to 47.7% amongst those that binge drink three or more times per week.

Risky drinking in North West school children and its consequences: A study of fifteen and sixteen year olds
Sara Hughes, Mark A. Bellis, Karen Hughes, Karen Tocque, Michela Morleo, Matt Hennessey, Linda Smallthwaite
Centre for Public Health. Liverpool

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Unfinished business - an evaluation of the Licensing Act 2003

New licensing laws came into operation in England and Wales in November 2005, opening the way for 24 hour drinking. Two years on, the Government published its assessment of how the legislation is working. Here, Marion Roberts gives her own assessment.

Wednesday 5th March 2008 saw the publication of the first Government review of the impact of the Licensing Act 20031. The early morning news reports highlighted a ‘mark’ of 7/10, apparently produced by the Department of Culture, Media and Sport, for the ‘success’ of the Act2. This somewhat triumphal assessment had been upstaged the night before by a statement from Sir Simon Milton, Chairman of the Local Government Association and leader of Westminster City Council, who dubbed the Act a ‘catastrophic’ mistake that had ‘failed miserably’ to change Britain’s drinking culture3. The media debate was therefore effectively framed in simplistic terms: modest success versus catastrophic failure.

When the Ministerial statement and the report that prompted it were made available a more balanced and mixed picture emerged. The DCMS evaluation, as would be expected from contemporary government, relentlessly emphasised the positive. No, 24 hour drinking was not the norm, licensing hours for on-licensed premises had increased by only 21 minutes on average and overall alcohol consumption had decreased rather than increased. Crimes involving violence had not increased in the evening and the night. Somewhat refreshingly the ministerial statement went on to report the negatives, highlighting the finding that alcohol related crime had increased between the hours of 3 am and 6 am and some locations had seen an overall increase in disorder. Drinking cultures had not changed on the one hand, but on the other, there had been no significant detrimental impact on live music performances. The media debate that followed focused on the issues of binge drinking, underage drinkers and pricing controls. The Government argued that the Licensing Act 2003 was only the beginning and that further action would be taken through tougher enforcement against licensees, shopkeepers and disorderly drinkers, better management of venues and town centres and voluntary agreements with the industry.

Although the debate was more reasoned than that surrounding the implementation of the Act two years earlier, some key observations were not made and several questions were left unanswered. To begin with, the evaluation of the crime statistics was judged against forecasts of steep rises in crime made by Chief Police Officers in January 2005 and reported in the Daily Mail’s ‘campaign’ against the Act. A more reasonable evaluation would have taken the original rationale for removing permitted hours proposed by the Better Regulation Taskforce report4 that preceded the White Paper5. This argued that doing away with permitted hours would in itself reduce crime and disorder and promote a more ‘relaxed drinking style’. Quite clearly this has not happened, for the very reasons that critics of the Licensing Bill made at the time: that in the 1990s venue sizes became larger and concentrations of licensed premises increased. The complaints made by the police then, that their resources would be stretched further into the night, were reiterated in ACPO’s response to the Evaluation report.

Evaluation of the Act suffered because, as with most ‘before’ and ‘after’ investigations of urban situations, precise impacts are difficult to isolate. Not only are changes made in anticipation of legislation, but other external influences, such as policing, change simultaneously. It is therefore not surprising that the legislation appears to have had little impact on behaviour or practices.

At the time of the Act’s implementation much was made of local residents’ potential for representation in licensing hearings. As Phil Hadfield pointed out in his excellent account of the Bill’s passage through Parliament, this was somewhat disingenuous given that the first draft of the Licensing Bill had effectively excluded residents from having influence and concessions were wrung out of the Government as the Guidance to the Act went through successive iterations6. The Evaluation quite properly points to the successes for residents and councillors in the transfer of responsibility to local authorities, but does not fully consider the problems that residents still have to face with regard to appeals and reviews. The burden that is placed on local residents and councillors to monitor applications requires a constant vigilance that may be beyond the means of some localities.

The concept of designating cumulative impact zones or ‘special policy areas’ was reluctantly conceded as the Bill passed into law. Attempts by the ODPM Select Committee to agree a further clause that would allow local authorities to set guidelines for an upper limit of licensed premises in any one locality were rejected on the grounds of restricting trade7. It is somewhat ironic then to see that the Ministerial statement now suggests local authorities and the police should identify ‘hotspots’, exercise more caution and conditions when issuing licenses in those areas and even allow the ‘wholesale withdrawal’ of licenses.

The reform of licensing law opened up an opportunity to simplify and streamline legislation, but if a more radical approach had been adopted, some genuine ‘joined up’ thinking could have been produced. The two systems, licensing and planning, were separate, even though planning legislation can impose conditions on premises’ hours and operation. A thorough reform of licensing legislation could have combined the two systems through one process for certain types of license application, thereby permitting a more holistic approach to forward planning and fulfilling the early objectives spelt out in ‘Time for Reform’, namely to make the centres of our towns and cities more pleasant. As it is, our own research at the University of Westminster8 found that in certain boroughs, wily lawyers were finding ways of playing off planning and licensing to achieve later hours.

There are more problems that are coming to light. One of the most pressing is that rather than encouraging ‘family friendly’ venues, the Act has unwittingly permitted an expansion in the numbers of lapdancing or ‘gentlemans’ clubs. Unwanted expansion has been reported in Brighton, Tower Hamlets and Durham. A campaign, ‘Object’ has been set up in opposition9, with action research funded by the Joseph Rowntree Reform Trust. It is to be hoped that Government will soon take action to rectify this situation.

So, was the Licensing Act 2003 a modest success or a catastrophic failure? Perhaps the verdict of history will be neither of these, but more of a lost opportunity for more profound and genuinely radical reform.

References:

1 DCMS (2008) Evaluation of the Impact of the Licensing Act 2003 [http://www.culture.gov.uk/Reference_library/Publications/
archive_2008/
evaluation_licensing_act_impact.htm]

2 www.politics.co.uk/issueoftheday/opinion-formerindex/ communities-and-local-government/24-hourdrinking-$ 1209319$1209319.htm

3 Winnett, R. Council Leaders attack 24-hour drinking laws The Daily Telegraph,4th March 2008. [www.telegraph.co.uk/news/main.jhtml?xml=/news/ 2008/03/03/nbooze103.xml]

4 Cabinet Office (1998) Better Regulation Taskforce: Licensing Regulation London: The Cabinet Office

5 Department for Culture Media and Sport (2001) Time for Reform: Proposals for the modernisation of our licensing laws (White Paper) CM4696.

6 Hadfield, P. (2006) Bar Wars: Contesting the Night in Contemporary British Cities Oxford, Oxford University Press.

7 House of Commons (2003) Government Response to the Committee's Sixth Report on the Licensing Bill (Lords) and the Evening Economy, (Ed, ODPM: Housing, P., Local Government and the Regions Committee) The Stationery Office, London.

8 Roberts, M. & Eldridge A. (2007) Expecting 'Great Things'? The Impact of the Licensing Act 2003 on Democratic Involvement, Dispersal and Drinking Cultures,University of Westminster [www.ias.org.uk/ resources/ukreports/cci/cci-0707.pdf]

9 For further information please contact Sandrine Levêque at sandrine@object.org.uk

Professor Marion Roberts is the Director of the Central Cities Institute at the University of Westminster

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Licensing Act 2003 - facts and figures

Most popular closing times

Across all types of premises, there was little change in closing times, though there was some movement towards later closing times. Tables show the percentage of premises with each of the most popular closing times, before and after the Act came into force.

Pubs, registered social clubs and hotels all still have a majority closing at 11pm.

Premises
11 pm
midnight
Pubs Before
88%
4%

After
63%
7%
Social clubs Before
87%
2%

After
77%
10%
Hotels Before
68%
15%

After
56%
23%

Restaurants have a range of closing times from 10 pm to midnight

Restaurants
10pm
10.30pm
11pm
11.30pm
midnight
Before
8%
9%
44%
9%
15%
After
6%
8%
41%
14%
18%

Bars have a wide range of later closing times.

Bars
11pm
Midnight
1am
2am
Before
55%
12%
9%
9%
After
42%
18%
13%
12%

Nightclubs’ closing times range from 2am to 4pm

Nightclubs
2am
3am
4am
Before
56%
22%
4%
After
44%
30%
8%

Data compiled by CGA Strategy for DCMS. Based on 9,894 registered/social clubs, 3,383 hotels, 21,929 pubs and bars, 8,375 restaurants and 1,182 nightclubs for which information was available about typical closing times before and after the introduction of the Act.

Recorded crime

A survey of 30 police forces found a reduction in violent crime during the day, and an increase between 3 am and 6 am. Overall, there was no increase in violent crime (1% decrease).

Time Dec 04 - Nov 05 Dec 05 -Nov 06 Absolute Difference % difference
6am-5.59pm
534413
516469
-17944
-3
6pm-8.59pm
323407
319899
-3508
-1
9pm-11.59pm
323369
319846
-3523
-1
12am-2.59am
239382
242999
3617
2
3am-5.59am
47543
57778
10235
22
Not known
12613
9609
-3004
-24
Total
1480727
1466600
-14127
-1

Hospital data

A survey of 33 Accident and Emergency departments found a 2% decrease in the number of patients seeking treatment for violence related injuries in 2006, compared with 2005. There was no record of alcohol consumed by either the assailant or the victim. Data were compiled by the Cardiff University Violence Research Group. A question asked in Parliament elicited the total number of A&E admissions in England for the years 2002 to 2006 in which the patient had an alcohol-related diagnosis, whether or not this was the main reason for admission. These figures showed an increase of 8% from 2005/06 to 2006/07. This was a smaller increase than the previous years, each of which showed a 17-19% increase.

Year No. of Admissions % increase
2002-03
91325

2003-04
108034
18%
2004-05
128342
19%
2005-06
149865
17%
2006-07
162080
8%

All alcohol-related diagnoses were counted, including liver disease. This increased by 10% in 2006/07, and by 14% in each of the four previous years. Given this general rise in alcohol-related diseases, is perhaps unsurprising that those attending A&E, possibly for unrelated injuries, would also show a rise in alcoholrelated diagnoses.

Data supplied to the Institute of Alcohol Studies show that the total number of hospital consultant episodes (which may be more than admissions, if one patient saw two or more consultants) in which the patient was diagnosed with acute intoxication increased by 7% in 2005/06. In each of the previous three years this figure had increased by more than 20%.

Year No. of consultations % increase
2002-03
2489

2003-04
31219
25%
2004-05
38239
22%
2005-06
46126
21%
2006-07
49325
7%

Data were supplied by the NHS Information Centre for health and social care. These figures are for all diagnoses of alcohol intoxication, whether or not this was the main reason for needing treatment. They include figures from A&E as well as other hospital departments.

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New Welsh Substance Misuse Strategy puts new emphasis on dealing with alcohol misuse

In January 2008 the Welsh Assembly Government launched its substance misuse Strategy for Wales 2008 - 2018. Here it is reviewed by Aneurin Owen.

Brian Gibbons AM, Minister for Social Justice and Local Government, in his foreword to the Strategy states: “I believe that we must redouble our efforts to tackle alcohol misuse. Most of us drink sensibly (though we also drink more than we think we do), but a substantial minority drink too much, too often, and blight the streets of our towns and cities through alcohol related crime and disorder and damage their own long term health in the process.” This is a familiar mantra, and not surprising since the implementation of the Strategy will be through partnership working at Community Safety Partnership level. Alcohol policy, health and social issues will need to continue to compete for agenda time and a fair share of resources at the commissioning tables of the CSPs. But there is at least recognition at Strategic and Ministerial level of the need to intensify responses to alcohol misuse.

Since the introduction of a joint substance misuse strategy in the mid-1980s alcohol issues have not always commanded centre stage in Wales and the overall emphasis has been on reducing crime and increasing harm reduction services in the drugs field. This new ten year Strategy “Working Together to Reduce Harm” now places alcohol firmly in the arena of harm reduction with all its incumbent benefits and pitfalls.

The Strategy is written in the belief that “there are distinctive issues to be considered in relation to alcohol misuse and a clear consensus exists for our Strategy to focus on tackling the problems caused by inappropriate or risky consumption of alcohol”. A specific alcohol plan (again a new feature within the Strategy) will focus effort on those who cause damage or problems for the wider community “but who may not need specialist treatment for addiction.” (Executive Summary p.1) For those who do require support and treatment, the Strategy outlines proposals for the expansion of services in an attempt to “do more to engage and help priority groups.” (p 3) There is a welcomed emphasis here on more investment in youth and other outreach services, on whole system approaches to the provision of services to children and on wraparound services – housing, education, training and employment.

Action Area 3 focuses on the need to support families by reducing the risk of harm to children and adults that is a consequence of a parent’s, a partner’s or a child’s substance misuse. An estimated 17,500 children and young people in Wales are living in families affected by drug misuse and “64,000 Welsh children may be adversely affected by parental alcohol problems.” (p 35)

The Welsh Assembly Government is to consult on a Strategy for Vulnerable Children in 2008 with the proposed Legislative Competency Order for Vulnerable Children and Child Poverty enabling the introduction of legislation in relation to the welfare of children and young people. Based on the experience of several imaginative and coordinated interventions, and on a growing evidence base, there is a stated objective to “develop an integrated family support tool to assist local authorities and their partners” and to increase support for young carers, parents and adult carers. There is also a commitment to producing a “module of the Substance Misuse Treatment Framework which sets out good practice in joint working where there is domestic abuse and coexisting substance misuse.” (p 39)

On the broader issue of tackling availability and protecting individuals and communities via enforcement activity, the Strategy recognises that “access to” the supply of alcohol has been increased through changes to the licensing legislation and a fall in the relative price of alcohol.” (p 41)

Under the heading ‘Tackling Alcohol Related Crime and Disorder’ (pages 42 – 44) the Strategy outlines actions to be taken to control the supply, sale and consumption of alcohol. This section recognizes the limitation of working within legislation (Licensing Act 2003) that is not devolved to the Welsh Assembly Government and concern is raised that “partners are not yet making best use of the Licensing Act and Violent Crime Reduction Act to reduce harms to individuals and communities from excessive drinking.” (p 42) Greater collaboration between CSPs and NHS Trusts should ensure that “traders who persistently sell or supply alcohol to children” and individuals “who drink irresponsibly and become involved in crime and anti-social behaviour” are tackled using the full force of current powers and legislation. Holistic approaches to the management of towns and cities, including the management of the evening and night-time economy, requires partnerships to work on the wider use of Proof of Age card schemes and on tackling rogue retailers, licensing, underage drinking, transport, CCTV and other environmental issues. “Reducing alcohol related injuries and the resultant pressure on the health service should be a key objective.” (p 44)

In another new departure from previous Strategies, the new Strategy contains specific references to the areas in which the Welsh Assembly Government will seek working co-operation with the UK Government, retailers and the alcohol industry in order to “tackle the inappropriate availability of alcohol.”(p 45)

The Welsh Assembly Government will “press the case for:

  • Stricter rules on the promotion of alcohol
  • Consideration of reducing demand by increasing the price by greater taxation
  • An increase in taxation on cider
  • A reduction of the drink drive limit and better enforcement of the limit through random testing for both alcohol and drugs
  • Inclusion of “safeguarding public health” as a statutory objective of the Licensing Act
  • Strengthening the Code of Conduct for the alcohol industry
  • Ensuring the availability and better promotion of low strength alcoholic drinks and low priced soft drinks

We will also consider whether there is support for exploring opportunities under the Government of Wales Act 2006 to strengthen the hand of licensing authorities in Wales in tackling these and related issues and for establishing a working group involving the licensed trade in Wales.” (p 43) Increases in direct resources to deliver this strategy are planned - a further £9.6 m to the Substance Misuse Action Revenue Fund, and £3 m over the period 2008/9 to 2010/11 specifically for the delivery of the alcohol action plan. The ringfenced allocation to LHBs will be increased to £10.9 million for 2008-9. Other funding streams such as those from the Home Office and Ministry of Justice, the European Union Convergence Fund, Rural Development Programme and Lottery Funding will support the delivery of the Strategy.

The delivery of the Substance Misuse Strategy for Wales 2008 - 2018 with its four priority action areas (prevention, support for substance misusers, support for families, tackling availability and protecting individuals and communities) will require the involvement of a range of policy areas within the Welsh Assembly Government and a variety of devolved and non-devolved agencies and service sectors. A commitment is made to the establishment of a National Substance Misuse Strategy Implementation Board made up of key stakeholders and representatives to oversee set indicators. (Annex 3) This is an important and new development that will provide stability over the medium to long term as local delivery mechanisms change.

The Substance Misuse Strategy for Wales 2008 - 2018 sets out a clear harm reduction course for Wales for the next ten years with firm commitments, new delivery structures and a new focus on alcohol. It is sufficiently broad to allow for the possibility of greater co-ordination across policy areas and service sectors. It specifies actions to be taken to tackle the inappropriate availability of alcohol and to provide support for at risk groups, families and communities. As the Strategy evolves it will be interesting to note the impact or otherwise of these ambitious plans and calls for action within Wales and on the UK Government. Harm reduction approaches need also to be supported by actions that take into account the evidence base for total population approaches and the sensitization of professionals, decision makers and to alcohol policy issues would also keep Wales in tandem with other national and European policies.

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