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UK Alcohol Policy Whither now?

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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 alcoholrelated 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: 501,800
• 2008/9: 945,500
• 2009/10: 1,057,000
• 2010/11: 1,200,000
– Alcohol-related falls and accidents
– Cirrhosis, heart disease
– Mental health disorders linked to alcohol
NHS Information Centre, 2011
Estimated number of people aged 16 and
over in England with alcohol dependence
Level of dependence
Prevalence in people
aged 16 and over (%)
Number of people
Mild
3.20
1,325,8000
Moderate
0.53
221,000
Severe
0.07
31, 600
Total
3.80
1,578,400
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 11-15 year
olds drinking alcohol and the amounts consumed
1. Turning the Tide
• Reducing availability
– Minimum unit price (MUP)
– Ban on multi-buy promotions (offtrade)
• 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 1971-2007
Alcohol-related liver disease
• 2001-2009: 25% increase in
alcoholic liver disease
• Alcoholic liver disease
accounts for в…“ (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 ВЈ20,000
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
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