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Alcohol Harm Reduction Strategy for...
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Alcohol HarmReduction Strategyfor England
March 2004
Prime Minister’s Strategy Unit
CONTENTS
Prime Minister’s Foreword 2
Executive Summary 4
1. Introduction 7
2. Alcohol and its harms 9
3. The future strategy framework 16
4. Education and communication 22
5. Identification and treatment 34
6. Alcohol-related crime and disorder 44
7. Supply and industry responsibility 67
8. Delivery and implementation 72
Contents
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PRIME MINISTER’S FOREWORD
Millions of us enjoy drinking alcohol with few, if any, illeffects. Indeed moderate drinking can bring some healthbenefits. But, increasingly, alcohol misuse by a smallminority is causing two major, and largely distinct,problems: on the one hand crime and anti-social behaviourin town and city centres, and on the other harm to healthas a result of binge- and chronic drinking.
The Strategy Unit’s analysis last year showed that alcohol-related harm is costing around £20bn a year, and thatsome of the harms associated with alcohol are gettingworse.
This is why the Government has been looking at how bestto tackle the problems of alcohol misuse. The aim has beento target alcohol-related harm and its causes withoutinterfering with the pleasure enjoyed by the millions ofpeople who drink responsibly.
This report sets out the way forward. Alongside the interimreport published last year it describes in detail the currentpatterns of drinking – and the specific harms associatedwith alcohol. And it clearly shows that the best way tominimise the harms is through partnership betweengovernment, local authorities, police, industry and thepublic themselves.
For government, the priority is to work with the police andlocal authorities so that existing laws to reduce alcohol-related crime and disorder are properly enforced, includingpowers to shut down any premises where there is a seriousproblem of disorder arising from it. Treatment servicesneed to be able to meet demand. And the public needsaccess to clear information setting out the full and seriouseffects of heavy drinking.
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For the drinks industry, the priority is to end irresponsiblepromotions and advertising; to better ensure the safety oftheir staff and customers; and to limit the nuisance causedto local communities.
Ultimately, however, it is vital that individuals can makeinformed and responsible decisions about their own levelsof alcohol consumption. Everyone needs to be able tobalance their right to enjoy a drink with the potential risksto their own – and others’ – health and wellbeing. Youngpeople in particular need to better understand the risksinvolved in harmful patterns of drinking.
I strongly welcome this report and the Government hasaccepted all its conclusions. These will now beimplemented as government policy and will, in time, bringbenefits to us all in the form of a healthier and happierrelationship with alcohol.
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This report sets out the Government’sstrategy for tackling the harms and costs ofalcohol misuse in England. The aim of thisstrategy is to prevent any further increase inalcohol-related harms in England. It willbecome a key feature of the public healthpolicy which the Government is at presentconsulting on and will publish later in theyear.
The vast majority of people enjoy alcoholwithout causing harm to themselves or toothers – indeed they can also gain somehealth and social benefits from moderate use.But for others, alcohol misuse is a very realproblem. The Strategy Unit’s interim analysisestimated that alcohol misuse is now costingaround £20bn a year.
This is made up of alcohol-related healthdisorders and disease, crime and anti-socialbehaviour, loss of productivity in theworkplace, and problems for those whomisuse alcohol and their families, includingdomestic violence.
The annual cost of alcohol misuseincludes:• 1.2m violent incidents (around half of all
violent crimes);
• 360,000 incidents of domestic violence(around a third) which are linked toalcohol misuse;
• increased anti social behaviour and fear ofcrime – 61% of the population perceivealcohol-related violence as worsening;
• expenditure of £95m on specialist alcoholtreatment;
• over 30,000 hospital admissions foralcohol dependence syndrome;
• up to 22,000 premature deaths per annum;
• at peak times, up to 70% of all admissionsto accident and emergency departments;
• up to 1,000 suicides;
• up to 17m working days lost throughalcohol-related absence;
• between 780,000 and 1.3m childrenaffected by parental alcohol problems; and
• increased divorce – marriages where thereare alcohol problems are twice as likely toend in divorce.
Some patterns of drinking areparticularly likely to raise the risk ofharm:• Binge-drinkers: Binge-drinkers are those
who drink to get drunk and are likely to beaged under 25. They are more likely to bemen, although women’s drinking has beenrising fast over the last ten years. Bingedrinkers are at increased risk of accidentsand alcohol poisoning. Men in particularare more likely both to be a victim ofviolence and to commit violent offences.There can also be a greater risk of sexualassault. The impacts on society are visiblein, for example, high levels of attendanceat A&E related to alcohol.
EXECUTIVE SUMMARY
• Chronic drinkers: These drinkers aremore likely to be aged over 30 and aroundtwo-thirds are men. They are at increasedrisk of a variety of health harms such ascirrhosis (which has nearly doubled in thelast 10 years), cancer, haemorrhagicstroke, premature death and suicide. Theyare also more likely to commit the offencesof domestic violence and drink-driving.
The direction set out in this strategy is basedon a detailed analysis of the key issues andthe current situation. It is intended to providea strong base for where government shouldintervene and lead, whilst recognising thatresponsibility for alcohol misuse cannot restwith government alone.
Importantly, the strategy sets out a newcross-government approach that relies oncreating a partnership at both national andlocal levels between government, the drinksindustry, health and police services, andindividuals and communities to tackle alcoholmisuse.
Better education and communicationThe strategy includes a series of measuresaimed at achieving a long term change inattitudes to irresponsible drinking andbehaviour, including:
• making the “sensible drinking” messageeasier to understand and apply;
• targeting messages at those most at risk,including binge- and chronic drinkers;
• providing better information forconsumers, both on products and at thepoint of sale;
• providing alcohol education in schools thatcan change attitudes and behaviour;
• providing more support and advice foremployers; and
• reviewing the code of practice for TVadvertising to ensure that it does nottarget young drinkers or glamoriseirresponsible behaviour.
Improving health and treatment servicesThe strategy proposes a number of measuresto improve early identification and treatmentof alcohol problems. These measures include:
• improved training of staff to increaseawareness of likely signs of alcohol misuse;
• piloting schemes to find out whetherearlier identification and treatment ofthose with alcohol problems can improvehealth and lead to longer-term savings;
• carrying out a national audit of thedemand for and provision of alcoholtreatment services, to identify any gapsbetween demand and provision; and
• better help for the most vulnerable – suchas homeless people, drug addicts, thementally ill, and young people. They oftenhave multiple problems and need clearpathways for treatment from a variety ofsources.
Combating alcohol-related crime and disorderThe strategy proposes a series of measures toaddress the problems of those town and citycentres that are blighted by alcohol misuse atweekends. These include:
• greater use of exclusion orders to banthose causing trouble from pubs and clubsor entire town centres;
• greater use of the new fixed-penalty finesfor anti-social behaviour;
• working with licensees to ensure betterenforcement of existing rules on under-age
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drinking and serving people who arealready drunk. We will also work inpartnership with the industry to reduceanti-social behaviours – issues to beaddressed may include layout of pubs andavailability of seating, managing crime anddisorder in city centres and improvedinformation on safe drinking in pubs; and
• in addition to local initiatives, the SecurityIndustry Authority (SIA) will begin thelicensing of door supervisors with effectfrom March 2004.
Working with the alcohol industryThe strategy will build on the good practiceof some existing initiatives (such as theManchester Citysafe Scheme) and involve thealcohol industry in new initiatives at bothnational level (drinks producers) and at locallevel (retailers, pubs and clubs).
At national level, a social responsibilitycharter for drinks producers, will stronglyencourage drinks companies to:
• pledge not to manufacture productsirresponsibly – for example, no productsthat appeal to under-age drinkers or thatencourage people to drink well overrecommended limits;
• ensure that advertising does not promoteor condone irresponsible or excessivedrinking;
• put the sensible drinking message clearlyon bottles alongside information aboutunit content;
• move to packaging products in safermaterials – for example, alternatives toglass bottles; and
• make a financial contribution to a fundthat pays for new schemes to addressalcohol misuse at national and local levels,
such as providing information andalternative facilities for young people.
At local level, there will be new “code ofgood conduct” schemes for retailers, pubsand clubs, run locally by a partnership of theindustry, police, and licensing panels, and ledby the local authority. These will ensure thatindustry works alongside local communitieson issues which really matter such as under-age drinking and making town centres saferand more welcoming at night.
Participation in these schemes will bevoluntary. The success of the voluntaryapproach will be reviewed early in the nextparliament. If industry actions are notbeginning to make an impact in reducingharms, Government will assess the case foradditional steps, including possiblylegislation.
Making it all happenMaking it happen will be a sharedresponsibility across government. Ministers atthe Home Office and the Department ofHealth will take the lead. We will measureprogress regularly against clearly definedindicators and will take stock in 2007.
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Alcohol plays an important role in our societyand in our economy. However, where it ismisused alcohol is also a major contributor toa range of harms, at considerable cost. Theseharms include:
• harms to the health of individuals;
• crime, anti-social behaviour, domesticviolence, and drink-driving and its impacton victims;
• loss of productivity and profitability; and
• social harms, including problems withinfamilies.
Government already intervenes in many waysto prevent, minimise and deal with theconsequences of the harms caused byalcohol. For example, government providesinformation on sensible drinking and healthservices to people experiencing harms (inaccident and emergency departments, onwards, through GP services, and through theprovision of treatment services). Through thecriminal justice system, government dealswith criminal and anti-social behaviours thatmay also result from alcohol misuse.
However, government interventions toprevent, minimise and manage alcohol-related harms have never before beenbrought together into a coherent strategy.The Prime Minister’s Strategy Unit wascommissioned to produce an ‘Alcohol HarmReduction Strategy for England’, incollaboration with other departments,including the Department of Heath and theHome Office. This document sets out that
strategy. Implementation will begin this yearand will be taken forward by the HomeOffice and the Department of Health,working closely with the Department forCulture, Media, and Sports, the Departmentfor Education and Skills, the Office of theDeputy Prime Minister and otherdepartments.
The Government has launched a consultationon the people’s health – called ChoosingHealth? – that will lead to a White Paper lateron in the year. The consultation covers awide range of issues concerning the differentresponsibilities not only of individuals andgovernment departments, but of other socialand commercial organisations and includesmany of the issues discussed in thisdocument. This alcohol strategy does notclose off any of the issues in thatconsultation. It develops important issues andquestions about alcohol and public healthpolicy and will be an important contributionto that process.
This strategy is for England only. TheGovernment has consulted with the devolvedadministrations in producing its analysis ofthe harms caused by alcohol, and willcontinue to do so as the strategy isimplemented – especially in those areaswhere this strategy’s proposals may berelevant to Scotland, Wales and NorthernIreland. All three devolved administrationshave produced their own strategies and theGovernment has been keen to learn fromthese.
1. INTRODUCTION
Introduction
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The direction set out in this strategy is basedon a detailed analysis of the key issues andthe current situation. Separately publisheddocuments include the interim analyticalreport (setting out the analysis of the harmsassociated with alcohol misuse), backgroundeconomic analysis and the responses to thepublic consultation exercise on the strategy.These are all available on the project website(www.strategy.gov.uk). Unless otherwisestated, the evidence presented in this reportis drawn from the interim analytical report.
The remainder of this strategydocument comprises seven sections:• Chapter 2 summarises the interim
analytical report’s key findings and sets outthe extent and nature of the harmsassociated with alcohol misuse.
• Chapter 3 sets out the four key areaswhere the Government’s strategy mustfocus in order to reduce alcohol harms.
• Chapters 4-8 set the strategy direction andmake a number of specific proposals ineach of those four areas:
- Chapter 4 sets out proposals for startingto change behaviour and culturethrough improved and better targetededucation and communication.
- Chapter 5 sets out proposals for betteridentification of those with alcoholproblems and for improving treatmentand aftercare services.
- Chapter 6 sets out proposals to preventand tackle a range of alcohol-relatedcrime and disorder.
- Chapter 7 sets out proposals for newways for government to work with thealcoholic drinks industry to reducealcohol harms.
- Chapter 8 sets out how the strategy willbe delivered and how progress will bemonitored.
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Alcohol has an importantplace in our society and bringsmany benefits
Over 90% of the adult population drink. Themajority do so with no problems the majorityof the time. For individuals, alcohol is widelyassociated with socialising, relaxing andpleasure. Drunk in moderation it can providehealth benefits by lowering the risk of death
from coronary heart disease and ischaemicstroke for those over the age of 40. While it isoutside the scope of this report to quantifythe economic benefits in detail, alcohol playsa key role within the leisure and touristindustry. It accounts for a substantial sectionof the UK economy: the value of thealcoholic drinks market is more than £30bnper annum and it is estimated that aroundone million jobs are linked to it.1
2. ALCOHOL AND ITS HARMS
Summary
• Alcohol plays an important and useful role both in the economy and in British societygenerally.
• Around a quarter of the population drink above the former recommended weeklyguidelines, which increases the risk of causing or experiencing alcohol-related harm.
• The Strategy Unit calculated that the cost of alcohol-related harms in England is up to£20bn per annum. These harms include:
- harms to health;
- crime and anti-social behaviour;
- loss of productivity in the workplace; and
- social harms, such as family breakdown.
• There is no direct correlation between drinking behaviour and the harm experienced orcaused by individuals. However, those most likely to be affected themselves, or harmothers, are binge-drinkers, chronic drinkers, the families of those who misuse alcohol,and people with multiple problems (including drug abuse and being homeless).
• The likelihood of causing or suffering harm is also affected by a complex interaction offactors, such as an individual’s personality, family background and cultural background.
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1 ‘Strategy Unit Alcohol Harm Reduction project: Interim Analytical Report’, 2003, available at www.strategy.gov.uk, p.8.
Around a quarter of thepopulation drink above formerrecommended weeklyguidelines and some 6mabove recommended dailyguidelines
Since the middle of the last century, levels ofalcohol consumption in the UK have beenrising (see Figure 2.1).
The UK is in the middle of the range foralcohol consumption compared to otherEuropean countries (see Figure 2.2).
However, while consumption has fallen overrecent years in most of the wine-producingcountries, British alcohol consumptioncontinues to rise. If present trends continue,the UK will rise to near the top of the
consumption league within the next tenyears.
Two drinking patterns are particularlylikely to lead to harm – binge-drinking and chronic drinkingThe common perception of binge-drinking isan occasion on which large amounts ofalcohol are drunk in a relatively short spaceof time. Binge-drinkers often drink with thespecific objective of getting drunk, andbinge-drinking is often associated withdrinking by large groups of people, oftenafter work or on a Friday or Saturdayevening. Some people may do thisoccasionally, whilst others drink excessivelymuch more regularly. From the current dataavailable it is not easy to identify thenumbers of people who went out within thelast week to get drunk. The best available
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2 Interim Analytical Report, p.13.
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Ready todrinkdrinks
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Figure 2.1: Alcohol Consumption in the UK: 1900-2000 per capita consumption of 100 per cent alcohol2
proxy is the numbers who drank abovedouble the recommended daily guidelines onat least one occasion in the last week. Usingthis as a measure of ‘binge’ drinking weestimate that around 5.9m adults drinkabove this level. Within this group there willbe many who are regularly drinking far morethan twice the recommended daily amount.Many others will do so only rarely.
We define chronic drinking as drinking largeamounts regularly. Around a quarter of thepopulation drink above the former weeklyguidelines of 14 units for women and 21units for men (see Box 2.1); 6.4m drink up to35 units a week (women) or 50 units a week(men). A further 1.8m, two-thirds of themmen, drink above these levels.
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3 Interim Analytical Report, p.14.4 Interim Analytical Report, p.12.
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Figure 2.2: Alcohol Consumption in the World – litres of pure alcohol per inhabitant, 19993
ABSTAINERS(0 units)
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LOW TO MODERATEDRINKING
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26.3m(m=12.1mw=14.2m)
ABOVE DAILYGUIDELINES
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MODERATE TO HEAVY DRINKING
(14/21-35/50 units per wk)
6.4m(m=3.9mw=2.5m)
5.8m(m=3.2mw=2.6m)
5.9m(m=4.0mw=1.9m)
VERYHEAVY
DRINKING(35/50+ units
per wk)
1.8m(m=1.2mw=0.6m)
Figure 2.3: How the Population Drinks4
Not all will suffer harm as aresult of alcohol misuse
Alcohol misuse does not lead automaticallyto harm. There is no direct relationshipbetween the amounts or patterns ofconsumption and types or levels of harmcaused or experienced, and it is likely thatmany of those who exceed the levels ofalcohol consumption described above willnot suffer harmful effects.
However, alcohol misuse does lead to anincreased risk of harm, depending on a rangeof factors, including:
• the amount drunk on a particular occasionand/or frequency of heavy drinking (thetype of alcohol drunk has relatively littleimpact);
• an individual’s genes, life experiences andpersonal circumstances;
• the extent to which the individual hasother substance misuse problems; and
• the environment in which the alcohol isdrunk (for example, a crowded and noisyenvironment can increase the risk ofdisorderly behaviour).
Alcohol misuse createssignificant harms
We identified four key groups of alcohol-related harms to be tackled:
• Health harms. We calculate the cost ofalcohol misuse to the health service to be£1.7bn per annum. Alcohol misuse islinked to:
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Box 2.1 – Government’s Recommended Sensible Drinking Guidelines
Government-recommended “sensible drinking” guidelines were developed on the basis ofcareful consideration of the harmful, and some beneficial, effects of drinking at differentlevels.
The “sensible drinking” message was first referred to in Government’s 1992 Health of theNation White Paper. This recommended that men should consume no more than 21 andwomen no more than 14 units per week. However, consumption at these unit levels had beenrecommended by the Health Education Authority since 1987 (when the term “units” was firstcoined), prior to which the message had been expressed in terms of “standard drinks”.
In 1995, in recognition of the dangers of excessive drinking in a single session, the sensibledrinking message was changed to focus on daily guidelines. It suggests:
• a maximum intake of 2-3 units per day for women and 3-4 for men, with two alcohol-freedays after heavy drinking; continued alcohol consumption at the upper level is not advised;
• that intake of up to two units a day can have a moderate protective effect against heartdisease for men over 40 and post-menopausal women; and
• that some groups, such as pregnant women and those engaging in potentially dangerousactivities (such as operating heavy machinery), should drink less or nothing at all.
- annual expenditure of £95m onspecialist alcohol treatment;
- over 30,000 hospital admissionsannually for alcohol dependencesyndrome;
- up to 22,000 premature deaths perannum; and
- at peak times, up to 70% of alladmissions to accident and emergency(A&E).5
- In addition, the Chief Medical Officer’sAnnual Report for 2001 identified arising trend in deaths from chronic liverdisease, with most cases most probablybeing caused by high levels of alcoholconsumption.
• Crime and anti-social behaviourharms. We calculate the overall annualcost of crime and anti-social behaviourlinked to alcohol misuse to be £7.3bn.Alcohol misuse shows strong links toviolence. 1.2m violent incidents (aroundhalf of all violent crimes) and 360,000incidents of domestic violence (around athird) are linked to alcohol misuse. Moregenerally, alcohol misuse is linked todisorder and contributes to drivingpeople’s fear of crime; 61% of thepopulation perceive alcohol-relatedviolence as worsening.6
• Loss of productivity and profitability.We calculate the overall annual cost ofproductivity lost as a result of alcoholmisuse to be £6.4bn per annum – up to17m working days are lost each yearthrough alcohol-related absence. Alcoholmisuse may also affect productivity ofworkers in their workplace and may resultin shorter working lives.7
• Harms to family and society. Wecalculate the cost of the human andemotional impact suffered by victims ofalcohol-related crime to be £4.7bn perannum. Between 780,000 and 1.3mchildren are affected by parental alcoholproblems. Marriages where there arealcohol problems are twice as likely to endin divorce.8 In addition, up to half of roughsleepers have problems with alcohol.
Overall, the cost of these harms is some£20bn a year. For the individuals affected theharms can be devastating – up to 1,000suicides a year can be linked with alcoholmisuse. The effects are not however confinedto the individuals who drink. Alcohol misusecan seriously damage families andcommunities, and its effects are also feltmore widely across society. As taxpayers, wepay for the costs of alcohol-related crime andhealth problems. As citizens, we are affectedby the visible effects of alcohol misuse on ourstreets.
The effects of binge- andchronic drinking are part of awider range of problems
Some patterns of drinking are particularlylikely to raise the risk of harm, although notall those drinking in these ways will cause orexperience harm:
• Binge-drinkers: Binge-drinkers and thosewho drink to get drunk are likely to beaged under 25. They are more likely to bemen, although women’s drinking has beenrising fast over the last ten years. Binge-drinkers are at increased risk of accidentsand alcohol poisoning. Men in particularare more likely both to be a victim of
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5 Interim Analytical Report, pp.32-49.6 Interim Analytical Report, pp.50-69.7 Interim Analytical Report, pp.70-76.8 Interim Analytical Report, pp.78-86.
violence and to commit violent offences.There can also be a greater risk of sexualassault. The impacts on society are visiblein, for example, high levels of attendanceat A&E related to alcohol. 5.9m peoplehave drunk more than twice the dailyguidelines in the past week.
• Chronic drinkers: These drinkers aremore likely to be aged over 30 and aroundtwo-thirds are men. They are at increasedrisk of a variety of health harms such ascirrhosis (which has nearly doubled in thelast 10 years), cancer, and haemorrhagicstroke; they are also at higher risk ofpremature death and suicide. If chronicdrinkers come into contact with thecriminal justice system, it is more likely tobe through crimes such as domesticviolence and drink-driving. The impacts onsociety are less visible but are reflected in
effects on their families, lost productivityand costs to the health service. 1.8mdrinkers consume more than twice formerrecommended weekly guidelines (see Box2.1).
In addition, alcohol-related harms may beexperienced by a range of vulnerable groups.These include problem drinkers who are fromvulnerable groups such as ex-prisoners, streetdrinkers, those who suffered abuse aschildren, children of those who misusealcohol, and young drinkers. As well asalcohol problems they are more likely toexperience a whole range of other problems,such as mental illness, drug use andhomelessness, which may compound theirmultiple needs.
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9 Interim Analytical Report, p.31.
HEALTH(up to £1.7bn)
FAMILY/SOCIALNETWORKS(cost not quantified)
WORKPLACE(up to £6.4bn)
CRIME/PUBLIC
DISORDER(up to £7.3bn)
Cost to health service of alcohol - related harm: £1.4-£1.7bn
[Cost unquantified due to limitations of current data]
Children affected byparental alcohol
problems, includingchild poverty:
780,000-1.3m
Number of streetdrinkers:
5,000-20,000
Alcohol-relateddeaths due toacute incidents:4,000-4,100
Alcohol-relateddeaths due tochronic disease:11,300-17,900
Drink-driving deaths: 530Working days lost
due to alcohol-related sickness:
11-17mWorking days lost
due to reducedemployment:
15-20m
Arrests fordrunkennessand disorder:80,000
Victims ofalcohol-relateddomesticviolence360,000
Cost to economy ofalcohol-relatedabsenteeism:£1.2-1.8bn
Cost to economy of alcohol-related deaths: £2.3-2.5bn Cost to economy of
alcohol-related lostworking days:
£1.7-2.1bn
Cost to services inanticipation ofalcohol-relatedcrime: £1.7-2.1bn
[Human costs ofalcohol-related
crime: £4.7bn]*
Cost to services as consequence of alcohol-related crime: £3.5bn
Cost of drink-driving: £0.5bn
Cost to CriminalJustice System:£1.8bn
ALCOHOL-RELATEDHARM
= Nos.affected/no. incidents
= Cost of harm
Figure 2.4: The Costs of Alcohol-related Harm9
Conclusion
The harms to be addressed by the strategyspan a range of areas and cost up to £20bn ayear. Around 6m people have drunk morethan twice recommended daily guidelines inthe past week, and around 8m people abovethe former recommended weekly guidelines.This means that they are at greater risk of arange of harms. Some groups are particularlylikely to cause or experience harm: binge-drinkers, chronic drinkers and vulnerabledrinkers with multiple problems. Harms resultfrom the interaction of a range of factors –no one single factor is to blame.
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This strategy has the objective of reducingthe harms caused by alcohol misuse inEngland. It recognises that there are bothbenefits and costs to alcohol use and,therefore, does not aim to cut alcoholconsumption by the whole population.Instead it focuses on the prevention,minimisation and management of the harmscaused by alcohol misuse.
Measures to tackle some of these harms arealso addressed in other governmentobjectives and initiatives. For example, thereare government objectives to:
• raise educational achievement;
• encourage regeneration and active andcohesive communities;
• raise productivity and profitability;
3. THE FUTURE STRATEGY FRAMEWORK
Summary
• This strategy aims to reduce the harm caused by alcohol misuse in England.
• The four key ways that government can act to reduce alcohol-related harms arethrough:
- improved, and better-targeted, education and communication;
- better identification and treatment of alcohol problems;
- better co-ordination and enforcement of existing powers against crime and disorder; and
- encouraging the industry to continue promoting responsible drinking and to continue to take a role in reducing alcohol-related harm.
• The Government also needs to ensure that interventions to reduce alcohol harms are:
- coherent, as isolated interventions are unlikely to succeed;
- sustained, as short-term initiatives will have little long-term impact;
- strategic, as without a co-ordinated strategy there is likely to be little progress; and
- measured, as without ways to chart progress, the success of the strategy cannot be assessed.
• This chapter sets out a framework to achieve these goals.
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• tackle health inequalities and promotepublic health;
• tackle crime, anti-social behaviour anddomestic violence;
• eradicate child poverty;
• deliver improved services to victims andwitnesses (as outlined in the NationalStrategy – July 2003); and
• promote leisure and tourism.
In the context of these wider policyobjectives, there are four key ways thatgovernment can act to reduce alcohol-relatedharms:
• through improved and better targetededucation and communication;
• through better identification andtreatment of alcohol problems;
• through better co-ordination andenforcement of the current framework totackle crime and anti-social behaviour; and
• through encouraging the alcoholic drinksindustry to promote more responsibledrinking and take a role in reducingalcohol-related harms.
The strategy will continue to develop as it isimplemented, drawing lessons from andlinking up with future initiatives such as‘Choosing Health? The Government’sconsultation on action to improve people’shealth’.
The first key aim of the strategy is toimprove the information available toindividuals and to start the process ofchange in the culture of drinking toget drunkIndividuals make choices about how muchand how often they drink. Individuals areresponsible for these choices, but they bothinfluence and are driven by their peers andthe wider culture of society.
Accurate information is needed if individualsare to make informed choices about alcohol.In particular, young people need to receiveadequate education on the issues. Anyonewho drinks alcohol needs to understand howsensible drinking guidelines apply to the kindof drinks they consume; and those who maybe experiencing problems, along with theirfamilies and friends, need to know where toget help and advice. But information is onlyone factor influencing behaviour. Theavailability of alcohol, its role in our cultureand the drinking behaviour by some groupsin our society – particularly young people –all affect attitudes, which in turn shape andare shaped by culture. If individuals are tomake responsible choices it is just asimportant to consider how to create socialenvironments which discourage attitudes andbehaviours which lead to the risk of harm.
‘Choosing Health? The Government’sconsultation on action to improve people’shealth’ will provide an excellent opportunityto learn more about how government canmotivate individuals, and how individuals canmotivate themselves to make responsiblechoices about drinking.
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The second key aim of the strategy isto better identify and treat alcoholmisuse
Policy to tackle alcohol misuse hastraditionally focussed most on health issues,and this is where the harms are bestdocumented. The scale and impact of theseharms are set out in the previous chapter.Failing to identify and treat thoseexperiencing alcohol problems can affect anindividual’s health, family and work, and canalso lead to crime, disorder and anti-socialbehaviour, which adds up to longer-termeconomic and social costs, as well as muchgreater cost to the health service.
The third key aim of the strategy is toprevent and tackle alcohol-relatedcrime and disorder and deliverimproved services to victims andwitnessesThe cost of alcohol misuse in terms of crimeand disorder is more than four times the costto health, and affects millions of people. Formany on the receiving end, the effects ofalcohol misuse may be short-lived and soonforgotten. But equally, many others can bedeeply affected – for example, victims ofdomestic violence, and those experiencingrepeated disturbance at night, injuries frombottles used as weapons, or loss of, or injuryto, a family member as a result of drink-driving.
The fourth key aim of the strategy isto work with the industry in tacklingthe harms caused by alcoholThe two main supply-side levers that arecommonly cited as influencing harm areprice and availability:
• price is controlled by government throughlevels of taxation; it is also governed bythe laws of supply and demand – forexample, price promotions; and
• availability is controlled throughrestrictions on suppliers (planning andlicensing law) and individuals.
There is a clear association between price,availability and consumption. But there is lesssound evidence for the impact of introducingspecific policies in a particular social andpolitical context:
• our analysis showed that the drivers ofconsumption are much more complexthan merely price and availability;
• evidence suggested that using price as akey lever risked major unintended sideeffects;
• the majority of those who drink do sosensibly the majority of the time. Policiesneed to be publicly acceptable if they areto succeed; and
• measures to control price and availabilityare already built into the system.
So we believe that a more effective measurewould be to provide the industry with furtheropportunities to work in partnership with theGovernment to reduce alcohol-related harm.Every consumer of alcohol has contact withthe industry in one form or another. Bycontrast, only a small proportion ofconsumers will come into contact withgovernment services because of theirconsumption. Industry should do more toplay a key role in:
• preventing problems arising – for example,industry can play a greater role indisseminating messages which stronglyencourage responsible consumption andensuring that establishments’ layouts aredesigned to minimise harm; and
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• tackling alcohol-related harms – forexample, by working with the police toexclude trouble-makers and helpingprovide transport home for its clients.
We therefore propose that governmentinvolves the industry in the prevention,minimisation and management of theconsequences of alcohol misuse on avoluntary basis.
If these interventions are to besuccessfully delivered they need to be:coherent, sustained, strategic,measured and publicly supported• Coherence
Isolated interventions are unlikely tosucceed. For example, education on theimpact of alcohol misuse is more effectivewhere it is backed up with measures in thecommunity. Detoxification in a hostel orprison is unlikely to have much impact ifnot backed up by aftercare and support.
• Sustained commitment over a periodof timeShort-term initiatives will have little long-term impact. For example, thetransformation in attitudes to drink-drivinghas taken decades of effort both inpublicity and in supporting measures suchas enforcement and punishment.
• Clear objectivesWithout clear objectives and a strategy todeliver and monitor them there is likely tobe little progress. This applies at the levelof both central and local government.
• Measuring progressWithout ways to chart progress, thesuccess of the strategy cannot be assessedand monitored.
• Publicly supportedInterventions must fit with social andcommunity values, and must beunderstood and supported by the public.Interventions without this support will beunlikely to work.
Who is responsible for making thestrategy happen?Government has taken the lead on producinga strategy for England in line with itscommitment in the 1999 White Paper OurHealthier Nation. But government is notsolely responsible for reducing harms – thisresponsibility is shared with individuals,families and communities, and with thealcoholic drinks industry. The role ofcommunities in reducing alcohol-relatedharm is especially important given the keyrole they play in taking ownership of, andenforcing, social norms.
The table below sets out the respectiveresponsibilities of each of these parties inminimising alcohol-related harms.
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Who?
Individuals andfamilies
Alcoholic drinksindustry
Government
Responsibilities
• Their own choices aboutwhat they and those forwhom they are responsibledrink, where and how
• The consequences of thosechoices, both asexperienced by themselvesand in their impact onothers
Individuals cease to beresponsible only where theyare genuinely unable toexercise that choice (forexample those who arementally ill) or could not bereasonably expected toexercise it (which is why weprotect the under-18s inlegislation). Intoxication doesnot relieve an individual ofresponsibility for their actions.
• Giving accurate informationabout the products it sells –and warning about theconsequences
• Supplying its products in away which minimises harm
• Work with national agenciesand local partners to tacklethe harms which the supplyof its product creates
• Ensuring that consumersreceive clear information,both through its own efforts
What they can expect fromothers
• Clear and accurateinformation, andencouragement to makeresponsible decisions
• Support to deal with theadverse consequences oftheir own or others’ actions
• Protection from others’actions where harm iscaused
• Social environments whichdo not encourage excessivedrinking
• Fair regulation consistentwith these responsibilities
• Provision of services forwhich it pays throughbusiness rates and taxes asdoes any other business
• To fulfil their responsibilities
• Voluntary co-operation andpartnership working
All of these responsibilities play out atcommunity level. Communities can beimmediately and directly affected by misuseof alcohol in a multitude of ways – a pubwhich repeatedly causes disorder, off-licenceswhich consistently sell to under-18s, groupsof teenagers perceived as intimidating orstreet drinking. We need to ensure thatcommunities can take the initiative increating the right kind of environment andsocial norms and that their voice is heard.
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and through working withthe industry
• Supporting those whosuffer adverse consequences
• Protecting individuals fromharm caused by the alcoholmisuse of others – forexample, through effectiveenforcement of the dutieson enforcement agencies
• Protecting against harmscaused by the supply ofalcohol where appropriate,and for regulating to theminimum necessary toachieve this
• Ensuring a fair balancebetween the interests of allstakeholders
• Providing the right strategicframework
4. EDUCATION AND COMMUNICATION
Summary
• For increasing numbers of people in England, getting drunk has become the definitionof “a good night out”. Many of them take little personal responsibility for theirbehaviour in getting drunk in the first place, or their subsequent actions when drunk.
• A first step in encouraging individuals to act responsibly involves making sure that theyunderstand the potential risks of irresponsible drinking and alcohol misuse. However,raising awareness alone is not enough. Any successful harm reduction strategy will needto achieve a long-term change in attitudes to irresponsible drinking and behaviour.
• Most people obtain alcohol-related information from five main sources:
- public health information and government campaigns;
- information provided by the alcohol industry;
- education in schools;
- the workplace; and
- advertising.
Further information may also be provided by friends, families and the wider community.
• Despite all these sources of information, consumers are generally not well-enoughequipped to take informed choices about their drinking behaviour:
- recognition of the Government’s “sensible drinking” message is relatively high, with80% of drinkers having heard of units. But this has little impact on behaviour as only10% of drinkers check their consumption in units and just 25% know what a “unit” is;
- while school programmes impart information, there is little evidence that they areeffective in changing drinking behaviour;
- levels of awareness of alcohol-related problems in the workplace are variable; and
- responses to our consultation exercise showed increasing concern at how some TVadvertising may be condoning (if not encouraging) irresponsible drinking behaviour.
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10 Interim Analytical Report, p.110.
For many people in England today,going out to get drunk has become apart of “a good night out”As a population we are drinking more, moreoften, and our consultation exercise and
interim analytical report both indicated thatwe are becoming more tolerant of theoutcomes.10 Drinking is often viewed as anend in itself, and public drunkenness issocially accepted, if not expected.
• This strategy contains a package of measures to:
- make the “sensible drinking” message easier to understand and apply;
- target campaigns at those most at risk: including binge- and chronic drinkers;
- share expertise better, both inside and outside Government;
- provide better information for consumers, both on products and at the point of sale;
- provide alcohol education in schools that can change attitudes and behaviour, as well as raise awareness of alcohol issue;
- provide more support and advice for employers; and
- review the code of practice for TV advertising to ensure that it does not target young drinkers or glamorise irresponsible behaviour.
Box 4.1 – Going Out To Get Drunk
“It’s very important to get drunk. I’m spending money and I want to get drunk, and if I don’t it’sjust a waste of money”.
There are clear differences in social norms and attitudes between Mediterranean drinkingculture, in which the dominant beverage is wine, and Northern European and Anglo-Saxoncultures in which beers and spirits have traditionally predominated. Our drinking cultureshares more characteristics with the latter. These characteristics are deeply rooted in culture,tradition and indeed climate.
There are many different subcultures within the overall drinking culture. Particularly evident –though not necessarily reflective of the population as a whole – is a culture of going out toget drunk. This culture is particularly associated with:
• 16-24 year old drinkers (though also, increasingly, for older drinkers);
• large numbers coming into town centres from up to 50-60 miles away;
• circuit drinking (moving from one establishment to another); and
• a strong likelihood of disorderly or criminal behaviour.
If individuals are to make informed choicesabout their drinking and act moreresponsibly, they need accurate and balancedinformation. But exercising responsiblechoice also depends on the availability ofalcohol, its role in our culture and thedrinking behaviour by some groups in oursociety – particularly young people. Attitudesand behaviour are inextricably linked to thesurrounding culture. Changes to behaviourand culture therefore go hand in hand:raising awareness is not enough to changebehaviour. The Government’s communicationand education initiatives will need not only toprovide information, but will also need to belinked to wider action to change attitudesand cultures which encourage excessivedrinking. The alcoholic drinks industry, too,will need to ensure that its advertising or theway in which it sells alcohol neither condonesnor encourages harmful drinking behaviour.
In this chapter, we focus on five key channelsthrough which information reaches theconsumer:
• public information and governmentmessages;
• information provided by the industry;
• school education;
• the workplace; and
• advertising.
4.1 Public information andgovernment messages
Drinkers have a right to clear,accurate information on which tomake choices about their alcoholconsumption
We set out in Chapter 3 the responsibility of individuals to make choices. To makeinformed and responsible choices, peopleneed to know about the effects of alcohol on their own lives and on the lives of others.To do this they need clear and credibleinformation.
Government communications onalcohol currently focus on theinformation contained in the “sensible drinking” messageThe Government’s “sensible drinking”message is a benchmark for sensible drinking,designed to increase public awareness of thelong- and short-term health effects ofexcessive drinking. Since 1995, the sensibledrinking message has been based on a dailyconsumption guideline, expressed in terms of“units” (see Box 2.1).
Responsibility for dissemination of thesensible drinking message falls largely to theDepartment of Health (DH). The message isalso featured on the publicity materialproduced by external organisations, such asthe Portman Group (see Box 4.2).
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The sensible drinking message can bedifficult to communicate, and lackscredibility with the public
The sensible drinking message has beeneffective in establishing an awareness of theprinciple of “sensible” levels of alcoholconsumption: 80% of drinkers have heard ofunits. Understanding and impact of thesensible drinking message on behaviour ishowever low – only 10% of drinkers actuallycheck their consumption in units, and just25% understand the practical implications ofwhat a unit is. The message is therefore notworking well.
Two key problems exist:
• The message is hard to apply to therealities of drinking. Drinkers can no longerrely on the received wisdom that one glassof wine or half a pint of beer equals oneunit:
- drinks are now stronger – for example,the average strength of wine is now12.5% whilst units are premised on 9%strength; similarly, the measurement of aunit of beer as half a pint is based on
beers with a value of around 3.5%, whilemost modern lagers are 4% and above;and
- glasses are larger – wine is routinelyavailable in 175ml or 250ml glasses,whilst a unit of wine is 125ml.
• The sensible drinking message does nottarget particular types of drinkers. Equally,it does not focus on changing behaviourand there is little emphasis onconsequences of misuse, on warning signs,or on how and where to seek help.
Government will therefore completelyoverhaul the way it presents messagesabout alcohol
A strategic approach to governmentmessages should be developed, based upon:
• a co-ordinated communications effort,with input from non-governmentalstakeholders where necessary;
• a revised “sensible drinking” message; and
• additional targeted messages, which focuson particular groups of people or
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Box 4.2 – The Portman Group
The Portman Group was set up in 1989 by the UK’s leading alcohol producers. Its purpose isto promote sensible drinking; to help prevent alcohol misuse; to encourage responsiblemarketing; and to foster a balanced understanding of alcohol-related issues.
In 1998, the Portman Group launched a campaign to promote unit awareness in the contextof the revised sensible drinking message. This has been promoted through the “unitcalculator”, which provides a ready reckoner for calculating how many units are contained ina range of standard drinks. The Portman Group’s ‘If You Do Do Drink, Don’t Do Drunk’campaign was launched in 2001, and aims to raise awareness amongst young drinkers of theadverse consequences of excessive drinking.
behaviours, and which support but do notcontradict the universal message.
A co-ordinated communications effortIn future, expertise should be shared moreeffectively across government. As part of thisprocess, it will be crucial to harness theresources of the alcoholic drinks industry andof other stakeholders. Whilst the PortmanGroup has provided a link to the alcoholicdrinks industry in disseminating sensibledrinking messages, more use could be madeboth of the industry’s expertise inunderstanding and targeting consumers andthe channels of communication at itsdisposal. ‘Choosing Health? TheGovernment’s consultation on action toimprove people’s health’ will provide moreinformation on the best way of targeting thepublic with messages about sensible drinking.
As the drink-driving campaign has proved,messages are most effective when they arereinforced over an extended period. It istherefore vital that consistentcommunications are sustained over time.
A revised sensible drinking messageThe current “universal” sensible drinkingmessage should be re-assessed, with a focuson developing a simpler format for themessage, and one which makes it easier torelate to everyday life. This re-assessmentshould be conducted in conjunction withstakeholders inside and outside governmentto ensure that the message is easilycommunicated, whilst retaining its scientificvalidity. This revised message could thenform the basis of wider communications.
Additional targeted messagesThe Government should target messages onthe risks of alcohol misuse towards the two
groups at most risk of causing andexperiencing alcohol-related harms – binge-and chronic drinkers. These messages shouldbe focused on the consequences of alcoholmisuse rather than on alcohol consumptionor intake, and should encourage drinkers toidentify with the risks and outcomesassociated with alcohol misuse.
Actions
‘Choosing Health? The Government’sconsultation on action to improve people’shealth’ will lead to a White Paper on PublicHealth issues later in the year. The actionsbelow will be taken in conjunction with thework on this White Paper.
1. The Department of Health and theHome Office, in consultation withother departments such as theDepartment for Education and Skills,the Department for Culture, Mediaand Sport, and the Department forEnvironment, Food and Rural Affairswill establish an alcoholcommunications group to share bestpractice and agree strategies. Thecommunications group will draw onthe expertise of outside stakeholdersincluding the industry and voluntaryorganisations. This will be establishedby Q3/2004.
2. The Department of Health will carryout a re-assessment of the current“sensible drinking” message, focusingon developing a simpler format forthe message, and one which makes iteasier to relate to everyday life. Thisshould be achieved by Q2/2005.
3. The Department of Health will workwith others inside and outsideGovernment to identify the mosteffective messages to be used with
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binge- and chronic drinkers, and themost effective media for disseminatingthese messages. The Governmentcommunications group should aim todevelop these messages anddisseminate them from Q2/2005.
4.2 Information provided bythe alcohol industry
Messages encouraging responsibledrinking disseminated by the industrywill reach most people who drinkEvery consumer of alcohol is by definitionexposed to a product. So products andoutlets for alcohol are likely to be one of themost effective means of giving consumersinformation on both the content of whatthey consume and the consequences.
Some information is already availableAlthough a number of producers alreadyvoluntarily display information on products,in general the industry provides littleinformation on the possible consequences ofalcohol misuse either at the point of sale or inits advertisements.
The Portman Group estimates that a largeproportion of the alcohol sold in the UK isvoluntarily unit labelled by the industry. Theyestimate that voluntary unit labelling isincluded on over half of all spirits, over athird of ciders and a significant number oflagers and beers.
Health warning labels on alcoholic beveragecontainers have been introduced on astatutory basis at the national level in anumber of countries worldwide, includingthe United States. In the UK, there is nohealth warning label legislation. Recently,however, the Robert Cains brewery has
voluntarily chosen to label its 2008 Ale withthe number of units per bottle and also placea warning on the label.
Nutrition labelling controls are a matter of EUcompetence. The European Commission hasbegun a review of the existing nutritionlabelling legislation. As part of this review, itis considering the case for compulsorynutrition labelling on all pre-packaged foodsand drinks, which may well include alcoholicbeverages. Current rules state that wherenutrition labelling is provided, informationgiven must consist of at least information onthe energy value and the amounts of protein,carbohydrate and fat.
All containers and pump handles in pubs andbars give details of alcohol by volume, andsome alcohol advertisements now carry aresponsible drinking message.
In addition, the drinks industry will beencouraged to play a full role in the publichealth consultation, ‘Choosing Health? TheGovernment’s consultation on action toimprove people’s health’.
Making more information available atthe point of sale alone is unlikely tochange behaviour, but it is anexcellent way of disseminatinginformation and raising awarenessThere is no evidence that consumers inEngland change their behaviour as a result ofthe current unit information on products;and fairly extensive research conducted inthe US reports no significant change indrinking behaviour as a result of theselabels.11
However, labels provide an excellent way ofdisseminating information, and – dependingon their content – may play a useful role in
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11 Interim Analytical Report, p.149.
raising awareness and in educating drinkersabout the risks associated with alcoholmisuse.
There is much greater potential forvoluntary good practice by thealcohol industry in informingconsumersBuilding on current good practice, and underthe aegis of the broader social responsibilityscheme set out in Chapter 6 and 7 of thisreport, the alcohol industry will be stronglyencouraged to add messages encouragingsensible consumption to the labels of itsproduct. A statutory approach to labellingwould need to be cleared under EUlegislation. Steps should therefore be taken inparallel to examine the legal and practicalfeasibility of compulsory labelling in thefuture, should voluntary arrangements proveless effective than hoped.
In the same way, Government would like tosee producers and retailers of alcohol, bothon- and off-licence, taking a more proactiverole in disseminating advisory information inboth drinking and purchasing environments.Advertisers, too, have a responsibility tostrongly encourage sensible drinking.
Actions
‘Choosing Health? The Government’sconsultation on action to improve people’shealth’ will lead to a White Paper on PublicHealth issues later in the year. This willinvolve working with a number of industrialand consumer groups about how they canimprove the health of the public and theactions below will be taken in conjunctionwith the work on this White Paper.
4. As part of the social responsibilityscheme (see Chapters 6 and 7),alcohol producers and manufacturerswill be strongly encouraged to addmessages encouraging sensibleconsumption, alongside unit content,to the labels of its products in a formagreed with the Department ofHealth.
5. As part of the social responsibilityscheme (see Chapters 6 and 7), allretailers of alcohol, both on- and off-licence, will be strongly encouraged todisplay information setting out thesensible drinking message andexplaining what a unit is and how ittranslates in practical terms to thedrinks sold.
6. As part of the social responsibilityscheme (see Chapters 6 and 7), thealcohol industry will be stronglyencouraged to display a reminderabout responsible drinking on itsadvertisements.
7. From Q2/2004, the Department ofHealth will work with the UKPermanent Representation to theEuropean Union (UKRep) and partnerswithin government to examine thelegal and practical feasibility ofcompulsory labelling of alcoholicbeverage containers.
Further detail of the arrangementssurrounding these recommendations can befound in Chapters 6 and 7.
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4.3 Education and youngpeople
Young people need clear andaccessible information in order tomake responsible choices aboutdrinking behaviourYoung people under the age of 16 aredrinking twice as much today as they did tenyears ago, and report getting drunk earlierthan their European peers. A number ofissues surround alcohol misuse by youngpeople, from specific health effects toalcohol-related crime, school exclusion andunsafe sex. As part of a long-term alcoholharm reduction strategy, it is vital that youngpeople are educated to make responsiblechoices about their drinking behaviour.
‘Choosing Health? The Government’sconsultation on action to improve people’shealth’ will also examine how children can beencouraged to make healthy choices.
Alcohol education in schools is provided in a number of different waysAlcohol education is already a statutoryrequirement of the National CurriculumScience Order. This represents the statutoryminimum, and schools are expected to usethe non-statutory framework for personal,social and health education (PSHE) as thebasis for extending their provision. PSHEprovides pupils with opportunities to developtheir knowledge, skills, attitudes andunderstanding about alcohol.
There are further opportunities for alcoholeducation to be addressed within Citizenship,which became statutory in secondary schoolsin September 2003. Alcohol education also
features as one of the ten themes of theNational Healthy School Standard (NHSS). So there is sufficient opportunity to educateabout alcohol.
Local authorities, the Connexions service,further and higher education colleges provideother avenues for helping young people learnto make responsible choices.
But although information is alreadybeing provided, we need to knowmore about how best to influenceattitudes and behaviourAlthough such programmes are successful inimparting information, an extensiveinternational literature suggests thatconventional alcohol education programmesare generally less effective in changingbehaviour. There is some suggestion thatpeer-led prevention programmes canenhance teacher-led programmes, and thatinteractive programmes to developinterpersonal skills can be effective inchanging behaviour. But we need to knowmore about what approaches will delivertangible changes in attitude and behaviour.
As well as giving more informationabout alcohol, Government will pilotinnovative approaches and feed themback into the school curriculumThe Blueprint programme is a researchprogramme designed to examine theeffectiveness of a multi-component approachto drug education. It differs from existingdrug education in that in addition to school-based activities the programme involvesparents, the community, the media andhealth policy work. It also uses normativeeducation techniques. The programme drawson worldwide evidence and adapts it to the
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English education system. It will be crucialthat the results of the Blueprint programmeinform future teaching practices in this area.
It will be equally important to address thelack of evidence relating to the effectivenessof interventions for children and youngpeople outside the classroom – in non-traditional settings such as youth centres andleisure facilities. As part of this, young peoplethemselves should be consulted on what ismost likely to make a difference.
Actions
8. By Q3/2007, the Department forEducation and Skills (in consultationwith the Department of Health andthe Home Office) will use the findingsof the Blueprint research programmeto ensure that future provision ofalcohol education in schools addressesattitudes and behaviour as well asproviding information.
9. This will be complemented by researchto review the evidence base for theeffectiveness of interventions onalcohol prevention for children andyoung people both inside and outsidethe school setting (including youthand leisure facilities). This researchshould be led by the Department ofHealth, in consultation with theDepartment for Education and Skills,the Department for Culture, Mediaand Sport, the Health DevelopmentAgency, and other appropriateresearch organisations. Research willbe completed by Q1/2005, andresults disseminated thereafter.
4.4 Alcohol misuse in theworkplace
Alcohol misuse leads to loss ofproductivity for the country and lossof employment opportunities for theindividualAlcohol misuse among employees costs up to£6.4bn in lost productivity through increasedabsenteeism, unemployment and prematuredeath. It can also lead to unemployment andloss of quality of life for individual problemdrinkers, who tend to stay in jobs for shorterperiods than employees who do not misusealcohol.
There is a clear framework on healthand safety, but less emphasis ongeneral awarenessThere is a clear framework in health andsafety law as well as in practices adopted byindividual businesses to ensure that alcoholdoes not cause accidents in the workplace.
However, as well as being a health and safetyissue, alcohol misuse is a major cause ofabsenteeism, and lost productivity andprofitability. Employers need to know how torecognise when an employee has an alcoholproblem and what actions to take andprocedures to follow. The Department ofHealth and the Health and Safety Executiverecommend that employers should have analcohol policy setting out signs to look forand procedures to follow. Whilst over half ofemployers do have an alcohol policy andthere are many examples of good practice(see Box 4.3), many of those who do not arelikely to be small businesses who couldbenefit from advice on what to do.
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Actions
‘Choosing Health? The Government’sconsultation on action to improve people’shealth’ will lead to a White Paper on PublicHealth issues later in the year. This willinvolve working with a number oforganisations within industry on how theycan improve employees’ health and theactions below will be taken in conjunctionwith the work on this White Paper.
10. The Department of Health will set upa website to provide advice on thewarning signs of alcohol misuse andhow to handle employees who appearto have an alcohol problem. This willbe established in consultation withthe Department of Trade andIndustry, the Health and SafetyExecutive, the Trades Unions Congress,the Confederation of British Industryand the Federation of SmallBusinesses. The site will also include alink to a directory of services forreferrals for extra help. This site willbe running by Q1/2005.
11. By Q3/2004, Home Office will extendthe scope of the National WorkplaceInitiative, which trains companyrepresentatives on handling drug usein the workplace, to include alcohol.
4.5 Advertising
Alcohol advertising should neithercondone nor encourage irresponsibledrinking behaviourThe UK alcoholic drinks industry spends over£200m per year on direct alcohol advertising(TV, radio, and print media). With thiscommercial right comes the responsibility toensure that advertising does not glamorise orcondone harmful drinking behaviour.
Current advertising regulation governingalcoholic drinks in the UK combines bothstatutory regulation and self-regulation.
In the UK, the advertising and marketing ofalcoholic products are subject to a frameworkof regulatory codes, some of which areregulated by statute and some by self-regulatory systems.
• Television and radio advertising isregulated by Ofcom. Regulation includesmandatory pre-clearance of advertisingbefore broadcast.
• Sales promotions and all advertisementsthat appear in print media are governedby a self-regulatory system, administeredby the Advertising Standards Authority(ASA). Since 1996, the Portman Group hasalso operated a voluntary code of practiceregulating the marketing of alcoholicdrinks.
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Box 4.3 – The Royal and Sun Alliance
The Royal and Sun Alliance’s Drug and Alcohol Policy, introduced from March 2000, involvedthe production of a Policy and Practice statement followed by the face to face training ofnearly 3000 managers and supervisors. The Royal & Sun Alliance also produced a video forother companies thinking about introducing a drug and alcohol policy.
All codes of practice, both statutory and self-regulatory, recognise the need for specialsensitivity to be taken in the treatment andportrayal of alcohol in advertisements. Theexisting codes prohibit approaches such asthe promotion of irresponsible consumption,the connection of alcohol with sexual andsocial success, and, in particular, advertisingbeing directed at or appealing to childrenand young people under 18. Anyoneassociated with drinking must be, and look,at least 25. Broadcasters breaching the TVand radio codes are obliged to withdraw theadvertisement, and may be required to paysubstantial fines.
Nevertheless, consultation on thestrategy revealed widespread concernthat some alcohol advertisementsbreach the spirit, if not the letter, ofthe TV advertising codeThe number of alcohol advertisementsattracting complaints in either broadcast ornon-broadcast media is very small. However,our consultation exercise showed increasingconcern at the way in which some TVadvertising appears to be in breach of thespirit, if not the letter, of existing codes. Thetypes of advertisements cited included those:
• condoning excessive drinking;
• linking alcohol with sexual and socialsuccess;
• encouraging irresponsible behaviour; and
• covertly targeting young people.
Given that young people may be especiallysusceptible to advertising, this latter issue isof particular concern. Evidence suggests thatthere is a link between young people’sawareness and appreciation of alcoholadvertising, and their propensity to drink
both now and in the future. However, thedirection of causality is ambiguous: it is notclear whether those who are predisposed todrink because of other influences areparticularly interested in alcohol advertising,or whether it is a particular interest in theadvertising which encourages their desire todrink.
The Government will also be looking morewidely at advertising and healthy choices aspart of its consultation on public health,which will lead to the publication of a WhitePaper later in 2004.
There is as yet no definitive proof ofthe effect of advertising on behaviourThere is no clear case on the effect ofadvertising on behaviour. One recent studysuggests that such an effect may exist, but iscontradicted by others which find no suchcase. So the evidence is not sufficientlystrong to suggest that measures such as aban on advertising or tightening existingrestrictions about scheduling should beimposed by regulation.
What does emerge clearly is that the currentsystem is not sufficiently tightly drawn upand enforced. On a precautionary basis, thereis a clear case for tightening existing rules onthe content of advertising. To work well:
• the existing codes need to set outunequivocally the issues which the rulesare designed to address but to be flexibleenough to allow the regulator to pursuethe public interest whatever new creativetechniques may emerge;
• the Code needs to be systematically andrigorously enforced by the BroadcastAdvertising Clearance Centre, whereadvertisements are “pre-cleared”,focussing not just on causing offence but
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more broadly on potential to condone orencourage misuse, taking account of allavailable relevant research; and
• the industry itself has to take a moreresponsible attitude to prove that self-regulation can be made to work effectively.
This responsibility has recently passed toOfcom.
Action
12. Ofcom will oversee a fundamentalreview of the code rules on alcoholadvertising and their enforcement.The review will focus in particular on:
i) ensuring that advertisements do nottarget under-18s, and tightening theprovisions if necessary;
ii) ensuring that advertisements donot encourage or celebrateirresponsible behaviour;
iii) the potential of advertisements toencourage alcohol misuse as well asthe simple potential to cause offence;and
iv) ensuring that, as part of its widerduty to publicise its remit, Ofcomensures publicity for the regulator’srole in relation to broadcastadvertising and complaints.
Ofcom will consult stakeholders andcomplete this review by Q4/2004.
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5. IDENTIFICATION AND TREATMENT
Summary
• A successful alcohol treatment programme requires:
- the identification and referral of people with alcohol problems;
- treatment tailored to differing individual needs and motivations, including support forfamilies where appropriate; and
- services that are effective in helping vulnerable and at-risk groups.
• There are a number of problems with the existing identification, referral and treatmentservices:
- alcohol problems are often not identified sufficiently early, leading to later financialand human costs;
- health service staff have low awareness of alcohol issues;
- there is little available information on demand for treatment, the provision of servicesto meet this demand, or for the current capacity of treatment services;
- the structure of alcohol treatment can vary widely, with no clear standards for, orpathways through, treatment; and
- procedures for referring vulnerable people between alcohol treatment and otherservices are often unclear.
• Government will improve the identification and referral of those with alcohol problems by:
- running pilot programmes to establish whether earlier identification and treatment ofthose with alcohol problems can improve health, lead to longer-term savings, and beembedded into mainstream health care provision; and
- raising health service staff awareness of alcohol misuse issues and improving theirability to deal with them.
• Government will aim to improve treatment by:
- conducting a national audit of alcohol treatment, including the provision of aftercare.This will establish levels of current provision and the extent of unmet demand, to formthe basis for improving services; and
- improving standards of treatment by introducing more co-ordinated arrangements forcommissioning and monitoring standards.
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This chapter considers the best way ofidentifying and treating those whohave established alcohol problemsthat may be affecting their health ortheir social functioning.
The previous chapter considered ways ofhelping people to identify problems withtheir drinking through education andcommunication. This chapter looks at whathealth and other services can do to helppeople identify and resolve these problems.
Effective treatment requires that:
• those with alcohol problems are identifiedand referred to the appropriate services;
• appropriate treatment is available; and
• treatment for vulnerable groups covers alltheir related needs and problems, andadequate aftercare is available.
Measures to better identify, treat and retainproblem drug users within the treatmentsystem have formed a central plank ofcurrent drugs policy. Current drugs policymeasures include using the criminal justicesystem to better identify and captureproblem drug users (testing those who havecommitted “trigger offences” and referringthem to treatment) and increasing treatmentcapacity and reducing waiting times fortreatment. An estimated 25% of drug usersmay also have an alcohol problem.12
The percentage of those abusing alcohol whoare likely to have a drugs problem is likely to
be much lower. The population of those whohave an alcohol problem is much broaderthan the population of problem drug users. A high proportion of high harm-causing drugusers (about 90%) will be committing anaverage (per individual) of approximately£90,000 worth of crime each per year tofund their habit (mainly a high volume of lowlevel, low impact crimes such as shop-liftingand stealing).13 Identification and capture ofthese high harm-causing drug users throughthe criminal justice system is thereforeappropriate. By contrast, the large majority ofthose abusing alcohol are unlikely to havecontact with the criminal justice system.
However, unlike in the area of drugs policythere has been little focus on how best toidentify and encourage those with alcoholproblems to move into treatment. Thissection therefore considers how best toidentify and treat problems with alcoholmisuse and consider whether there are anylessons to be learnt from drugs policy.
5.1 Identification and referralof those with alcoholproblems
Alcohol problems are not alwaysidentified and appropriate referral ortreatment does not always occurIdentification and treatment of an individual’salcohol problems can prevent and reduce the
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12 Interim Analytical Report, p.26.13 Brand, S. and Price, R. (2000), Home Office Research Study 217: The economic and social costs of crime, Home Office; and Bennett,T. and Sibbitt, R. (2000), Home Office RDS Directorate Research Findings 119: Drug Use Among Arrestees, Home Office.
• Government will improve services for vulnerable groups by:
- commissioning integrated care pathways for the most vulnerable, who often havemultiple problems: those with drug problems, mental illness, homeless people andyoung people.
human and social costs which can arisewhere serious problems with alcohol develop.
People with alcohol problems are likely tocome into contact with a range of publicinstitutions. These include:
• health services;
• social services;
• a variety of voluntary bodies – forexample, those offering alcohol advice andtreatment, as well as those offeringservices to vulnerable groups;
• the police and the criminal justice system;and
• schools and educational institutions.
Although people with alcohol problems canpresent at any point of the health service, orindeed though other public services, theirproblems may not be picked up for anumber of reasons including:
• the absence of a clear identificationprocess; and
• lack of staff training to enable them toidentify an underlying problem of alcoholmisuse or to know how to refer anindividual with a problem – there are oftenpressures on staff time and possible uneaseabout a problem which still carries astrong stigma.
The majority of alcohol misusers needinghelp are likely to see the health system astheir first port of call. They are much lesslikely than drug misusers to have a criminalrecord. What we set out below thereforefocuses in particular on the health system.But it recognises that those with alcoholproblems – or families affected by alcoholmisuse – can present in any part of thesystem and that procedures therefore need tobe in place more widely to ensure that theyare identified and referred to help.
Improving the identification process inthe health systemAccess points in the health system
The health service presents a variety of accesspoints for those with alcohol misuseproblems:
• many individuals and families will use theirlocal GP surgery or local primary healthcare clinic as the first port of call. It isestimated that each GP sees 364 heavydrinkers a year;
• A&E is another key route. Researchcommissioned by the SU suggested that40% of A&E admissions, rising to 70% atpeak times, are related to alcohol. Thereare examples of excellent practice inidentifying alcohol misuse by this route.For example, St Mary’s Hospital inPaddington applies a customisedquestionnaire to all entrants and refersthose with problems to an alcohol misuseworker;
• hospital inpatient and outpatient services(for example, in Cardiff, the briefinterventions are carried out in themaxillofacial clinic since many alcohol-related violent incidents result in injuries tothe face);
• mental health care services. Around a thirdof those with mental illness have substancemisuse problems and half of thoseattending drug and alcohol services havemental health problems; and
• ante-natal care.
All these points of access could provideopportunities to establish whether a patienthas an alcohol problem and to take action.
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Identifying the problem: screeningand brief interventionsThere are essentially two different types ofalcohol screening:
• Universal screening is the screening of allpatients in a GP surgery, clinic, outpatientdepartment or other setting. However,recent research has raised questions aboutthe value and effectiveness of universalscreening, which means that it is difficultto advance a sound case for this type ofscreening.
• Targeted screening involves screening onlythose people who may be drinking in aproblematic way. Under this system, onlythose people who present to the healthservice with symptoms and conditionswhich may be linked to problematicdrinking are screened – for example, apatient presenting to a GP surgery withpersistent stomach pains, or who is inhospital following a cardiac arrest.
Following screening, individuals may benefitfrom a “brief intervention”. There is nostandard definition of a brief intervention –interventions can range from a shortconversation with a doctor or nurse to anumber of sessions of motivationalinterviewing. But there are some elements
which are common to all brief interventions –the giving of information and advice,encouragement to the patient to considerthe positives and negatives of their drinkingbehaviour, and support and help to thepatient if they do decide that they want tocut down on their drinking. Briefinterventions are usually “opportunistic” –that is, they are administered to patients whohave not attended a consultation to discusstheir drinking.
For patients whose problems are not yet toosevere, brief interventions may be an effectiveapproach. For example, evidence shows thatdrinkers may reduce their consumption by asmuch as 20% as a result of a briefintervention.14 Equally, evidence shows thatheavy drinkers who receive an interventionare twice as likely to cut their alcoholconsumption as heavy drinkers who receiveno intervention.
However, the research evidence on briefinterventions draws heavily on small-scalestudies carried out outside the UK. Moreinformation is needed on the most effectivemethods of targeted screening and briefinterventions, and whether the successesshown in research studies can be replicatedwithin the health system in England.
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14 Babor, T. et al..(2003), Alcohol: No Ordinary Commodity – Research and Public Policy (O.U.P.)
Box 5.1 – Screening
• Screening is a method of identifying alcohol consumption at a level sufficiently high tocause concern. Screening can be carried out using a specially developed screening tool,usually a questionnaire.
• A number of screening questionnaires have been developed, but the most comprehensiveis felt to be the Alcohol Use Disorders Identification Test (known as the AUDIT) which wasdeveloped by the World Health Organisation.
• Screening does not need to involve a specific tool: it can also take the form of relevantquestions asked during the course of a consultation, e.g. at a GP surgery.
Actions
13. The Department of Health (DH) willstrengthen the emphasis on theimportance of early identification ofalcohol problems throughcommunications with doctors, nursesand other health care professionals.DH will do this with immediate effect.
14. The Department of Health will set upa number of pilot schemes byQ1/2005 to test how best to use avariety of models of targetedscreening and brief intervention inprimary and secondary healthcaresettings, focusing particularly onvalue for money and mainstreaming.
Staff training to identify and referthose with alcohol problemsAt present there is little training on alcoholissues for health professionals. Many healthprofessionals acknowledge that they needmore training, and studies indicate that somedo not feel adequately trained to deal withalcohol-related problems. Some doctorsreport receiving as little as one afternoon’straining on alcohol issues during the fiveyears of their undergraduate medicaleducation. This can lead to issues aroundbasic awareness of alcohol misuse, lack ofclarity on next steps and sometimesnervousness about opening up discussion.
However, there is no central requirement totrain on alcohol issues. Each medical schoolhas the leeway to make decisions about itsown curriculum. These are “quality-assured”by the General Medical Council (GMC) toensure that graduates can be registered withthe GMC as doctors. The GMC expectsmedical graduates to be aware of issues suchas alcohol misuse, but the attention that thissubject receives in medical curricula will vary.
Broadly similar arrangements exist for thetraining of nurses and other healthprofessionals. While the Department ofHealth has no responsibility for curriculumdecisions, it has a role to play in clarifying thevalue of this education to curriculum bodies.
Once health professionals are working in theNHS, their further development is usuallydriven by the needs of continuingprofessional development where the deliverymechanism is increasingly through appraisaland personal development planning. Forsome, like doctors in training, postgraduateeducation is undertaken against curriculadeveloped by medical Royal Colleges andapproved by the competent authorities. Inother cases, training will be offered againstprogrammes commissioned by, for example,workforce development confederations orlocal employers. The main avenue forprogress is through local health economiesworking with the NHSU (the corporateuniversity for the NHS), Skills for Health andthe higher education sector to producemodules and programmes which adequatelycover alcohol concerns.
Actions
15. The Deputy Chief Medical Officer forHealth Improvement and the ChiefNursing Officer will act as “trainingchampions” to raise the profile ofmedical and nurse training on alcoholissues, from Q3/2004.
16. The Department of Health will workwith medical and nursing colleges andother training bodies to developtraining modules on alcohol, coveringundergraduate, postgraduate andmedical curricula and updatedregularly, by Q3/2005.
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Identifying problems with alcohol inother servicesWe set out in the project’s interim analyticalreport the wide variety of “capture points”other than the health service for individualsand families affected by alcohol misuse.15
Problems can be picked up, for example:
• at pre-school care;
• at school, further education and highereducation institutions;
• by the Connexions service;
• in the workplace;
• by social services; and
• at any stage of the criminal justice system– police, courts, probation and prison.
In many of these areas procedures arealready in place:
• the Healthy Schools strategy lists alcohol asone of its ten priorities;
• the Connexions service has an assessmentframework which includes substancemisuse and which will be made mandatoryin April 2004; and
• Youth Offending Teams will share a targetwith the National Treatment Agency fromApril 2004 to ensure: that all young peopleare screened for substance misuse, andthat those with identified needs receiveappropriate specialist assessment within 5working days and – following assessment –access the early intervention and treatmentservices they require within 10 workingdays.
So there is a widespread recognition of theissues already. But it is important that basicawareness of the issue and where to referpeople for help is bedded into existing
services across the board. We set out inChapter 4 proposed measures for theworkplace, and in Chapter 6 how links mightbe made between the health and criminaljustice systems.
Action
17. From Q2/2004, the Department ofHealth will work with the HomeOffice, the Department for Educationand Skills and the National TreatmentAgency to develop guidance withinthe Models of Care framework on theidentification and appropriate referralof alcohol misusers.
5.2 Treatment
Different types of treatment are appropriatefor different types of individuals
Around £95m is spent each year onproviding treatment at around 475specialised alcohol treatment services inEngland. The majority of these are funded bythe NHS, but run by voluntary organisations.However, this is a small fraction of the£1.7bn the NHS spends on dealing withalcohol-related illness.
The effectiveness of treatment is dependenton degree of motivation and type ofproblem, but no one single treatment can besingled out as more effective. Differentindividuals will respond to different types oftreatment. Treatments need to be tailored toan individual’s circumstances, needs andmotivation, and include:
• Community structured counselling,including motivational therapy, coping /social skills training, behavioural self-control training, marital / family therapy.
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15 Interim Analytical Report, p.140.
• Community detoxification, usuallytakes place in the home, with the supportof a GP, nurse or alcohol treatment worker.
• Specialised residential services – forclients who are not able to receive or notsuitable to receive community basedtreatment.
• Self-help groups such as AlcoholicsAnonymous.
The Models of Care work will incorporate areview of the appropriateness andeffectiveness of different types of treatment,to inform commissioners and serviceproviders.
There has been little focus on alcoholtreatment
In the area of drugs policy an extensiveamount of work is going on to form a betterpicture of the relationship between demandand supply of treatment places at both alocal and a national level. By contrast, in thearea of alcohol policy, there is:
• no national or local picture of the amountof demand for alcohol treatment or thenumber and type of treatment placesavailable;
• there are no comprehensive standards inthe treatment field for access, types oftreatment or aftercare; and
• no system to allow for the consistent andcoherent commissioning of alcoholtreatment services.
There is little information on theextent to which existing levels ofprovision of alcohol treatment servicesmeet demandAs with drugs, alcohol services have been setup and funded on a historical basis ratherthan in a way designed to meet need. As aresult there is a patchwork of provisionrelying heavily on the voluntary sector.Providers draw funding from a confusingvariety of sources, with a risk of conflictingaccountabilities. In the area of drugs policy aconcerted effort is currently being made toensure that local treatment demand can bemet. The same is not true in the area ofalcohol policy.
As a result there is very little information onthe demand for, or provision of, alcoholtreatment services. No information iscollected on:
• the numbers of people entering treatmenteach year;
• the proportion of successful outcomes;
• the length of waiting times;
• the extent to which the treatments offeredmeet the individual’s need for treatment,aftercare and other support;
• how many times individuals pass throughthe system;
• how levels of provision meet need locallyas well as nationally;
• the involvement of families in treatment;and
• whether some groups find access toservices particularly difficult.
However, there is some evidence to suggestthat there is more demand for treatmentthan currently provided.16 There is a clear
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16 See, for example, Turning Point (2003), Waiting for Change: Treatment Delays and the Damage to Drinkers.
perception amongst providers that alcoholreceives a low priority and needs moreresources.
There are no comprehensive standardsIn the area of drugs policy there has alsobeen considerable work to develop measuresof standards and effectiveness of treatment.By contrast, in the area of alcohol policythere is no clear statement of the type ofalcohol treatment services to be provided, ofcare pathways or of standards, althoughthere is much excellent practice – forexample, the Drugs and Alcohol NationalOccupation Standards (DANOS), whichspecify the standards of performance towhich people in the drugs and alcohol fieldshould be working.
There is no system to allow forcoherent or consistent commissioningFor drugs, structures and funding have beenput in place to secure greater consistency inthe way in which treatment is commissioned.By contrast, there is currently littleconsistency in the way alcohol treatment iscommissioned. Providers receive fundingfrom a wide range of sources to cover oneservice. Discussions with practitioners suggestthat there is sometimes uncertainty as towhich funds (if any at all) can be used foralcohol services, and that such services areperceived as low priority.
Actions
Better information on services to inform futureprovision
18. The Department of Health willconduct an audit of the demand forand provision of alcohol treatment inEngland by Q1/2005. The audit willprovide information on gaps between
demand and provision of treatmentservices and will be used as a basis forthe Department of Health to developa programme of improvement totreatment services.
Clear standards
19. The National Treatment Agency (NTA)will draw up a “Models of Careframework” for alcohol treatmentservices, drawing on the alcoholelement of the existing Models of Careframework. It would look to theCommission for Healthcare Audit andInspection (CHAI) to monitor thequality of treatment services subjectto the formulation of suitable criteriaand CHAI's workload capability.
Coherent commissioning
20. From Q2/2004, remaining DrugAction Teams will be encouraged tobecome Drug and Alcohol ActionTeams (or other local partnershiparrangements) to assume greaterresponsibility in commissioning anddelivering alcohol treatment services;though their capacity to do so willhave to be carefully considered.
5.3 Treatment and aftercarefor vulnerable groups
There is a risk that alcohol treatmentfor vulnerable groups might fail dueto lack of co-ordination of treatmentsand servicesSome people have complex needs of whichalcohol is only one. For example:
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• around a third of psychiatric patients witha serious mental illness also have asubstance misuse problem;
• around half of rough sleepers are alcohol-reliant, and many other homeless people –such as those in hostels – have problemswith alcohol;
• an estimated 25% of drug misusers alsomisuse alcohol; and
• some young people have complexmultiple needs.
Offenders are disproportionately representedin these groups. We return to their needs inChapter 6.
Alcohol misusers with multiple problems canaccess treatment and support services via anumber of different routes. However, thereare not always procedures for identifying thepresence of alcohol problems or referringclients from one service to another. Evenwithin the substance misuse field there is noagreed protocol, for example, that a clientwith drug and alcohol problems attending adrug and alcohol treatment service for drugtreatment will necessarily receive treatmentfor both their drug and alcohol problems.
This has two consequences. It means,crucially, that very vulnerable people do notget help. It also means that resourcesinvested by one service may be less effectivebecause of the lack of follow-up. Forexample, there is little point providingdetoxification treatment for a homelessperson with a chaotic lifestyle if he or shedoes not continue to receive support to findand/or sustain accommodation.
We are aware that there is an associationbetween alcohol problems and mental illhealth, which often causes concern forcommissioners as well as providers ofservices. To help address this concern the
Department of Health published a “DualDiagnosis Good Practice Guide” in May2002.
The guidance summarises current policy andgood practice in the provision of mentalhealth services to people with severe mentalhealth problems and problematic substancemisuse. The substances concerned include alltypes of substances whether licit or illicit.Crucially, it includes alcohol and othersubstances which may be purchased legally,such as solvents, as well as illegal drugsincluding opiates, stimulants and cannabis.
The guidance provides a framework withinwhich staff can strengthen services so thatthey have the skills and organisation to tacklethis area of work. It also recognises thatmental health services must also work closelywith specialist substance misuse services toensure that care is well co-ordinated. Inaddition, the guidance highlights someexamples of excellent practice in NHSservices.
Around half of rough sleepers are dependenton alcohol: often they will drink on the streetand may disturb members of the public.Local authority homelessness strategies havea role to play for those street drinkers whoare homeless.
Facilities already exist for some street drinkers– during the day, wet centres provide safeand sheltered provision for many suchdrinkers, providing support and adviceincluding on housing. Over night, places areavailable in night shelters and hostels.
There are a number of examples of goodpractice in helping street drinkers, particularlythose who are also homeless. The Office ofthe Deputy Prime Minister’s Homelessnessand Housing Support Directorate and theKing’s Fund have co-funded a review of the
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function and impact of existing wet centres,and a guidance manual for setting up andrunning new facilities.17 The review studiedfour wet centres in detail, including theBooth Centre in Manchester (Box 5.2). Wetcentres allow people to consume alcohol ontheir premises, and some local authorities areconsidering starting up such centres in aneffort to curb street drinking and providemore targeted resources for drinkers.
On 1 April 2003, the Office of the DeputyPrime Minister launched the ‘SupportingPeople’ programme, which offers vulnerablepeople, including those with alcohol-relatedproblems, the opportunity to improve theirquality of life by providing a stableenvironment which enables greaterindependence. The programme aims todeliver high quality and strategically plannedhousing-related support services which arecost effective and reliable, and complementexisting care services. Supporting Peoplecommissioning bodies have been set up ineach administering authority area to take astrategic view of the provision of housing-related support in their areas and bringtogether the local authority (both the countyand district councils in two-tieradministrations), Primary Care Trusts andlocal probation services.
Supporting People Administering Authoritiesacross England have been allocatedapproximately £19.6m for 2004/05 to helpvulnerable people with alcohol problems.Supporting People can provide the means tothose with alcohol-related problems to settlein a new home and sustain a tenancy or stayin one place long enough to benefit fromtraining, counselling and other support topromote independence and stability.
Action
21. From Q2/2004, the Department ofHealth will work with the HomeOffice, the Department for Educationand Skills, the Office of the DeputyPrime Minister and the NationalTreatment Agency to developguidance within the Models of Careframework on integrated carepathways for people in vulnerablecircumstances, such as people withmental illness, rough sleepers, drugusers and some young people.
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17 See www.kingsfund.org.uk/grants
Box 5.2 – The Booth Centre (Manchester)
The Booth Centre has been operating as a drop-in and activity centre for homeless peoplesince May 1995. The Centre’s activity programme provides a range of education, training,creative arts, sports and outdoor activities designed to help people find an alternative tohomelessness and street drinking. The Centre’s garden provides a supervised environmentwhere people can drink twice a week during the drop-in sessions. Through regular support,advice and encouragement, the Centre achieves great success in helping street drinkers tofind and maintain suitable accommodation and to start tackling the problems which theirdrinking causes.
6: ALCOHOL-RELATED CRIME AND DISORDER
Summary
• Alcohol misuse is a major contributor to crime, disorder and anti-social behaviour, withalcohol-related crime costing society up to £7.3bn per annum.
• The most visible areas of concern for most people include:
- alcohol-related disorder and anti-social behaviour in towns and cities at night; and
- under-age drinking.
• Less visible but equally significant concerns are:
- crime, disorder and anti-social behaviour – often caused by repeat offenders;
- domestic violence; and
- drink-driving.
• Government will reduce the problems caused by drinking in town and city centres byclearly defining the shared responsibilities of individuals, the alcoholic drinks industryand the Government. This will require:
- making greater use of existing legislation and penalties to combat anti-socialbehaviour – for example, greater use of Fixed Penalty Notices;
- working with the alcohol industry to manage and deal with the consequence of townand city centre drinking, by agreeing a new code of good practice and the jointfunding of local initiatives; and
- encouraging local authorities more actively to tackle problems where they occur.
• Government will tackle under-age drinking by:
- greater enforcement of existing laws not to sell alcohol to under-18s;
- improving the information about the dangers of alcohol misuse available to youngpeople; and
- encouraging provision of more alternative activities for young people.
• Government will tackle alcohol-related repeat offending by further piloting of arrest-referral schemes and exploring the effectiveness of diversion schemes.
• Government will seek better identification of alcohol problems and referral to alcoholservices as part of existing measures on domestic violence.
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Alcohol-related crime is amajor issue
Alcohol misuse is closely linked with a widerange of crimes, disorders and anti-socialbehaviours. It is not necessarily a direct causeof those crimes: there are a variety of factorsinvolved, such as surrounding environmentand circumstance. Often though, alcohol willbe a contributory factor.
The costs of alcohol misuse for crime anddisorder outweigh those for any other harmidentified. We estimate the costs of alcohol-related crime to be up to £7.3bn.18
The remainder of this chapter focuses on thecurrent major challenges for government thatwe have identified in terms of alcohol-relatedcrime, disorder and anti-social behaviour.Public perception is that two issues are ofparticular concern:
• alcohol-related disorder and anti-socialbehaviour in towns and cities at night; and
• reducing levels of under-age drinking.
However, we also focus on three other areaswhich are less publicly visible but equallyimportant:
• managing repeat offenders of alcohol-related crime;
• alcohol and domestic violence; and
• drink-driving.
In some of these areas, strategies alreadyexist – such as those on anti-social behaviourand for supporting victims – and arecomplemented by this strategy.
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18 Interim Analytical Report, p.68.19 Interim Analytical Report, p.69.
• Drink-driving measures appear to have worked well but there is some evidence thatdrink-driving may be increasing amongst some groups (e.g. young men). Governmentwill, therefore, closely monitor the trends to assess whether additional action is needed.
6.1 Crime, disorder and anti-social behaviour in towns andcities at night
City and town centre evening life (the ‘nighttime economy’) has burgeoned over the last10 years, often directly linked to urbanregeneration. This has had many positiveeffects in terms of energising localeconomies, raising business rates andimproving consumer choice. Where night-time economies are well managed, withconstructive support from the alcoholicdrinks industry, everyone wins: consumers areencouraged to come into town centres andbusinesses and local economies flourish.
But alcohol-related violence and disorder area highly visible part of the night-timeeconomy. This is a phenomenon no longerconfined to weekends. The British CrimeSurvey shows that 33% of stranger and 25%of acquaintance alcohol-related assaultshappen on weekday evenings/nights. Ourconsultation suggested that it is increasinglyspreading out to suburbs. Particularly evident– though not necessarily reflective of thepopulation as a whole – is a culture of goingout to get drunk (see Box 4.1).
The effects are widely apparent and have animpact on large numbers of people in avariety of ways:
• Through violence, assault and disorder. In1999, there were an estimated 1.2mincidents of alcohol-related violence. Morethan half of those arrested for breach ofthe peace and nearly half of those arrestedfor criminal damage have been drinking.19
Heavy drinking raises the risk of sexualassault: one UK study found that 58% ofrapists reported drinking beforehand.20
Many victims of alcohol-related violencemay also have been drinking, and oftenshare similar profiles to offenders.21
• Through the impact on the urbaninfrastructure. The direct effects are brokenglass, noise, litter from late-night fast-foodoutlets and, on occasion, human waste.Street drinking can be perceived asintimidating by others.
The growth of the night-time economy canbring significant economic and socialbenefits. At the same time, however, it canalso create major costs for the tax payer interms of additional policing required, criminaljustice system costs, the costs of tidying upcity centres and accident and emergencycosts. Resources may also be skewed topolicing the night-time economy with knock-on effects for policing elsewhere.
It also directly undermines the Government’sstrategy of encouraging a more diverseeconomy in town and city centres. Sixty-oneper cent of the population think that alcohol-related violence on the streets is increasing,whilst 43% of women and 38% of men seedrinking on the street as a problem.22 Manypeople are therefore less, rather than more,likely to want to spend more time in citycentres perceived as violent and dominatedby alcohol.
Many factors fuel this cultureCulture changes over time. Findings from ourconsultation exercise suggested that drinkingat lunchtime is now less acceptable. Drink-driving has become completely unacceptableto the vast majority of the population. Bycontrast, low-level alcohol-related crime anddisorder have become – in public perception
at least – a dominant theme in town and citycentres.
Alcohol-related violence and disorder arefuelled by three main factors:
• Individual reactions. Alcohol impairscognitive and motor skills. Drunk peopleare therefore more likely to misreadsituations, react aggressively, and haveaccidents. The decision to get drunk isfuelled by a wide range of factors – forexample price, availability, accepted socialnorms, fashion and perception of risk. Inthe culture of drinking to get drunk, whichoften sets the tone for the night-timeeconomy, the norms differ from usualbehaviour – noisy behaviour may beexpected and aggressive behaviourtolerated, with drunkenness used as anexcuse. Where there is little social control,such behaviour is likely to increase.
• The supply of alcohol. There is evidencethat a number of factors around thesupply of alcohol are likely to raise the riskof disorder. Premises where there is littleseating, loud music, large numbers ofyoung customers, poorly-trained staff andexcessively cheap promotions areparticularly likely to fuel disorder andviolence. The effects can becomeparticularly apparent where there is a highdensity of premises. Conversely, solutionsinvolving the industry such as ‘Pubwatch’schemes or those helping to police late-night transport work well because theytarget the problems at source and useexisting expertise.
• The surrounding infrastructure. Atnight, fights and disputes occur overscarce infrastructure such as food outletsand transport e.g. queuing for taxis orbuses. These problems are worse wherepremises all close at the same time and
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20 Interim Analytical Report, p.62.21 Interim Analytical Report, p.60.22 Interim Analytical Report, p.53.
there is no supervision from authorityfigures. The Licensing Act 2003 has beendesigned to tackle this.
There is, therefore, a shared responsibility formanaging the problems generated by thenight-time economy:
• individuals need to take moreresponsibility for the consequences of theirdrinking decisions;
• the alcoholic drinks industry needs to takemore responsibility for preventing andtackling the harmful effects of alcoholmisuse not only inside but outsidepremises; and
• the statutory authorities need to managethe infrastructure and consequencesactively.
All of this plays out directly in communitiesand neighbourhoods. For example, aresidential area can be transformed, notalways to the advantage of residents, by thegrant of a late licence. So communities needto able to influence the agenda actively.
The key to managing the night-timeeconomy lies in the effective joining-up of resourcesIn some areas the co-ordination of tools tomanage the night-time economy is alreadyhappening and is yielding results (see Box6.1). But overall there are varying degrees ofawareness of the problem, of the approacheswhich can be brought to bear and of theresults which can be achieved.
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Box 6.1: The Manchester Citysafe Scheme
When the centre of Manchester was rebuilt after the bombing of the Arndale Centre, thedevelopment of a vibrant night-time economy was a key result. However the increase inlicensed capacity was accompanied by an increase in assaults. The Manchester Citysafescheme was therefore set up to co-ordinate approaches and actively manage the economy.The scheme:
• Targets individuals with a variety of messages through posters, or on litter bins, forexample, reminding them of the need to drink safely. It enforces penalties on anti-socialbehaviour so as to achieve maximum deterrent effect.
• Works with the industry to ensure good practice. Establishments which fall short are placedon a “top 10” list and attract close police attention.
• Brings together a range of statutory authorities to ensure effective management of thenight-time infrastructure. For example, transport may be secured through the supportingof a late-night bus service with CCTV and supervised bus loaders, as well as throughtackling unlicensed taxis and patrolling taxi ranks. Statutory authorities work alongside thepolice to ensure that all aspects of the night-time economy are actively managed.
• As a result, the rising trend of late night disorder was reduced by 8.5% in the first year and12.3% in the second.
As the example above shows, a strategicapproach to managing the night-timeeconomy incorporates three key principles:
• individual responsibility: individuals areresponsible for making choices about theirbehaviour in an informed way, andresponsible for the consequences of thosechoices;
• responsibility of the alcoholic drinksindustry: local establishments areresponsible for giving accurateinformation, minimising the harm causedby alcohol misuse and working with localagencies to help tackle the consequences;and
• Government responsibility: Government isresponsible for ensuring that information isprovided, for protecting individuals andcommunities from harm caused by thebehaviour of others, and for ensuring a fairbalance between the interests ofstakeholders.
Individual responsibility for choicesand consequencesTo make choices individuals need accurateinformation. As we explain in Chapter 4,individuals already receive information aboutdrinking from a variety of sources: theGovernment’s sensible drinking message, unitlabelling on bottles, and material producedby the Portman Group. This is supplementedby various local information campaigns: forexample, the West Midlands Police haveproduced a series of posters depicting theconsequences of heavy drinking. However,the overall impact is stronger in some areasthan others.
The consequences of failing to behaveresponsibly are already dealt with in anumber of ways:
• under the 1902 Licensing Act anyindividual who has been convicted ofoffences related to drunkenness threetimes within the preceding twelve monthscan be banned by the courts from buyingalcohol from any licensed premise forthree years;
• it is an offence to be drunk and disorderlyand/or drunk and incapable;
• Acceptable Behaviour Contracts engageindividuals in recognising the negativeimpact of their anti-social behaviour onother people and in agreeing to change it.Although they are informal and voluntary,breach may result in an application for anAnti-Social Behaviour Order or other legalaction; and
• Anti-Social Behaviour Orders are civilorders which aim to protect thecommunity from behaviour which causesor is likely to cause harassment, alarm ordistress to others, and can be clearly linkedto alcohol misuse. For example, they canprevent an individual associating withother people with whom they commitanti-social behaviour. Breach is a criminaloffence with a maximum penalty of fiveyears imprisonment and/or a fine.
Enforcement of legislation on drunk anddisorderly behaviour has dropped sharplyover the last 10 years. This reflects not onlyfalling priority but also, crucially, the sheerpracticalities of policing large numbers ofdrunk people. Arresting someone for drunkand disorderly behaviour and taking them tothe custody suite can take two hours or more– during which the officer is effectively offthe streets. If charged and convicted, averagefines are around £100. The introduction of
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Fixed Penalty Notices means that enforcinglegislation on drunk and disorderly behaviourwill be easier.
Government should consult with the policeon how best to:
• raise the priority given to dealing withalcohol-related crime and disorder. Themeasures outlined in the strategy and theprovisions in the Licensing Act aredesigned to reduce problems, freeing uppolice time to pre-empt trouble spots andmake more use of deterrent policing; and
• ensure that officers are fully aware ofcurrent powers, on how and when tobring prosecutions and on seeking andmaking a case for reviewing existinglicences and objecting to new ones whereappropriate.
The Home Office Police Standards Unit (PSU)is developing a programme to reduceviolence in the key violent crime areas inEngland and Wales, with particular emphasison alcohol-related violent crime. As withstreet and gun crime, such violent crime canbe concentrated in a few localities. Researchsuggests that a relatively small number ofareas with boundaries that overlap cause, orare responsible for, a disproportionateamount of violence and serious violent crime.Focusing resources in these areas couldtherefore help to reduce alcohol-relatedviolent crime.
The PSU will produce a “good practiceguide” by the end of April 2004 drawn fromcurrent experience of what has worked so farthat is helping to tackle alcohol-relatedcrime. Additional tactics will also bedeveloped with the key stakeholders at thenational level, once research has got behindthe data, to establish the emerging trendsand key themes for intervention, preventionand enforcement. These tactics will include
targeted interventions against thoseresponsible for the proliferation of the under-age and high-volume drinking cultures whichresult in so much of our violent crime. Theaim will also be to encourage the inclusion ofCommunity Support Officers (CSOs),neighbourhood and street wardens, in thekey areas to support community-basedinitiatives.
Key to the success of any enforcementelements of a strategy will be addressing the“drinking culture” which exists. A mainelement of the enforcement strategy will beto engage upon a concerted marketingcampaign and re-enforcing key messages toall major stakeholders that operating outsidethe law will not be tolerated, particularlywhere juveniles and young-people areconcerned. Those who do so should beprepared for sustained, highly pro-activeenforcement of current and new legislation.The message will be clear that those who arenot prepared to “self-police” and contributeto changing the present high-volume andbinge-drinking culture should be preparedfor a strong response not only from thepolice but also those other responsibleenforcement agencies.
Only a concerted partnership approach willachieve the success which communitiesdemand. Police forces and their partneragencies will need to be pro-active inenforcement, intervention and preventionand provide assessments on enforcementactivity on a regular basis to show whatenforcement results have achieved and whatsuccess looks like; what actions have takenplace, with what result relating to arrests andactions against irresponsible stakeholders andhow they manage their business.
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Actions
22. The Home Office will consult and workwith the police and the courts onenforcing the law more tightly onthose who offend, from Q2/2004. Wewill:
i) encourage greater use of FixedPenalty Notices (FPNs) to clamp downon low-level drunk and disorderlybehaviour such as noise and urinatingin public;
ii) encourage greater use of FixedPenalty Notices for a wider range ofoffences, such as littering, and for barand retail staff found to have soldalcohol to those already drunk;
iii) encourage full use ofpreventative/prohibitive measuressuch as Acceptable BehaviourContracts and applications for Anti-Social Behaviour Orders inappropriate cases to tackleunacceptable behaviour;
iv) use conditional cautions, onceintroduced, as a basis for directlytargeting the offence – linked to anagreement not to frequent local pubs;
v) look at making more use ofaccreditation schemes for non-policestaff introduced under the PoliceReform Act 2002. These can improveco-ordination and information sharingwith the police and, whereappropriate, suitable people can beaccredited to use a limited range ofpolice powers – for example, doorsupervisors, who will be licensed bythe Security Industry Authority, couldalso be accredited by the police; and
vi) encourage police forces to makegreater use of Community SupportOfficers at night (as well as during the
day) where appropriate, and consultstakeholders on extending theirpowers to enforce licensing offences.
23. Through the Police Standards Unit theHome Office will:
i) develop a programme to reduceviolence in the key violent crime areasin England and Wales with particularemphasis on alcohol-related violentcrime, by Q4/2004 ;
ii) identify and spread good practicein local policing strategies and tacticswhich tackle alcohol-related violence,by Q2/2004; and
iii) contribute to a concertedmarketing campaign and re-enforcingkey messages to all majorstakeholders that operating outsidethe law will not be tolerated,particularly where juveniles andyoung-people are concerned, byQ4/2004.
24. The Home Office will establish a smallworking group, includingrepresentatives from outsideGovernment, to look at whether anyadditional measures are required toeffectively clamp down on thoseresponsible for alcohol-fuelleddisorder, particularly in city centres.This group will include representativesfrom the police and organisationswith an interest and will report byQ2/2004 whether any additionaltargeted measures may be required.
Industry responsibility for preventingand tackling harmThere is already some voluntary goodpractice: the Portman Group’s initiatives ondrunkenness, the British Beer and PubAssociation’s (BBPA) code on irresponsible
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promotions and their work with Crime andDisorder Reduction Partnerships, and theSafer by Design scheme. Where these areadopted they work well. However, examplessuch as these are isolated initiatives ratherthan universal good practice.
The industry also has statutory obligations.Under the 1964 Licensing Act it is a criminaloffence to sell either to drunks or under-18s,and to allow a drunk to be on the premises;these provisions have been carried forwardinto the Licensing Act 2003, and theprovisions on sales to under-18s tightened toplace test purchasing on a statutory footing.
However, our consultation exercise suggestedthat more needs to be done. We thereforepropose a two-part scheme to help:
• minimise and prevent harm through acode of good practice; and
• tackle the consequences through afinancial contribution from the industrylocally.
Part 1: A code of good practice
All retailers of alcohol, on and off licence,would be strongly encouraged to sign up tothis code and would receive accreditation.We envisage that the code of good practicemight include:
• a commitment to seek a passport, drivinglicence or other form of identification (forexample, through the industry-led PASSaccreditation scheme) as proof of age, andto display prominently information thatunder-18s will not be served;
• a commitment to undertake “testpurchasing” to ensure that retailers are notserving under-18s or allowing drunks onthe premises;
• display of information about responsibledrinking including unit levels, the sensibledrinking message and the risks of drink-driving;
• clear and prominent sign-up to a‘designated driver scheme’ (wherebypeople are encouraged to designate adriver for the evening who will not drink);
• an agreement that all bar staff will have aminimum level of training on managingalcohol misuse: although qualifications doexist the take-up is very low, which reflectsthe fast turnover of staff. Businesses mightfor example band together to buy intraining. This will complement thelicensing of door staff from March 2004,which will be piloted in Hampshire and theIsle of Wight;
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Box 6.2: Managing the Consequences of the Night-Time Economy
Example 1: Getting home safely
In Wolverhampton, door supervisors help to police bus routes home from clubs, preventingdisorder and ensuring clubbers return home in safety.
Example 2: Preventing trouble before it occurs
In York, the Pubwatch scheme has been running for 10 years. Justices require all licensees tooperate the scheme. Both licensees and police carry a pager, which allows transmission ofinformation about troublemakers in less than a minute. Community Support Officers in Yorkare now to be issued with video cameras to help crack down on disorder and violence.
• abiding by the existing British Beer andPubs Association code on irresponsiblepromotions, with a commitment not tosell drinks at unsustainably low prices or toencourage high levels of irresponsibleconsumption (for example, “all you candrink for £10”);
• a commitment to provide reasonablypriced soft drinks and to make free wateravailable on all bars. A start has alreadybeen made by the requirement imposedby the Department of Trade and Industryto display prices of all soft drinks;
• designing premises to minimise the risk ofharm and disorder, for example by usingthe “Safer by Design” scheme;
• use of safer forms of glass. As there is noclear consensus, we propose asking aworking group of industry representatives,police and doctors to make a definitiverecommendation which would then formthe industry standard; and
• where such schemes exist, agreement tojoin radio/text pager schemes linked to thepolice.
The code would be drawn up jointly byGovernment and industry. Both its use andcontent could be tailored to localcircumstances: we envisage the localauthority taking the lead in this processconsulting with partners through the Crimeand Disorder Reduction Partnership, theindustry and the local community. Adherenceto the code could be taken into accountwhen there is an official complaint against apremises and license removal is beingconsidered. Take-up of the code would beassessed as part of the proposed review ofthe scheme early in the next parliament.
Part 2: A financial contribution fromthe industry towards managing thecrime and disorder consequences ofalcohol misuse, where necessary
Depending on the outcome of the proposedconsultation process, a financial contributiontowards the costs of alcohol misuse may berequired. This contribution would be paidinto a local fund, which would be collectedand managed by local authorities, withcouncils at an individual authority levelcovering their costs through contributionsreceived. It would be for Crime and DisorderReduction Partnerships and, importantly, forthe local community to decide how the fundwould be used to target and tackle alcoholmisuse, particularly that which is associatedwith the night-time economy.
The money would be used to tackle some ofthe costs of alcohol misuse and therebyattract a wider variety of customers into towncentres. For example, the fund might beused to pay for additional CommunitySupport Officers, additional cleaning,additional bus services, or for setting up aPubwatch scheme. The exact use woulddepend on local priorities, in the context ofSection 17 of the Crime and Disorder Act1998, but the fund would provide additionalhelp and not replace existing services ormeasures. The mechanism might also varydepending on local needs: for example, aBusiness Improvement District might beappropriate for improving infrastructure insome areas. Administration costs would bemet from the fund itself.
This fund would be complemented by thework that is underway to establish a VictimsFund. The proposed Victims Fund will ensurethat victims can access a variety of supportservices tailored to their needs by puttingmore money into services such as practical
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support, information and advice to victims ofrape and sexual offences, road traffic incidentvictims, and those who have been bereavedby crime.
The operational details of the scheme(including the conditions of the code ofpractice, the scale and scope of the financialcontribution and the need to fund authoritiesfully for the additional responsibilities theyface) will be developed in consultation withthe industry, councils and the localcommunity. In light of local priorities, localauthorities will be responsible for decidingwhether and, if so, where the scheme shouldoperate.
Criteria for assessing the effectiveness of thescheme will be developed as part of theconsultation process. However, successmeasures should include: the number ofretailers participating in the scheme, the sizeof the fund created, the range of activitiesfunded, and the effectiveness of theseactivities in reducing alcohol-related harm.
Action
25. Government will consult with theindustry on the introduction of a two-part voluntary social responsibilityscheme for alcohol retailers. This will(i) strengthen industry focus on goodpractice and, (ii) where necessary, seeka financial contribution from theindustry towards the harms caused byexcessive drinking. The scheme will bevoluntary in the first instance andshould be established in participatingareas by Q1/2005.
The success of the voluntary approachwill be reviewed early in the nextparliament. If industry actions are notbeginning to make an impact inreducing harms, Government will
assess the case for additional steps,including possibly legislation.
Statutory responsibility: balancing theinterests of stakeholders andproviding a clear strategic framework
Local authorities have a duty under Section17 of the Crime and Disorder Act 1998 toconsider the implications for crime anddisorder in policy and decision-making acrosstheir full range of services and do all theyreasonably can to prevent crime and disorderin their area. They have a variety of tools attheir disposal for setting a strategicframework to manage the night-timeeconomy:
• planning law and policy;
• licensing law;
• better security inside premises through theestablishment of the Security IndustryAuthority;
• existing provision on litter and noise; and
• transport policy.
Planning law and policy
• Developers and local planning authoritiescan make agreements under Section 106of the Town and Country Planning Act1990 to deal with the impacts of adevelopment. This takes the form of anegotiated agreement, but the Office ofthe Deputy Prime Minister is currentlyproposing a new approach to improvespeed and certainty, which would offer theoption of either a planning charge or anegotiation.
• Changes have already been announced tothe Town and Country Planning UseClasses Order to ensure that any proposalto change use of an existing building intoa pub or bar has to apply for planningpermission: this will make it harder, for
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example, for a restaurant to change to abar without seeking permission first, andwill allow the presence of other outlets tobe taken into account.
• Under Section 17 of the Crime andDisorder Act 1998 the local planningauthority must have regard to the likelyeffect on crime and disorder in its areawhen determining a planning application.They must also consider whether theproposal could be amended or planningconditions imposed to contribute to theprevention of crime and disorder. It is important that full use is made of this power.
• The joint Home Office and Office of theDeputy Prime Minister guidelines onplanning out crime, “Safer Places: ThePlanning System and Crime Prevention”,recognise that planning should aspire tomake places better for people and deliverdevelopment which is sustainable. The
guidelines are intended to make designers,planners and planning authorities thinkmore about designing crime and disorderresistance into new developments, and towork with the police to this end. They arenot prescriptive – crime and disorder issuesvary and there are, therefore, no universalsolutions. An example of how planning outcrime can work is the series ofimprovements to Stroud town centre (seeBox 6.3).
Licensing law
• The new licensing regime under theLicensing Act 2003 sets four key licensingobjectives:
- prevention of crime and disorder;
- prevention of public nuisance;
- public safety; and
- prevention of harm to children.
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Box 6.3: Improvements to Stroud Town Centre
Stroud has a pleasant town centre that has suffered from high levels of crime and anti-socialbehaviour. In particular, there have been problems associated with street drinking, begging,drug addiction and shoplifting.
A holistic approach to planning out crime has been taken in Stroud, including:
• public realm improvements incorporating the redevelopment of the town square,maintaining the cleanliness of the town centre, sign-posting and permanent public art;
• efforts to increase activity in the town centre: events, a farmers market, living over the shopand reusing derelict buildings;
• building the identity of the town centre by promoting its civic design strengths and‘theming’ quarters with locally-relevant motifs. A database of local artists exists for publicart projects;
• installing CCTV, controlled by a central office and connected to a police radio system. Inorder to reduce negative visual impact, cameras are housed in small domes; and
• good quality street lighting.
• The duty to promote the four licensingobjectives falls on anyone carrying out anyfunction under the Act. This includes notonly personal and premises licence holdersand holders of club premises certificates,but also, for example, licensing authorities,the police and environmental healthofficers.
• The Licensing Act includes provisions forlicensing authorities to take into accountprovisions on local saturation whenconsidering applications for licences.
• The removal of fixed closing hours isdesigned to encourage later closing timesin order to lengthen the period of timeduring which customers leave licensedpremises, thereby reducing the largeconcentrations at fixed, early closing timeswhich actively provoke disorder andnuisance.
• The Act significantly expands existingpolice powers to close down instantly forup to 24 hours, pubs, nightclubs, hotelsand restaurants that are disorderly, likely tobe disorderly or from which noise nuisanceis emanating – to include licensedpremises of all kinds and temporaryevents.
• The Licensing Act tightens the law on thesale of alcohol to minors and places testpurchasing on a statutory footing.
• Under the Act local authorities can includethe use of Security Industry Authoritylicensed door supervisors as part of anestablishment’s licence requirement.
Security inside premises
• The Security Industry Authority will assumeits functions from March this year underthe provisions of the Private SecurityIndustry Act 2001. In future it will be alegal requirement for all door supervisorsto be licensed through the Security
Industry Authority, with training formingpart of that licensing. This will raisestandards and good practice in animportant area of the night-time economyon a country-wide basis.
Existing provision on litter and noise
• Littering that can be linked directly to aspecific premises can be dealt withthrough Street Litter Control Notices,which can be issued by local authoritiesunder s.93 of the Environmental ProtectionAct 1990. The notice specifiesrequirements on the owner or occupier tokeep the land free of litter and refuse.Local authorities wardens and accreditedofficers can also issue Fixed Penalty Notices(currently £50) for anyone caughtcommitting a littering offence, and cankeep the proceeds of these. Under theLicensing Act 2003, the premisesoperating policy can also require licenseesto deal with litter.
• Local authorities already have powers todeal with noise related to premisesthrough the Environmental Protection Act1990. In addition, the Anti-SocialBehaviour Act 2003 gives EnvironmentalHealth Officers powers to close noisypremises, while the Licensing Act 2003allows the police to close premises on thegrounds of noise and disorder.
• What is less clear is how noise outsidepremises can be tackled. The issue mergeswith more general disorder and anti-socialbehaviour.
Transport policy
• There are already good local initiatives,which work in partnership with the localauthority, transport providers and thepolice: for example, provision of nightbuses, encouragement of late night taxiservices. Authorities’ Local Transport Plans
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are the mechanism by which localauthorities should work in partnership withall appropriate bodies to deliver effectivelocal transport strategies. Effectivestrategies will include provision of night-time and evening services, where this isappropriate to the local situation. It is forlocal authorities to identify where and howto take action. In some cases, busoperators also provide night bus serviceson a commercial basis.
Not all areas have problems with the night-time economy. We do not therefore see acase for requiring every authority to producea strategy to tackle the issues. Different socialnorms and markets operate in different partsof the country, and it is important to ensurethat the right approaches are tailored to localcircumstances. In order to ensure that theissues are properly considered, however, localauthorities should be encouraged to:
• work with industry to set up local schemesas set out above, encouragingmembership as part of licensing policy;
• ensure that all the services they providethemselves linked to the night-timeeconomy (licensing, trading standards,transport strategy, street cleaning,environmental health) are co-ordinated todeal with the consequences; and
• co-ordinate a strategy for managing thenight time economies in their areas as partof existing local strategies.
Actions
26. The Office of the Deputy PrimeMinister will provide guidance to alllocal authorities in England onmanaging the night-time economy aspart of existing local strategies, byQ3/2004.
27. The Home Office will serve as thefocus of good practice on alcohol-related crime and disorder and willco-ordinate a cross-governmentalapproach by Q4/2004. It will do soby providing a toolkit for tacklingissues and act as a source of advice,consultancy and training. It willachieve this by working closely with:
i) the Improvement and DevelopmentAgency to disseminate change inmanagement practice;
ii) the Anti-Social Behaviour Unit toensure that good practice on theground is rapidly disseminated; and
iii) Government Offices to identifyareas of good practice (we see meritin identifying ten trailblazer areas totest out approaches).
It will be important to co-ordinategood practice across these areas tominimise bureaucracy.
28. The Regional Co-ordination Unit willensure that areas with alcohol-relatedproblems are taking action to tacklethem by asking Government Offices toidentify areas and work with theirCrime and Disorder ReductionPartnerships to develop approaches aspart of existing strategies: this shouldbe completed by Q4/2004.
29. One of the objectives of the LicensingAct is to reduce alcohol-relateddisorder. So evaluation of the Act iscrucial: the Home Office and theDepartment for Culture, Media andSport will work to ensure thishappens. The Office of the DeputyPrime Minister will also commission astudy to report by Q4/2006 to look
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at the costs for local authoritiesassociated with the introduction ofthe Licensing Act and how it isworking alongside the other measureswe have outlined: this will helpGovernment to decide whetherregulation is needed.
6.2 Under-age Drinkers
Under-age drinking on the streets is widelyperceived as the most serious type ofproblem drinking: 57% of those who wereasked about problem drinking in their areaidentified under-18s as the biggest issue.Although it is illegal for under-18s to buyalcohol and for it to be sold to them, under-aged drinking is an important issue intackling alcohol-related disorder.23
British teenagers are some of the heaviestdrinkers in Europe. This can lead to a varietyof problems
British teenagers are some of the heaviestdrinkers in Europe: more than a third of 15year-olds report having been drunk at age 13or earlier compared to around one in tenFrench or Italian children. By the age of 15just under half of all teenagers reportdrinking in the previous week, and thenumber of units consumed has doubled from5.3 in 1990 to 10.5 in 2002. Thisconsumption is more likely to be outside thehome and less likely to be in the home undersupervision.
Many young people who drink willexperience nothing worse than a hangover.But some will suffer very seriousconsequences. They may progress less well atschool and find it difficult to establish andsustain friendships. Evidence arising from ourconsultation exercise suggests that thenumber of hospital admissions of childrenwith acute alcohol poisoning has risendramatically. Young people who drink are,
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23 Interim Analytical Report, p.53.
Box 6.4: Alcopops and Young People
“Alcopops”, or Ready to Drinks (RTDs), were introduced in 1996. There is no evidence thatthey raised the number of young people drinking. However, they may have contributed tothe increase in the amount drunk: between 1992 and 2001, the average amount of alcoholconsumed increased by 63%, with approximately half of this growth first measured in theyear in which RTDs were introduced.
Consumption of RTDs by 11-15 year olds rose by two-thirds between 1996 and 2001 with adip in 1998 – which is likely to relate to rising prices and the introduction of the PortmanGroup's code of practice for the packaging, marketing and sale of alcoholic drinks.
like others, at higher risk of accidents,unwanted pregnancies and assault.
Our analysis suggested that a range of factorsinfluence this behaviour, including individualreactions and circumstances, familybackground, surrounding culture and themarket.
A range of approaches are alreadyused to help young people learn todrink responsibly
Enforcement
There is already a clear legal frameworkpreventing the sale of alcohol to under-18s:
• The Licensing Act 1964 specifies that it isan offence to sell to under-18s on licensedpremises, or knowingly to allow another todo so.
• It places test purchasing on a statutoryfooting and also makes proxy purchasingan offence.
• The 1964 Act and these offences willshortly be repealed and replaced by theLicensing Act 2003, which will containsimilar provisions but increase the penaltiessignificantly, as well as making it anoffence to sell to an under-18 anywhere.
• The Confiscation of Young Persons(Alcohol) Act 1997 allows for confiscationof alcohol from a young person on thestreet.
• Local authorities can restrict drinking inareas where it is causing nuisance ordisorder.
There is also a clear framework of options forunder-age drinkers:
• Fixed Penalty Notices can now be given to16 and 17 year olds for drunk anddisorderly behaviour.
• We describe Acceptable BehaviourContracts and Anti-Social Behaviour Ordersin section 6.1 above. Under the CriminalJustice Act 2003, Individual Support Orderswill be introduced for 10-17 year olds whoare subject to Anti-Social BehaviourOrders. Individual Support Orders willrequire the individual to help to tackle thecauses of their anti-social behaviour – forexample, through counselling to tacklealcohol misuse.
Retailers use proof-of-age schemes in avariety of ways, but there is no consistency intheir use.
Attitudes and alternatives
Enforcement is backed up by measures toeducate young people about the dangers ofalcohol misuse and provide alternatives. Wedescribe in Chapter 4 measures already beingtaken.
One reason often cited for under-agedrinking is that there are few alternativeforms of entertainment available for thisgroup. The Government is already taking anumber of steps in this area. It will, forexample, be investing £1bn a year for thenext two years in improving sports facilities.The Youth Justice Board and the Home Officeare carrying out work in this area throughthe Positive Futures programme and PositiveActivities for Young People, which involvesfunding sporting and leisure activities toreduce crime, disorder and substance misuse.The Children’s Fund provides a further sourceof funding.
However, provision varies widely. In somecases street drinking reflects a genuine lack ofalternatives. In others, it may be seen as thepreferred activity, with other activities – eventhough provided – coming a poor second.
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But despite these measures, levels ofdrinking by under-18s remain high,suggesting that more needs to bedone.As we explain above, levels of drinking haverisen amongst under-18s over the last 10years and alcohol is widely available. Soclearly more needs to be done.
Rightly or wrongly, young people often feelthat the only option available is to drink –whether on the street or at home. So theymay congregate outside local off licences oron housing estates, causing low-leveldisturbance and disruption to local residents.
Although the legal framework iscomprehensive, enforcement is very limitedand has dropped sharply in the last 10 years.In 2000 there were 130 prosecutions forselling to under-18s of which 56 were foundguilty; there were 24 prosecutions for under-age purchase of which 22 were found guilty.The 2002 Schools Survey found that 48% of11-15 year olds drinkers reported neverbuying alcohol. However, 17% bought fromfriends/relatives and 16% from off-licences,10% from shops and supermarkets and 8%from pubs. Smuggled alcohol was notseparately recorded but may account forsome of the purchase from friends andfamily.24
Our consultation exercise suggested that thelow level of enforcement reflects both thehigher priority given to other issues and theamount of effort involved compared to thelikelihood of punishment. So measures tomake enforcement swifter and easier buildingon the range of sanctions for licensedpremises introduced under the Licensing Actare required.
Meanwhile, retail practice varies on seekingproof of age. There is no universally acceptedmeans of proof of age. It is not routinelysought and evidence from our consultationexercise suggests that the available cards areeasily forged. In some areas – such asManchester – there is already anunderstanding that young drinkers will needto produce a passport or driving licence asproof of age. The expectation that identitywill need to be proved is at best patchy.
The Government’s plans for a nationalidentity cards scheme would provide anationally accepted, useful and secure way ofproving and determining age when youngpeople wish to purchase age restrictedproducts such as alcohol. However, this issome way in the future – the introduction ofplain identity cards on a phased basis would,on current plans, begin during 2007/08.
In the shorter term, the Government has astrong interest in initiatives like the BritishRetail Consortium’s Proof of Age StandardsScheme (PASS) which establishes a commonstandard for issuing the various proof of agecards that are available. This should go someway towards assisting retailers in recognisingand accepting reputable cards whenrequesting proof of ID and for young peopleto prove their age.
We will introduce a range of measures tocrack down on under-age drinking. These willapply to all premises with a licence, not onlypubs and bars. More alcohol is now boughtoff licence than on. So policy in this areamust focus on the off licence trade –supermarkets, off licences and other sources– as well as on licence.
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24 Blenkinsop, S et al. (2003), Smoking, drinking and drug use among young people in England in 2002, London: TSO.
Actions
30. Under the Licensing Act 2003 sellingto under-18s can already lead to anautomatic request for a licencereview. From Q2/2004, Home Officewill build on this, looking at measuresto secure tighter enforcement ofexisting policies of not selling tounder-18s, consulting with the police,the courts, and with young people:
i) ensuring that full use is made ofexisting powers to tackle under-agedrinking, including test purchasing,and, where there is anti-socialbehaviour linked to alcohol,applications forpreventative/prohibitive measuressuch as Anti-Social Behaviour Orders;
ii) we will include powers to tacklesales to under-18s as part of ourconsultation on new powers forCommunity Support Officers;
iii) we will consult with the police onmaking more use of powers to targetproblem premises;
iv) Fixed Penalty Notices for disorderare being rolled out in England andWales from January 2004, allowing amore direct response to alcohol-related disorder; and
v) we will consider introducing FixedPenalty Notices for bar staff who sell tounder-18s.
31. The social responsibility scheme foralcohol retailers (see section 6.1) willstrongly encourage:
i) better training for staff; and
ii) an expectation that all premiseswith a licence, on and off licence, willmake it clear they do not sell to or forunder-18s – for example, by a clearly
displayed poster – and that identitywill be sought as a matter of course,building on the provisions of theLicensing Act. Retailers will beencouraged to ask for a PASS card,passports or driving licences if indoubt.
These measures will be backed up by:
• the work of the Home Office’s PoliceStandards Unit (described in section 6.1above);
• improving the focus in education onbehaviour and attitudes as outlined inChapter 4; and
• making it easier for communities to fundalternative schemes. We will set up anindustry fund which is independentlyadministered and to which communitieswill be able to bid for funding foralternative provision for young people. Weexplain more about this in Chapter 7.
6.3 Dealing with people whorepeatedly commit alcohol-related offences
Cutting repeat offending caused byalcohol misuseThe large majority of alcohol-relatedoffenders will not be habitual offenders andmany will have only one encounter with thecriminal justice system. However, someoffenders are arrested repeatedly for alcohol-related offences: around 20% of alcohol-related arrestees have four or more previousconvictions.25 Mechanisms for identifyingthem and referring them for help arehaphazard, meaning that they continueoffending to their own detriment, and that ofsociety, whilst taking up criminal justiceresources.
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25 Maguire, M and Nettleton H. (2003) “Reducing alcohol-related violence and disorder: An evaluation of the ‘TASC’ project”. London:Home Office.
Repeat offenders are not a homogenousgroup. Different offenders will have differentneeds – some may need extensive alcoholtreatment and other support, but many willnot. It will be important to ensure that arange of interventions are available, allowingdifferent interventions to be offered tooffenders with different needs.
Many offenders who are repeatedly arrestedfor alcohol-related offences will not bedependent on alcohol, although they may bedrinking heavily and frequently. Evidencesuggests that, in particular, many of thosearrested for violence are likely to be youngerand not dependent on alcohol. This group ofoffenders is unlikely to need extensive alcoholtreatment. However, people in this group dohave problems which need to be addressed:brief interventions, counselling, or referral toself-help groups may well be appropriate,depending upon the individual case. In othercases, more generic treatment may be moreappropriate.
By contrast, offenders who are dependent onor who have serious problems with alcoholmay be helped by specialist alcoholtreatment, although much will depend onthe individual offender’s motivation toengage with the treatment.
There are currently eight referral schemeswith a specific focus on alcohol: some ofthese are based on arrest and others on bailconditions. These have not beensystematically evaluated, but availablemanagement statistics suggest that one suchscheme reduced re-offending by up to half.These encouraging results suggest that it isworth looking at whether more use could bemade of arrest referral schemes. Schemes willneed to ensure that they offer a full range ofinterventions.
In terms of criminal justice interventions, it iscrucial that – as part of existing regularupdates – sentencers are made aware of thetreatment that is available as part of asentence. Currently, this could be as part of aCommunity Rehabilitation Order or aCommunity Punishment and RehabilitationOrder. In due course, the Criminal Justice Act2003 will introduce the Community Orderand Suspended Sentence Order to which analcohol treatment requirement can be addedin appropriate cases. Furthermore, under thenew provisions it will no longer be arequirement that the offender’s dependencyon or misuse of alcohol caused orcontributed to the offence. We do not see acase for mandatory testing for alcohol use,although of course treatment agencies maytest offenders as a way of gauging theirprogress. Around a quarter of drug users alsohave problems with alcohol, and this isalready addressed as part of the overalltreatment package.
The introduction of conditional cautioningcould be used to deal with alcohol-relatedoffenders. Certain offenders might, forexample, be required to keep away fromlocal pubs for three months and asked toseek treatment as well, if a referral totreatment was appropriate in that individual’scase.
Anti-Social Behaviour Orders (ASBOs) may beappropriate for use on those who offendrepeatedly in order to draw clear boundarieson acceptable behaviour. ASBOs can be usedto prohibit people from anti-social actsrelated to alcohol – for example, byprohibiting them from entering specifiedpubs/areas, consuming alcohol in public orassociating with persons with whom theybehave anti-socially. In addition, orders toprohibit anti-social behaviour can be made
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when an individual is convicted of a criminaloffence.
Action
32. The Home Office and the Departmentof Health will:
i) consider establishing pilot arrestreferral schemes for evaluation withan aim of having clear emergingconclusions by Q4/2007; and
ii) encourage Crime and DisorderReduction Partnerships to work withLocal Criminal Justice Boards toimplement the conclusions of thoseschemes if there is a clear case foreffectiveness.
Protecting offendersCertain offenders may be repeatedly arrestedfor being drunk and incapable and placed inpolice custody suites where they prevent useof cells for other potentially more seriousoffenders. They also require checking everyfifteen minutes. Intoxicated arrestees need tobe carefully monitored whilst in policecustody: in 2001-02, there were 16 deaths inpolice custody involving substance misuse.
It may be possible to offer better protectionto these offenders, either by ensuring ahigher level of support in police custodysuites or by referring these offenders to othervenues where it may be easier to protecttheir health, for example at local wet hostels,other temporary accommodation, or withinthe health service. However, no research hasbeen conducted on whether theseapproaches offer improved protection tooffenders or whether they can also offer theopportunity to tackle repeat offendingthrough linking up with the interventionsdescribed above.
Actions
33. The Home Office, the Department ofHealth and the Office of the DeputyPrime Minister will considercommissioning research to report byQ4/2007 to explore the effectivenessof diversion schemes in protectingrepeat offenders and combatingalcohol misuse among these offenders.
34. Crime and Disorder ReductionPartnerships will build the results ofthis research into their plans if thereis a clear case for effectiveness (fromQ4/2007).
Alcohol misuse amongst prisonersProblems with alcohol are widespread inprison. In the year before conviction, 63% ofsentenced male prisoners and 39% ofsentenced female prisoners reported“hazardous” drinking. The criminal justicesystem has a key role in reducing recidivismthrough both the prisons and the probationsystem, who have a joint target for reducingre-offending.
These routes into the system for some ofthose with the most deep-seated problemsare vital. To ensure that they work effectivelythere needs to be:
• consideration of alcohol as an issue beforesentencing as discussed above;
• screening of new prisoners to identifywhether there are alcohol problems;
• provision of treatment; and
• effective follow-up, as part of widerrehabilitation policy – to ensure thatoffenders are directed to appropriateservices when they leave prison.
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Some provision is already made:
• detoxification is available on reception inall local and remand prisons: during 2002-3 an estimated 6,400 prisoners receivedalcohol detoxification and an estimated7,000 combined drug and alcoholdetoxification;
• some prisons run alcohol awarenesscourses;
• Alcoholics Anonymous run services inaround 50% of prisons;
• some offending behaviour programmesalready address some of the underlyingcriminogenic factors associated withalcohol-related offending;
• for prisoners whose alcohol misuse is partof poly-drug misuse, CARAT’s services (Co-ordinating, Assessment, Referral, Adviceand Throughcare) are available – a low-level intervention that creates a care planbased on the specific needs of theprisoner; and
• new funds under Spending Review 2002are improving drug and alcohol serviceprovision and resettlement planning forjuveniles in custody, led by the YouthJustice Board in partnership with the PrisonService, Secure Training Centres and localauthority Securer Children’s Homes.
The Prison Service will introduce an AlcoholStrategy for prisoners from Spring 2004.Within existing resources, there will be a newprison rule to allow alcohol testing at thediscretion of the governor; and atreatment/interventions good practice guidewhich sets out a model treatment framework.
Alcohol misuse among offenders underprobation supervisionAlcohol-related offending is also a significantissue for the Probation Service. Evidence from
the pilots of the Prison and ProbationServices’ joint Offender Assessment System(OASys) found that, of those assessed,alcohol was a criminogenic need for 35%and a disinhibitor in the current offences of37%.
Some provision is already made to meet thisneed, frequently delivered in partnership witha range of voluntary and statutory agencies:
• probation areas refer some alcoholmisusing offenders into mainstreamspecialist interventions;
• substance misuse programmes;
• a programme aimed at drink-drivers; and
• lifestyle interventions – such asemployment, training and education.
However, existing provision is not centrallyco-ordinated and monitored, and delivery oftreatment can be inconsistent. The NationalProbation Service is therefore developing analcohol strategy to establish a consistency ofapproach to tackling alcohol-relatedoffending across the Probation Service basedupon evidence of good practice. An agreedframework, “Towards an NPS' AlcoholStrategy” is in place, which identified ten keyissues that should form the structure of thestrategy and the steps which should form thenext stages of the development process. Thiswork, centred around three distinct but inter-related strands of research, is presently beingtaken forward. Within existing resources, theemphasis of the strategy is likely to have tobe on consolidating the work already beingdone across the Service, and building ongood practice.
The National Probation Directorate (NPD) isworking closely with the Prison Service toensure that the emerging probation strategydovetails with the equivalent Prison Servicestrategy. This will become especially
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important with the creation of the NationalOffender Management Service (NOMS) fromJune 2004.
6.4 Domestic violence
Alcohol is one of the risk factors in domesticviolence. Almost one in four women areestimated to have been assaulted by apartner since age 16, and one third of victimsof physical domestic violence assaults say thattheir attacker had been drinking.
Alcohol is not the cause of domestic violence,but it can exacerbate the effects – forexample increasing the severity of injuriessustained by the victim. It is a fact thatsubstance misuse and domestic violenceoften co-exist: rates of alcohol misuse anddependence among perpetrators may be upto seven times higher than in the generalpopulation.26
Victims of domestic violence may also usealcohol as a coping mechanism. Heavydrinkers are also at increased risk ofvictimisation.27 Either way problems withalcohol can make it harder to access help.
We need to recognise the nature of the linksbetween alcohol misuse and domesticviolence and address those links in publicpolicy and in the design of local services. Wealso need to recognise that – as withresponsible drinking messages – those whoproduce and sell alcohol may have animportant role to play in disseminating keymessages about domestic violence.
Action35. The Home Office and the Department
of Health will, from Q2/2004:
i) ensure that the work to develop theModels of Care commissioning
framework takes account of the needto ensure that perpetrators andvictims of domestic violence receivehelp from both domestic violence andalcohol treatment services, asappropriate to their needs;
ii) explore the potential forpartnerships with alcohol producersand sellers to promote key messages –for example, helpline numbers tovictims and the message thatdomestic violence is unacceptable toperpetrators; and
iii) encourage local partnerships toconsider using money from the Fund(described in section 6.1) to supportlocal domestic violence projects andsupport services.
6.5 Drink-DrivingDrink-driving has been successfullyreduced over the last 30 years
Drink-driving has long been regarded associally unacceptable. Alcohol impairs adriver’s reaction time, and puts the driver,passengers, other road users and pedestrianslives at risk.
Government has tackled drink-drivingthrough a package of measures, combiningpreventative measures, information andawareness campaigns and enforcement. This“package” approach, which has beenintroduced over the last 30 years, has beeneffective in reducing drink-drive deaths.Between 1993 and 2001 the total number ofdriving casualties fell by 12%. This hasachieved real culture change for many. Drink-driving is no longer socially acceptable, andtough enforcement – e.g. loss of drivinglicence – has a major impact on offenders’lives. The concept of a package of measures
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26 Interim Analytical Report, p.61.27 Ibid.
used here is a good model for tackling otheralcohol-related harms.
The drink-driving package consists of thefollowing measures:
• an absolute offence rather than one thatdepends upon proof of impairment ineach case: it is illegal to drive with a bloodalcohol concentration above the legal limitof 0.08% (80mg of alcohol per 100mlblood) in the UK;
• specific breath testing powers. Police canbreath test drivers who they suspect tohave been drinking, have committed adriving offence, or have been involved inan accident;
• disqualification from driving for aminimum period of one year to punish adrink-driving conviction;
• rehabilitation courses;
• mandatory medical tests for High RiskOffenders (those convicted of a bloodalcohol concentration of 200mg or more,those committing two or more offenceswithin 10 years, or those refusing to give aspecimen); and
• advertising campaigns: promoting thedrink-drive message through a variety ofmedia (such as radio and TV) and workingin partnership with other bodies such asthe Nationwide Football League.
In addition, the Home Office has beenworking closely with voluntary groups suchas RoadPeace and the Campaign AgainstDrinking and Driving to establish moreclearly the effects of serious road incidentsand the options on emotional and practicalsupport services. The evidence is that thetrauma and suffering caused by road deathand serious injury can be exacerbated incases that have involved drinking anddriving. The Government’s National Strategy
for Victims and Witnesses proposes moresupport for victims of serious road incidents,as part of a more diverse provision of servicesfor victims. The Home Office is running pilotprojects in Bedfordshire, Merseyside andWest Yorkshire (Bradford and Calderdale) totest different approaches to deliveringsupport services for road crash victims and toidentify good practice.
Overall, the UK’s record on drink-driving is excellentAlthough the blood alcohol limit of 0.08% inthe UK is amongst the highest in Europe(most countries set it at 0.05%), sustainedadvertising and vigorous enforcement andpunishment have ensured some of the lowestlevels of casualties. It is essential, however, tokeep current policies under review, and co-ordinated with alcohol policies in the rest ofgovernment.
But drink-driving related casualtieshave been risingHowever, between 1993 and 2001 the totalnumber of casualties from road accidentsrose by one fifth. Research identifies youngmen (who are likely to be unemployed or inmanual work) in particular. Amongst 18-25year old men, heavy or problem drinkerswere six times more likely to be involved inan accident than moderate drinkers. There isno clear evidence to link this to any rise inbinge-drinking. But Government will need tomonitor trends very closely and considerwhether more should be done to target thesespecific groups.
As far as enforcement is concerned, themaximum penalty for the offence of causingdeath by careless driving when under theinfluence of drink or drugs has beenincreased from 10 to 14 years’ imprisonment.
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The Government is also planning to requireall offenders disqualified for two years ormore to retake the driving test, and toincrease police powers to allow them to carryout evidential roadside breath-testing.
Alcohol retailers need to support the currentapproach by promoting designated driverschemes, and offering free/cheaper softdrinks to drivers. This already exists under thePortman Group’s “I'll be Des” scheme. Aspart of the social responsibility schemedescribed in Chapter 7, pubs and otherestablishments will be encouraged to sign upto and publicise the scheme. They will alsobe expected to display information on unitcontent of drinks, sensible drinking anddrink-drive limits.
Actions
36. Although policies have worked verywell, the Department for Transportwill monitor closely trends which aregiving cause for concern and considerwhether more should be done totarget 18-25 year olds, especially[from Q2/2004].
37. As part of the proposed socialresponsibility scheme, the industry willbe encouraged to make moreprominent use of the existing “I’ll beDes” scheme and to displayinformation about drinking anddriving.
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7. SUPPLY AND INDUSTRY RESPONSIBILITY
Summary
• The alcoholic drinks market is valued at more than £30bn per annum, with around onemillion jobs estimated to be linked to it. Excise duties on alcohol raise about £7bn peryear and, like other sectors, the industry pays local and central taxes.
• Chapter 3 highlighted the shared responsibility for tackling the harms associated withalcohol misuse. This requires a partnership between individuals, families andcommunities, public services such as the NHS and the police, the government, and thealcohol industry.
• Working with the industry is, therefore, at the heart of this strategy. Analysis showedthat solutions implemented with the industry were highly effective and reached largenumbers of people.
• It is also clear that there is a strong business case for more socially responsible practicesby the industry itself.
• The industry does recognise its responsibilities and a number of good examples of socialresponsibility initiatives already exist. However, best practice is patchy and not alwayswell co-ordinated across the industry, and it is not strategically aligned with the efforts ofgovernment and the voluntary sector.
• Government will work with the industry at national level to introduce a new awardscheme. This scheme will combine a code of good practice with a financial contributionfrom the industry towards efforts to tackle the harms caused by alcohol misuse. Thescheme will be overseen by a small independent board. This complements the proposalsfor working with the industry at local level set out in Chapter 6.
• The scheme will be voluntary at first. This allows the industry to demonstrate itswillingness to develop best practice and work with Government. But an independentaudit of the scheme will be commissioned early in the next parliament to assess itsefficiency.
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7.1 The central role of thealcohol industry
The alcohol drinks market is asubstantial and valuable part of theUK economy and society. However,alcohol can also be harmful – for thedrinker, their friends and family andfor wider societyThe alcohol drinks market generates over£30bn annually, provides around one millionjobs and plays an important role inmaintaining a dynamic leisure and hospitalitysector. The alcohol industry contributes £7bna year to the national exchequer in the formof excise duty. Like other sectors, it alsocontributes through VAT and local andcentral taxation.
However, the harms resulting from alcoholmisuse are rising, affect a wide cross-sectionof society, and are calculated to cost theeconomy up to £20bn per year.
The alcohol industry has a vital role inhelping to prevent and tackle theharms caused by alcohol misuse
As we set out in Chapter 3, tackling theharms associated with alcohol misuse is ashared responsibility – between individuals,their families and communities, publicservices such as the NHS and the police, thegovernment and the alcohol industry.
Our analysis found that the industry needs tobe at the heart of preventing and tacklingalcohol misuse, and that approaches whichinvolved the industry have proved to besuccessful and reach large numbers ofpeople. Many of the factors which theindustry can affect (ranging from the way inwhich alcohol is packaged and promoted, to
the management of the pub or bar in whichit is consumed) can help encourage a moreresponsible approach to alcohol.
The industry’s role needs to go beyondcomplying with its statutoryresponsibilities, to setting highstandards of socially responsiblepractice
Businesses that produce, promote and sellalcoholic drinks already have a complex setof statutory responsibilities and regulatoryregimes – in relation to health and safetylegislation, licensing law, fire-safety law andother areas. The industry’s first responsibilityis to ensure that it is complying with its legalrequirements effectively.
But we believe that the industry’sresponsibilities go beyond this, and that theindustry has a wider social responsibility topromote and strongly encourage bestpractice. Moreover, there is an importantbusiness case – in terms of benefits such asenhanced reputation, improvedcompetitiveness and strengthened risk-management – to adopting more sociallyresponsible business practices, as businessesin other sectors, such as the energy sector,have already demonstrated.
Whilst there are many excellentinitiatives, corporate socialresponsibility in the alcohol industry iscurrently patchy and not well co-ordinated
There are already a number of goodexamples of social responsibility initiativesundertaken by the alcohol industry bothcollectively and individually.
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However, best practice is patchy and notalways well co-ordinated across the industry,or strategically aligned with the work ofgovernment and other stakeholders, such asthe police, health professionals, and thevoluntary sector in this area. Only by moreeffectively spreading existing best practice,and by joining efforts with the work of theseother stakeholders, can we maximise ourimpact in tackling the harms.
7.2 Government will workwith alcohol producers to setup a scheme to reduce harm
In addition to the social responsibility schemefor retailers at a local level set out in Chapter6, Government will also work with alcoholproducers at a national level to increasecorporate social responsibility. The proposednational-level scheme will comprise threeparts:
Part 1: Promotion of good practice inproduct development, branding,advertising and packaging
Accreditation criteria might include:
• agreement not to manufactureirresponsibly – for example, productsapparently targeted at under-age drinkersor encouraging drinkers to drink well overrecommended limits;
• agreement to observe advertising codes;
• conforming to the Portman Group’sexisting code on packaging;
• as discussed in Chapter 4, an agreementto put the sensible drinking message onbottles alongside information about unitcontent; and
• moving towards packaging products insafer materials – for example, alternativesto glass bottles: a working group ofindustry, medical and other experts shouldbe convened to reach a clear view on whatthese are as set out above.
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Box 7.1: Social Responsibility Initiatives
The alcohol industry has set up and funded a number of ‘social aspects organisations’,operating at global (e.g. the International Center for Alcohol Policies), European (e.g. TheAmsterdam Group), and at national levels (e.g. The Portman Group).
The Portman Group is the principal social responsibility body for the UK alcohol industry. Itwas established in 1989 to promote sensible drinking, to help prevent alcohol misuse, toencourage responsible marketing, and to foster a balanced understanding of alcohol-relatedissues. The Portman Group provides ‘sensible drinking’ advice and supports the government,media, industry and consumers with research, educational materials and campaigns. It alsoencourages responsible marketing practices through its Code of Practice.
Some companies within the UK alcohol industry have already taken a variety of initiativessuch as creating dedicated teams of social responsibility advisers; establishing sociallyresponsible marketing codes; piloting responsible drinking advertisements; and fundingcommunity and citizenship programmes.
Part 2: A donation to an independentfund
This will be:
• used to fund community and national-levelprojects designed to tackle alcohol-relatedharm: it might for example fund projectsaimed at providing alternative activities foryoung people, targeting information andhelping culture change or helping to dealwith specific consequences of misuse;
• administered by an independent board, on which industry, government and thevoluntary sector will be represented.The board will assess bids for fundingaccording to agreed criteria; and
• financed on a basis agreed between theindustry and government.
Part 3: Promotion of good practicedown the supply chain
For example, assistance in training andserving practices or discounts to retailers whosign up to the retail accreditation schemedescribed in Chapter 6.
Our intention is to have the scheme up andrunning by April 2005. We expect to consultextensively with the industry and otherstakeholders on the details of what should beincluded and how the scheme should work.
7.3: How the scheme mightwork
AdministrationThe Department of Health and the HomeOffice would take the lead in establishing asmall administering body for the scheme. Itcould be established as a separate board, andwould have a number of functions:
• spreading best practice;
• advising businesses who are seekingaccreditation;
• promoting the scheme;
• managing accreditation; and
• agreeing criteria for projects to be fundedand overseeing the administration of thefund created.
Administration needs to be as light touch aspossible. Businesses would submit a self-assessment of how they comply with clearly-defined criteria. The applications would needto be approved by the accreditation body. Atproducer level, companies will be required tosubmit a self-assessment report forindependent auditing. Although this checklistapproach lacks the subtlety of a moresophisticated qualitative assessment of acompany’s corporate social responsibility,such as an in-depth social audit, it is easier toadminister, and has the advantage ofencouraging a wide compliance.
Membership of the scheme would berenewed annually. Producers would submit areport on initiatives taken over the year,which would again be independentlyaudited.
FinanceThe scheme would be self-financing:administration costs would be covered by asmall charge on all those organisations thatparticipate. This charge should beproportional to the size of the organisation,to avoid imposing excessive burdens on smallbusinesses.
GovernanceThe administration of the scheme also needsto guarantee its credibility. So it will need toretain sufficient independence and distance
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from the organisations which it accredits.It should be governed by an independentboard, which would include representationfrom the industry, but also the voluntarysector, experts in corporate socialresponsibility, perhaps drawn from anotherbusiness sector, representatives of the generalpublic, and other stakeholders such as thepolice and the NHS. The board needs tounderstand and appreciate commercialbusiness practice, and the particular featuresof this industry. It needs equally to appreciatethe problems caused by alcohol misuse andtheir effects on the ground. And it needs tocommand credibility and respect as anindependent body in its own right.
The fundThe fund should be operated at arm’s lengthfrom the body administering the scheme,perhaps by an independent boardcomprising representatives from government,the industry, the health service, voluntarysector providers and communityrepresentatives. Its task would be to set clearcriteria for giving funds and ensure theirefficient use, building on good practicewhere appropriate.
7.4 Ensuring the scheme isworking
Incentives to participateRecognition and status will be a main reasonfor businesses taking up the scheme. Overtime we expect the scheme to develop acritical mass of its own, so that thepresumption will be that businesses expect toparticipate unless they have very goodreasons not to. Our aim would be to workactively with industry leaders to use peerinfluence to bring others on board.
What will we do if the scheme is notmaking a difference?We are keen to allow the industry todemonstrate its willingness to abide by bestpractice. We propose that participation in thescheme should initially be voluntary. We willcommission an independent audit early inthe next parliament to assess how well thescheme is working (to be funded by thescheme itself). The key criteria for success willbe the number of large producersparticipating, the size of the fund created,the number and scope of projects funded,and the effectiveness of these projects inreducing alcohol-related harm. If industryactions are not beginning to make an impactin reducing harms, Government will assessthe case for additional steps, includingpossibly legislation.
Action
38. Government will consult with theindustry on the introduction of athree-part voluntary socialresponsibility scheme for alcoholproducers. This will (i) strengthenindustry focus on good practice, (ii)seek a financial contribution from theindustry towards the harms caused byexcessive drinking, and (iii) encourageproducers to promote good practicedown the supply chain. The schemewill be voluntary in the first instanceand should be established byQ1/2005.
The success of the voluntary approachwill be reviewed early in the nextparliament. If industry actions are notbeginning to make an impact inreducing harms, Government willassess the case for additional steps,including possibly legislation.
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We argue in Chapter 3 that, amongst otherresponsibilities, government has aresponsibility to set out a clear strategicframework for reducing the harms caused byalcohol misuse. Chapters 4 to 7 set out whatthat strategy is. In this chapter we set out themechanisms through which we will deliverthe strategy and monitor progress. Weidentify three main mechanisms:
• better co-ordination and a more strategicapproach in central government;
• a clear framework of directional indicatorsto enable measurement of progresstowards the overarching objective ofreducing harm, and arrangements formonitoring progress; and
• arrangements for delivery at local levelwhich give flexibility to meet localpriorities within the strategic objective ofreducing harm.
8. DELIVERY AND IMPLEMENTATION
Summary
• Our analysis identified four key harms arising from alcohol misuse:
- harms to health;- harms to public order;- harms to productivity; and- harms to families and society.
• It found that without clear responsibilities at central and local level, and clear indicatorsof progress, effective change is unlikely.
• Currently:
- there is no strategy at national level;- Government has no over-arching objective for tackling alcohol misuse; and- there are examples of excellent practice at local level, but no established ways of
delivering them.
• Government therefore proposes:
- light-touch central arrangements, with the Home Office and the Department of Healthsharing a responsibility for delivery. They will work closely with other departments suchas the Department for Culture, Media and Sport, the Office of the Deputy PrimeMinister, and the Department for Education and Skills;
- using new indicators to track progress; and- flexibility for local partnerships to deliver what is needed in their area, whilst staying in
line with the aims of the national strategy.
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8.1 Better co-ordination and amore strategic approach incentral government
Government has, until now, not takena strategic approach to addressingalcohol issuesA large number of government departmentshave a stake in alcohol issues. The leadcurrently lies with the Department of Health.Although responsibility for the key harmsassociated with alcohol lie with theDepartment of Health and the Home Office,many other departments also have aninterest in the issues:
• The Department for Culture, Media andSport is responsible for licensing legislationrelating to the sale and supply of alcohol,and sponsors the tourism and hospitalityindustry to which the sale of alcohol isimportant;
• The Office of the Deputy Prime Minister,through local authorities, is responsible forplanning and management of local night-time economies and for provision ofservices to some of the most vulnerablethrough ‘Supporting People’ and servicesto homeless people;
• The Department for Education and Skills isresponsible for alcohol education inschools and provision of services tochildren and young people;
• The Department for Transport isresponsible for drink-driving, and forsetting the framework for local authorities’local transport strategies;
• The Department for Environment, Foodand Rural Affairs is responsible for sectorsponsorship;
• The Department for Trade and Industry isresponsible for social responsibility;
• The Department for Work and Pensions isinvolved through disability benefits, andtogether with the Health and SafetyExecutive has responsibility for the healthand safety aspects of alcohol misuse in theworkplace;
• HM Customs and Excise is responsible forcollecting alcohol excise duty andpreventing smuggling; and
• HM Treasury is responsible for settinglevels of alcohol (excise) duty and VAT onalcohol (collected by HM Customs andExcise) and for general levels of taxation inrespect of industry and business.
Consequently:
• there is no clear focus for policy making;
• communications are not co-ordinated; and
• research evidence is weak in some areas,making it difficult to evaluate policy.
The two key areas for publicintervention are health and crimeThe key harms in terms of cost and numberslie in health and crime. So there is a clearlogic to giving a joint responsibility to theDepartment of Health and the Home Officeto deliver against agreed outcomes as thetwo departments with responsibility fordealing with the greatest harms and havingthe most effective levers to tackle them.
However alcohol misuse is an issue whichinfluences virtually every area of public policy.Much of the strategy we have outlinedhinges on raising awareness of alcohol anddealing with its consequences within existingactivity, making it a mainstream issue ratherthan isolating it. So it is essential that theDepartment of Health and the Home Office
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work very closely across Whitehall,particularly with departments that have astrong interest such as the Department forCulture, Media and Sport, the Office of theDeputy Prime Minister and the Departmentfor Education and Skills.
Action
39. The Minister of State for Policing andCrime Reduction (Home Office) andthe Parliamentary Under-Secretary ofState for Public Health (Departmentof Health) will assume jointresponsibility for delivery of thestrategy [from Q2/2004]:
i) they should report quarterly to anappropriate Cabinet Committee;
ii) the Cabinet Committee will besupported by regular meetings ofdesignated officials from Whitehalldepartments with an interest toensure better co-ordination of policy,communications and research. Thiswill be organised by DH and HOofficials and chaired alternately bythe two ministers; and
iii) an external stakeholder group willbe created to bring an outsideperspective and serve as a sounding-board for initiatives.
8.2 Setting goals andmonitoring progress
There is no comprehensive target forreducing the harms caused by alcoholmisuseThere is no over-arching governmentobjective for reducing the harms caused byalcohol misuse and few indicators. It istherefore hard to identify how far desired
outcomes on managing alcohol misuse arebeing achieved.
It is also difficult to ensure that the rightresearch data is gathered to measureprogress. There are currently fewmechanisms to ensure that research intoalcohol misuse is co-ordinated acrossgovernment, and many elements of alcohol-related harm can be difficult to measure.
The Government will be reviewing itsperformance management and monitoringarrangements as part of the forthcomingSpending Review. The paragraphs below setout a framework for monitoring the strategy,but this framework will need to be subsumedwithin the Government’s wider performancemanagement framework referred to above.
To track progress effectively government willneed:
• clear aims;
• indicators to measure progress;
• a baseline to inform future evaluation;
• better co-ordination of research; and
• a clear timetable for review andmonitoring.
Clear aims
The aim of this strategy is to prevent anyfurther rise in the harms caused by alcoholmisuse and, subsequently, to begin to reducethem.
Indicators to measure progress on reducing harm
This will need to be underpinned byindicators against which government willmeasure its progress in reducing the four keyharms caused by alcohol misuse.
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• Reducing the harms to health:
Each year it would be good practice foreach Primary Care Trust (PCT), or byarrangements a lead PCT or partnershipwhich acts on behalf of other PCTs andagencies within a local authority area, topublish:
- details for the partnership responsible forcommissioning alcohol prevention andtreatment services including itsmembership and a single point ofcontact for enquiries;
- planned and actual increases in thenumbers accessing treatment foralcohol-related problems;
- a statement outlining the arrangementsfor alcohol treatment and points ofcontact for those requiring help;
- a statement outlining the arrangementsfor the promotion of sensible drinking;
- a statement outlining the contributionalcohol prevention and treatment willmake to the Crime and DisorderStrategy.
We can see value in such indicators beingcollected and published to help trackprogress of the Government’s Alcohol HarmReduction Strategy, though recognise that atpresent some of this information might notbe readily available or robust enough in someareas. In the longer term, some of theseindicators might also in some way usefullyform part of the Comprehensive PerformanceAssessments for local authorities.
• Reducing the harms caused by crime anddisorder:
- to reduce the number of incidents ofalcohol-related violent crime and tochange the perception that drunk androwdy behaviour is increasing, asmeasured by the British Crime Survey;
- to reduce low-level disorder in the night-time economy and improve its diversity:we will measure this both through theuse of existing surveys and through theevaluation of the Licensing Act set out inChapter 6;
- to monitor through existing statistics theextent to which under-age drinking isbeing prevented and tackled;
- the Home Office will examine whether itis possible to measure a reduction in thenumber of repeat offences of domesticviolence where alcohol is involved; and
- to resume the downward trend in drink-driving incidents as measured in statisticsproduced by the Department forTransport.
• Reducing the harms to productivity:
- to monitor through examination ofexisting statistics levels of alcohol-relatedemployee absenteeism, unemploymentand reduced efficiency.
• All of these should be backed up bykeeping consumption trends under reviewto inform future policy. The Department ofHealth and the Home Office will:
- monitor through the General HouseholdSurvey and the Health Survey forEngland whether levels of chronicdrinking and binge-drinking (35/50+units a week) are dropping;
- in tandem with this they will revisit thedefinitions used in existing research toallow more accurate identification oflevels of binge-drinking which shouldgive cause for concern; and
- monitor the proportions of under-16swho drink, and the average amount theydrink.
Delivery and Implementation
75
Establishing a baseline to inform futureevaluation
The baseline should be monitored from April2004. This will be established by:
• the treatment audit discussed in Chapter 5;
• the evaluation on the Licensing Actdiscussed in Chapter 6; and
• the estimates on effects on productivitycontained in the Strategy Unit’s interimanalytical report.
Better co-ordination of research
As we set out above, there are nomechanisms for co-ordinating research toensure that gaps are filled and that best useis made of resources. So in future theDepartment of Health and the Home Officewill take the lead in co-ordinating researchpriorities and funding more effectively. It isimportant that this process extends outsidegovernment and includes funders of researchsuch as the Medical Research Council, theEconomic and Social Research Council andthe Alcohol Education and Research Council.There is also a case for working more closelywith the industry. The Department of Healthand the Home Office will examine ways inwhich this can be done more effectively.
A timetable for monitoring progress
• An appropriate Cabinet Committee willmonitor progress quarterly for the first yearthen six-monthly.
• As set out above, there will be anindependent review early in the nextparliament to assess whether enoughprogress has been made on working withthe industry.
• This will inform a general review of policyby Q2/2007 to see if the trends are
moving in the right direction and focus onwhat needs to happen next.
Action
40. Government will have a clearcommitment to deliver an over-arching alcohol harm reductionstrategy from Q2/2004. This will be:
i) assessed against indicators ofprogress for the four key harmsidentified;
ii) set against a clear baseline;
iii) supported by better co-ordinationof research; and
iv) regularly monitored.
8.3 Flexibility to deliver atlocal level
Local partnerships already exist whichcan form a focus for reducing theharms caused by alcohol misuse, andthere are excellent examples of goodpractice. But practice variesAlcohol misuse is an issue which spans a widerange of bodies:
• local health Primary Care Trusts;
• local authorities (including social services);
• the local police and other parts of thecriminal justice system;
• education services and services for youngpeople;
• the hospitality, leisure and retail industriesand others selling alcohol; and
• local voluntary organisations, such asservice providers or residents’ associations.
Alcohol
Harm R
eduction S
trategy
for
England
76
A variety of partnerships already exist whichbring these together in differing formats:
• Crime and Disorder ReductionPartnerships. The Crime and Disorder Act1998 (CDA98) sets out statutoryrequirements for responsible authorities(the police, local authorities and otherlocal agencies and organisations) todevelop and implement strategies to tacklecrime and disorder in their area. These areknown as Crime and Disorder ReductionPartnerships (CDRPs). They areaccountable to Government Offices andultimately the Home Office for tacklingcrime and disorder and misuse of drugs.Working together, the responsibleauthorities and other agencies make up avirtual body of diverse partners. This multi-agency approach looks to encouragepartners to promote consideration of crimeand disorder issues in their own coreactivities in order to raise and improvesafety and security in localneighbourhoods;
• Criminal Justice Boards and YouthOffending Teams provide a specific focusfor criminal justice at local level for adultsand for juveniles;
• Drug and Alcohol Action Teams setstandards for and commission treatmentservices in around 70% of areas; in theremainder their focus is solely on drugs, asDrug Action Teams; and
• Local Strategic Partnerships provide anoverarching and voluntary forum for co-ordination of local priorities: they do nothave statutory responsibilities.
To comply with changes to the Crime andDisorder Act 1998 brought in by the PoliceReform Act 2002, the Home Office isencouraging Crime and Disorder ReductionPartnerships to integrate with Drug and
Alcohol Action Teams/Drug Action Teams.Many partnerships began theintegration/closer working process from 1April 2003. Integration of all DATs and CDRPsin unitary/metropolitan authorities and closerworking in two tier authorities should befinalised by 1 April 2004.
Integration will bring many benefits, such assimplified local working relationships, givegreater recognition to common interests, andprovide the right framework to enable themore effective delivery of the crime reductionand drugs agendas.
Primary Care Trusts in England will become aresponsible authority within the CDRP subjectto commencement order not before 1 April2004. They will bring together the key localagencies with an interest in reducing theharms caused by alcohol misuse: the healthservice, the criminal justice system and thelocal authority.
In some areas alcohol misuse is already firmlybedded into these partnerships as an issue,and there are excellent examples of goodpractice.
However delivery of strategy and servicesvaries widely, and good practice is not alwaysdisseminated.
How the strategy will be delivered atlocal levelEffective delivery of outcomes at local levelwill be crucial if the objectives set out aboveare to be achieved. Our guiding principlesare:
• maximum local flexibility;
• a minimum of new bureaucracy; and
• raising the profile of alcohol misuse inexisting services and structures.
Delivery and Implementation
77
Who will deliver the strategy locally?
As set out above, there is already some closeworking between some Crime and DisorderReduction Partnerships and some local healthservices. With the addition of representativesfrom local voluntary organisations and theindustry, they form the obvious body forformulating and delivering a strategy withinthe wider framework set by the LocalStrategic Partnership (which brings togetherat a local level the different parts of thepublic, private, community and voluntarysectors).
The CDRP as a partnership can helpindividual members achieve their objectivesby:
• providing a forum for agreeing a strategicframework on alcohol misuse which
reflects local priorities, ensurescomplementary objectives and sits withinexisting strategies where appropriate;
• ensuring that organisations shareinformation and good practice; and
• providing a forum for agreeing howorganisations will work together, forexample police and A&E departments.
It is essential that other key stakeholders areinvolved in this process:
• representation from the alcohol industry,building on the existing British Beer andPubs Association partnership scheme;
• representation from local voluntarygroups; and
• representation from the local community.
Alcohol
Harm R
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Box 8.1 – Hammersmith and Fulham Alcohol Strategy The London borough of Hammersmith and Fulham has brought together all those with aninterest to agree a three-year alcohol strategy spanning health and crime issues. The strategyhas a full time co-ordinator and is supported by a sergeant within the Metropolitan Police.
The crime and disorder element of the strategy is supported by a Public Service Agreementsigned with the Government to reduce alcohol-related disorder and assaults in the Shepherd’sBush Green area. Key strands of activity for this element of the strategy include:
• a multi-agency night-time economy working group, which has developed an action planfor managing the night-time economy;
• the Shepherds Bush Bar Charter – a forum which promotes responsible management oflicensed premises. It has membership from the public, local licensees, the police and thelocal authority. Projects have included the installation of a “safety net” radio system inlicensed premises around the Green and the delivery of safer drinking and personal safetycampaigns;
• the production of a “safer pubbing” guide – a supporting document developed for thelocal licensing policy which will include guidance on minimising the risks of alcohol-relateddisorder and environmental and noise pollution;
• a review of transport provision in light of changed dispersal patterns;
• the introduction of a controlled drinking area in Fulham; and
• the improvement of support services for street drinkers.
The overarching aim of such frameworks willbe to tackle the four key harms identified inthe analysis. But it is for local partnerships todecide what their priorities are within thatframework. For example one area may haveserious problems with the night-timeeconomy. Another might have large numbersof under-age drinkers with consequentimpacts on their health, performance atschool and the local environment. So localstrategies need to be tailored to local needs.
We set out four key levers for intervention inthe strategy. Local agencies will work withinexisting chains of accountability to deliveroutcomes. But we will look to the CDRPworking in consultation with the industry, thevoluntary sector and the local community toprovide a forum for discussion, sharing ofgood practice and co-ordination to maximiseeffect in the use of each lever.
• Education and communication:partners will work with local schools andinstitutions to find innovative ways ofconveying messages about alcohol andachieving behavioural change. Forexample the police and the PCT might joinforces to give clear messages about thedangers of under-age drinking;
• Treatment: the remaining DATs will beencouraged to take on responsibility foralcohol services. PCTs will remainresponsible for treating alcohol-relatedconditions, whilst all partners will share aresponsibility for the identification andreferral of individuals with alcohol-relatedproblems and for wider prevention activity.
• Community safety: The police will takethe lead in demonstrating a reduction inalcohol-related crime and disorder. Bettermanagement of the night-time economy islikely to be at the heart of this for manypartnerships, and the local authority willneed to take a lead.
• Working with the industry: Localauthorities will take the lead in setting uplocal social responsibility schemes asdescribed in Chapter 6 to feed into themanagement of the night-time economyand in bringing together all the statutorypartners needed to manage it effectively.
How will outcomes be monitored?
We expect that, where there is a clear casefor a strategy, local authorities will wish toproduce an alcohol strategy. This is likely tobe in the context of existing strategies andwill be left to the discretion of localauthorities.
To ensure that the harms caused by alcoholmisuse are tackled effectively, GovernmentOffices will be asked to identify areas withparticular issues, ensure that a strategy isbuilt into the Service Delivery Agreementwhere appropriate, and monitor its deliveryas part of the agreement. In addition, allCrime and Disorder Reduction Plans will beexpected to include a statement concerningalcohol-related problems.
Action
41. From Q2/2004, where appropriate tolocal need, Crime and DisorderReduction Partnerships – includingrepresentation from the local PrimaryCare Trust – will provide a co-ordinating body for agreeing localpriorities and determining futuredirection. We will not be seekingcompulsory strategies from localauthorities, but expect to seemeasures for tackling alcohol misuseembedded within existing strategicframeworks. Government Offices willwork with areas that have identifiedparticular issues.
Delivery and Implementation
79
Alcohol
Harm R
eduction S
trategy
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England
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126
The
Dep
artm
ent
of H
ealth
and
the
Hom
e O
ffice
, in
con
sulta
tion
with
D
H,
HO
Q3/
2004
othe
r de
par
tmen
ts s
uch
as t
he D
epar
tmen
t fo
r Ed
ucat
ion
and
Skill
s,
the
Dep
artm
ent
for
Cul
ture
, M
edia
and
Sp
ort,
and
the
Dep
artm
ent
for
Envi
ronm
ent,
Foo
d an
d Ru
ral A
ffairs
will
est
ablis
h an
alc
ohol
com
mun
icat
ions
grou
p t
o sh
are
best
pra
ctic
e an
d ag
ree
stra
tegi
es.
The
com
mun
icat
ions
gro
up
will
dra
w o
n th
e ex
per
tise
of o
utsi
de s
take
hold
ers
incl
udin
g th
e in
dust
ry a
nd
volu
ntar
y or
gani
satio
ns.
This
will
be
esta
blis
hed
by Q
3/20
04.
226
The
Dep
artm
ent
of H
ealth
will
car
ry o
ut a
re-
asse
ssm
ent
of t
he c
urre
nt “
sens
ible
D
HQ
2/20
05
drin
king
” m
essa
ge,
focu
sing
on
deve
lop
ing
a si
mp
ler
form
at f
or t
he m
essa
ge,
and
one
whi
ch m
akes
it e
asie
r to
rel
ate
to e
very
day
life.
Thi
s sh
ould
be
achi
eved
by Q
2/20
05.
326
The
Dep
artm
ent
of H
ealth
will
wor
k w
ith o
ther
s in
side
and
out
side
Gov
ernm
ent
to
DH
Q2/
2005
iden
tify
the
mos
t ef
fect
ive
mes
sage
s to
be
used
with
bin
ge-
and
chro
nic
drin
kers
,
and
the
mos
t ef
fect
ive
med
ia f
or d
isse
min
atin
g th
ese
mes
sage
s. T
he G
over
nmen
t
com
mun
icat
ions
gro
up s
houl
d ai
m t
o de
velo
p t
hese
mes
sage
s an
d di
ssem
inat
e
them
fro
m Q
2/20
05.
428
As
par
t of
the
soc
ial r
esp
onsi
bilit
y sc
hem
e (s
ee C
hap
ters
6 a
nd 7
), a
lcoh
ol p
rodu
cers
In
dust
ry
and
man
ufac
ture
rs w
ill b
e st
rong
ly e
ncou
rage
d to
add
mes
sage
s en
cour
agin
g
sens
ible
con
sum
ptio
n, a
long
side
uni
t co
nten
t, t
o th
e la
bels
of
its p
rodu
cts
in a
for
m
agre
ed w
ith t
he D
epar
tmen
t of
Hea
lth.
528
As
par
t of
the
soc
ial r
esp
onsi
bilit
y sc
hem
e (s
ee C
hap
ters
6 a
nd 7
), a
ll re
taile
rs o
f In
dust
ry
alco
hol,
both
on-
and
off-
licen
ce,
will
be
stro
ngly
enc
oura
ged
to d
isp
lay
info
rmat
ion
sett
ing
out
the
sens
ible
drin
king
mes
sage
and
exp
lain
ing
wha
t a
unit
is a
nd h
ow
it tr
ansl
ates
in p
ract
ical
ter
ms
to t
he d
rinks
sol
d.
Delivery and Implementation
81
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nLe
ad R
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ilit
yD
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AP
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EDU
CA
TIO
N A
ND
CO
MM
UN
ICA
TIO
N (
con
tin
ued
)
628
As
par
t of
the
soc
ial r
esp
onsi
bilit
y sc
hem
e (s
ee C
hap
ters
6 a
nd 7
), t
he a
lcoh
olIn
dust
ry
indu
stry
will
be
stro
ngly
enc
oura
ged
to d
isp
lay
a re
min
der
abou
t re
spon
sibl
e
drin
king
on
its a
dver
tisem
ents
.
728
From
Q2/
2004
, th
e D
epar
tmen
t of
Hea
lth w
ill w
ork
with
the
UK
Perm
anen
t D
HQ
2/20
04
Rep
rese
ntat
ion
to t
he E
urop
ean
Uni
on (
UKR
ep)
and
par
tner
s w
ithin
gov
ernm
ent
to
exam
ine
the
lega
l and
pra
ctic
al f
easi
bilit
y of
com
pul
sory
labe
lling
of
alco
holic
beve
rage
con
tain
ers.
830
By Q
3/20
07,
the
Dep
artm
ent
for
Educ
atio
n an
d Sk
ills
(in c
onsu
ltatio
n w
ith t
heD
fES
Q3/
2007
Dep
artm
ent
of H
ealth
and
the
Hom
e O
ffice
) w
ill u
se t
he f
indi
ngs
of t
he B
luep
rint
rese
arch
pro
gram
me
to e
nsur
e th
at f
utur
e p
rovi
sion
of
alco
hol e
duca
tion
in s
choo
ls
addr
esse
s at
titud
es a
nd b
ehav
iour
as
wel
l as
pro
vidi
ng in
form
atio
n.
930
This
will
be
com
ple
men
ted
by r
esea
rch
to r
evie
w t
he e
vide
nce
base
for
the
D
HQ
1/20
05
effe
ctiv
enes
s of
inte
rven
tions
on
alco
hol p
reve
ntio
n fo
r ch
ildre
n an
d yo
ung
peo
ple
both
insi
de a
nd o
utsi
de t
he s
choo
l set
ting
(incl
udin
g yo
uth
and
leis
ure
faci
litie
s).
This
res
earc
h sh
ould
be
led
by t
he D
epar
tmen
t of
Hea
lth,
in c
onsu
ltatio
n w
ith t
he
Dep
artm
ent
for
Educ
atio
n an
d Sk
ills,
the
Dep
artm
ent
for
Cul
ture
, M
edia
and
Sp
ort,
the
Hea
lth D
evel
opm
ent
Age
ncy,
and
oth
er a
pp
rop
riate
res
earc
h or
gani
satio
ns.
Rese
arch
will
be
com
ple
ted
by Q
1/20
05,
and
resu
lts d
isse
min
ated
the
reaf
ter.
10
31Th
e D
epar
tmen
t of
Hea
lth w
ill s
et u
p a
web
site
to
pro
vide
adv
ice
on t
he w
arni
ngD
HQ
1/20
05
sign
s of
alc
ohol
mis
use
and
how
to
hand
le e
mp
loye
es w
ho a
pp
ear
to h
ave
an
alco
hol p
robl
em.
This
will
be
esta
blis
hed
in c
onsu
ltatio
n w
ith t
he D
epar
tmen
t of
Trad
e an
d In
dust
ry,
the
Hea
lth a
nd S
afet
y Ex
ecut
ive,
the
Tra
des
Uni
ons
Con
gres
s,
the
Con
fede
ratio
n of
Brit
ish
Indu
stry
and
the
Fed
erat
ion
of S
mal
l Bus
ines
ses.
Alcohol
Harm R
eduction S
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for
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82
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ilit
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EDU
CA
TIO
N A
ND
CO
MM
UN
ICA
TIO
N (
con
tin
ued
)
The
site
will
als
o in
clud
e a
link
to a
dire
ctor
y of
ser
vice
s fo
r re
ferr
als
for
extr
a he
lp.
This
site
will
be
runn
ing
by Q
1/20
05.
11
31By
Q3/
2004
, H
ome
Offi
ce w
ill e
xten
d th
e sc
ope
of t
he N
atio
nal W
orkp
lace
Initi
ativ
e,
HO
Q3/
2004
whi
ch t
rain
s co
mp
any
rep
rese
ntat
ives
on
hand
ling
drug
use
in t
he w
orkp
lace
, to
incl
ude
alco
hol.
12
33O
fcom
will
ove
rsee
a f
unda
men
tal r
evie
w o
f th
e co
de r
ules
on
alco
hol a
dver
tisin
gO
fcom
Q4/
2004
an
d th
eir
enfo
rcem
ent.
The
rev
iew
will
foc
us in
par
ticul
ar o
n:
i)en
surin
g th
at a
dver
tisem
ents
do
not
targ
et u
nder
-18s
, an
d tig
hten
ing
the
pro
visi
ons
if ne
cess
ary;
ii)en
surin
g th
at a
dver
tisem
ents
do
not
enco
urag
e or
cel
ebra
te ir
resp
onsi
ble
beha
viou
r;
iii)
the
pot
entia
l of
adve
rtis
emen
ts t
o en
cour
age
alco
hol m
isus
e as
wel
l as
the
sim
ple
pot
entia
l to
caus
e of
fenc
e; a
nd
iv)
ensu
ring
that
, as
par
t of
its
wid
er d
uty
to p
ublic
ise
its r
emit,
Ofc
om e
nsur
es
pub
licity
for
the
reg
ulat
or’s
rol
e in
rel
atio
n to
bro
adca
st
adve
rtis
ing
and
com
pla
ints
.
Ofc
om w
ill c
onsu
lt st
akeh
olde
rs a
nd c
omp
lete
thi
s re
view
by
Q4/
2004
.
CH
AP
TER
5:
IDEN
TIF
ICA
TIO
N A
ND
TR
EAT
MEN
T
13
38Th
e D
epar
tmen
t of
Hea
lth (
DH
) w
ill s
tren
gthe
n th
e em
pha
sis
on t
he im
por
tanc
eD
HQ
2/20
04
of e
arly
iden
tific
atio
n of
alc
ohol
pro
blem
s th
roug
h co
mm
unic
atio
ns w
ith d
octo
rs,
nurs
es a
nd o
ther
hea
lth c
are
pro
fess
iona
ls.
DH
will
do
this
with
imm
edia
te e
ffect
.
14
38Th
e D
epar
tmen
t of
Hea
lth w
ill s
et u
p a
num
ber
of p
ilot
sche
mes
by
Q1/
2005
to
DH
Q1/
2005
test
how
bes
t to
use
a v
arie
ty o
f m
odel
s of
tar
gete
d sc
reen
ing
and
brie
f in
terv
entio
n in
prim
ary
and
seco
ndar
y he
alth
care
set
tings
, fo
cusi
ng p
artic
ular
ly o
n va
lue
for
mon
ey a
nd m
ains
trea
min
g.
Delivery and Implementation
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nLe
ad R
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ilit
yD
ate
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AP
TER
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IDEN
TIF
ICA
TIO
N A
ND
TR
EAT
MEN
T (
con
tin
ued
)
15
38Th
e D
eput
y C
hief
Med
ical
Offi
cer
for
Hea
lth Im
pro
vem
ent
and
the
Chi
ef N
ursi
ngD
HQ
3/20
04O
ffice
r w
ill a
ct a
s “t
rain
ing
cham
pio
ns”
to r
aise
the
pro
file
of m
edic
al a
nd n
urse
tr
aini
ng o
n al
coho
l iss
ues,
fro
m Q
3/20
04.
16
38Th
e D
epar
tmen
t of
Hea
lth w
ill w
ork
with
med
ical
and
nur
sing
col
lege
s an
d ot
her
DH
Q3/
2005
trai
ning
bod
ies
to d
evel
op t
rain
ing
mod
ules
on
alco
hol,
cove
ring
unde
rgra
duat
e,
pos
tgra
duat
e an
d m
edic
al c
urric
ula
and
upda
ted
regu
larly
, by
Q3/
2005
.
17
39Fr
om Q
2/20
04,
the
Dep
artm
ent
of H
ealth
will
wor
k w
ith t
he H
ome
Offi
ce,
the
DH
Q2/
2004
D
epar
tmen
t fo
r Ed
ucat
ion
and
Skill
s an
d th
e N
atio
nal T
reat
men
t A
genc
y to
dev
elop
gu
idan
ce w
ithin
the
Mod
els
of C
are
fram
ewor
k on
the
iden
tific
atio
n an
d ap
pro
pria
te r
efer
ral o
f al
coho
l mis
user
s.
18
41Th
e D
epar
tmen
t of
Hea
lth w
ill c
ondu
ct a
n au
dit
of t
he d
eman
d fo
r an
d p
rovi
sion
D
HQ
1/20
05of
alc
ohol
tre
atm
ent
in E
ngla
nd b
y Q
1/20
05.
The
audi
t w
ill p
rovi
de in
form
atio
n on
gap
s be
twee
n de
man
d an
d p
rovi
sion
of
trea
tmen
t se
rvic
es a
nd w
ill b
e us
ed a
s a
basi
s fo
r th
e D
epar
tmen
t of
Hea
lth t
o de
velo
p a
pro
gram
me
of im
pro
vem
ent
to
trea
tmen
t se
rvic
es.
19
41Th
e N
atio
nal T
reat
men
t A
genc
y (N
TA)
will
dra
w u
p a
“M
odel
s of
Car
e fr
amew
ork”
N
TAQ
4/20
04fo
r al
coho
l tre
atm
ent
serv
ices
, dr
awin
g on
the
alc
ohol
ele
men
t of
the
exi
stin
g M
odel
s of
Car
e fr
amew
ork.
It w
ould
look
to
the
Com
mis
sion
for
Hea
lthca
re
Aud
it an
d In
spec
tion(
CH
AI)
to
mon
itor
the
qua
lity
of t
reat
men
t se
rvic
es s
ubje
ct t
o th
e fo
rmul
atio
n of
sui
tabl
e cr
iteria
and
CH
AI's
wor
kloa
d ca
pab
ility
.
20
41Fr
om Q
2/20
04,
rem
aini
ng D
rug
Act
ion
Team
s w
ill b
e en
cour
aged
to
beco
me
HO
Q2/
2004
Dru
g an
d A
lcoh
ol A
ctio
n Te
ams
(or
othe
r lo
cal p
artn
ersh
ip a
rran
gem
ents
) to
as
sum
e gr
eate
r re
spon
sibi
lity
in c
omm
issi
onin
g an
d de
liver
ing
alco
hol t
reat
men
t se
rvic
es;
thou
gh t
heir
cap
acity
to
do s
o w
ill h
ave
to b
e ca
refu
lly c
onsi
dere
d.
Alcohol
Harm R
eduction S
trategy
for
England
84
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
5:
IDEN
TIF
ICA
TIO
N A
ND
TR
EAT
MEN
T (
con
tin
ued
)
21
43Fr
om Q
2/20
04,
the
Dep
artm
ent
of H
ealth
will
wor
k w
ith t
he H
ome
Offi
ce,
the
DH
Q2/
2004
Dep
artm
ent
for
Educ
atio
n an
d Sk
ills,
the
Offi
ce o
f th
e D
eput
y Pr
ime
Min
iste
r an
d th
e N
atio
nal T
reat
men
t A
genc
y to
dev
elop
gui
danc
e w
ithin
the
Mod
els
of C
are
fram
ewor
k on
inte
grat
ed c
are
pat
hway
s fo
r p
eop
le in
vul
nera
ble
circ
umst
ance
s,
such
as
peo
ple
with
men
tal i
llnes
s, r
ough
sle
eper
s, d
rug
user
s an
d so
me
youn
g p
eop
le.
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
22
50Th
e H
ome
Offi
ce w
ill c
onsu
lt an
d w
ork
with
the
pol
ice
and
the
cour
ts o
n H
OQ
2/20
04en
forc
ing
the
law
mor
e tig
htly
on
thos
e w
ho o
ffend
, fr
om Q
2/20
04.
We
will
:i)
enco
urag
e gr
eate
r us
e of
Fix
ed P
enal
ty N
otic
es (
FPN
s) t
o cl
amp
dow
n on
lo
w-le
vel d
runk
and
dis
orde
rly b
ehav
iour
suc
h as
noi
se a
nd u
rinat
ing
in p
ublic
;
ii)en
cour
age
grea
ter
use
of F
ixed
Pen
alty
Not
ices
for
a w
ider
ran
ge o
f of
fenc
es,
such
as
litte
ring,
and
for
bar
and
ret
ail s
taff
foun
d to
hav
e so
ld a
lcoh
ol
to t
hose
alre
ady
drun
k;
iii)
enco
urag
e fu
ll us
e of
pre
vent
ativ
e/p
rohi
bitiv
e m
easu
res
such
as
Acc
epta
ble
Beha
viou
r C
ontr
acts
and
ap
plic
atio
ns f
or A
nti-S
ocia
l Beh
avio
ur O
rder
s in
ap
pro
pria
te c
ases
to
tack
le u
nacc
epta
ble
beha
viou
r;
iv)
use
cond
ition
al c
autio
ns,
once
intr
oduc
ed,
as a
bas
is f
or d
irect
ly t
arge
ting
the
offe
nce
– lin
ked
to a
n ag
reem
ent
not
to f
req
uent
loca
l pub
s;
v)
look
at
mak
ing
mor
e us
e of
acc
redi
tatio
n sc
hem
es f
or n
on-p
olic
e st
aff
intr
oduc
ed u
nder
the
Pol
ice
Refo
rm A
ct 2
002.
The
se c
an im
pro
ve c
o-or
dina
tion
and
info
rmat
ion
shar
ing
with
the
pol
ice
and,
whe
re a
pp
rop
riate
, su
itabl
e p
eop
le
can
be a
ccre
dite
d to
use
a li
mite
d ra
nge
of p
olic
e p
ower
s –
for
exam
ple
, do
or
sup
ervi
sors
, w
ho w
ill b
e lic
ense
d by
the
Sec
urity
Indu
stry
Aut
horit
y, c
ould
als
o be
acc
redi
ted
by t
he p
olic
e; a
nd
Delivery and Implementation
85
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
(co
nti
nu
ted
)
22
50(c
ontin
ued)
vi)
enco
urag
e p
olic
e fo
rces
to
mak
e gr
eate
r us
e of
Com
mun
ity S
upp
ort
Offi
cers
at
nig
ht (
as w
ell a
s du
ring
the
day)
whe
re a
pp
rop
riate
, an
d co
nsul
t st
akeh
olde
rs
on e
xten
ding
the
ir p
ower
s to
enf
orce
lice
nsin
g of
fenc
es.
23
50Th
roug
h th
e Po
lice
Stan
dard
s U
nit
the
Hom
e O
ffice
will
:H
Oi)
Q4/
2004
i) de
velo
p a
pro
gram
me
to r
educ
e vi
olen
ce in
the
key
vio
lent
crim
e ar
eas
in
ii) Q
2/20
04En
glan
d an
d W
ales
with
par
ticul
ar e
mp
hasi
s on
alc
ohol
-rel
ated
vio
lent
crim
e,
iii)
Q4/
2004
by Q
4/20
04 ;
ii)
iden
tify
and
spre
ad g
ood
pra
ctic
e in
loca
l pol
icin
g st
rate
gies
and
tac
tics
whi
ch t
ackl
e al
coho
l-rel
ated
vio
lenc
e, b
y Q
2/20
04;
and
iii)
cont
ribut
e to
a c
once
rted
mar
ketin
g ca
mp
aign
and
re-
enfo
rcin
g ke
y m
essa
ges
to a
ll m
ajor
sta
keho
lder
s th
at o
per
atin
g ou
tsid
e th
e la
w w
ill
not
be t
oler
ated
, p
artic
ular
ly w
here
juve
nile
s an
d yo
ung-
peo
ple
are
co
ncer
ned,
by
Q4/
2004
.
24
50Th
e H
ome
Offi
ce w
ill e
stab
lish
a sm
all w
orki
ng g
roup
, in
clud
ing
rep
rese
ntat
ives
HO
Q2/
2004
fr
om o
utsi
de G
over
nmen
t, t
o lo
ok a
t w
heth
er a
ny a
dditi
onal
mea
sure
s ar
e re
qui
red
to e
ffect
ivel
y cl
amp
dow
n on
tho
se r
esp
onsi
ble
for
alco
hol-f
uelle
d di
sord
er,
par
ticul
arly
in c
ity c
entr
es.
This
gro
up w
ill in
clud
e re
pre
sent
ativ
es f
rom
the
p
olic
e an
d or
gani
satio
ns w
ith a
n in
tere
st a
nd w
ill r
epor
t by
Q2/
2004
whe
ther
an
y ad
ditio
nal t
arge
ted
mea
sure
s m
ay b
e re
qui
red.
25
53G
over
nmen
t w
ill c
onsu
lt w
ith t
he in
dust
ry o
n th
e in
trod
uctio
n of
a t
wo-
par
t G
over
nmen
t an
d Q
1/20
05vo
lunt
ary
soci
al r
esp
onsi
bilit
y sc
hem
e fo
r al
coho
l ret
aile
rs.
This
will
(i)
stre
ngth
en
indu
stry
(re
taile
rs)
indu
stry
foc
us o
n go
od p
ract
ice
and,
(ii)
whe
re n
eces
sary
, se
ek a
fin
anci
al
cont
ribut
ion
from
the
indu
stry
tow
ards
the
har
ms
caus
ed b
y ex
cess
ive
drin
king
.
Alcohol
Harm R
eduction S
trategy
for
England
86
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
(co
nti
nu
ted
)
25
53(c
ontin
ued)
The
sche
me
will
be
volu
ntar
y in
the
firs
t in
stan
ce a
nd s
houl
d be
est
ablis
hed
in
par
ticip
atin
g ar
eas
by Q
1/20
05.
The
succ
ess
of t
he v
olun
tary
ap
pro
ach
will
be
revi
ewed
ear
ly in
the
nex
t p
arlia
men
t.If
indu
stry
act
ions
are
not
beg
inni
ng t
o m
ake
an im
pac
t in
red
ucin
g ha
rms,
G
over
nmen
t w
ill a
sses
s th
e ca
se f
or a
dditi
onal
ste
ps,
incl
udin
g p
ossi
bly
legi
slat
ion.
26
56Th
e O
ffice
of
the
Dep
uty
Prim
e M
inis
ter
will
pro
vide
gui
danc
e to
all
loca
l O
DPM
Q3/
2004
auth
oriti
es in
Eng
land
on
man
agin
g th
e ni
ght-
time
econ
omy
as p
art
of e
xist
ing
loca
l str
ateg
ies,
by
Q3/
2004
.
27
56Th
e H
ome
Offi
ce w
ill s
erve
as
the
focu
s of
goo
d p
ract
ice
on a
lcoh
ol-r
elat
ed
HO
Q4/
2004
crim
e an
d di
sord
er a
nd w
ill c
o-or
dina
te a
cro
ss-g
over
nmen
tal a
pp
roac
h by
Q
4/20
04.
It w
ill d
o so
by
pro
vidi
ng a
too
lkit
for
tack
ling
issu
es a
nd a
ct a
s a
sour
ce o
f ad
vice
, co
nsul
tanc
y an
d tr
aini
ng.
It w
ill a
chie
ve t
his
by w
orki
ng
clos
ely
with
:
i)th
e Im
pro
vem
ent
and
Dev
elop
men
t A
genc
y to
dis
sem
inat
e ch
ange
in
man
agem
ent
pra
ctic
e;
ii)th
e A
nti-S
ocia
l Beh
avio
ur U
nit
to e
nsur
e th
at g
ood
pra
ctic
e on
the
gro
und
is r
apid
ly d
isse
min
ated
; an
d
iii)
Gov
ernm
ent
Offi
ces
to id
entif
y ar
eas
of g
ood
pra
ctic
e (w
e se
e m
erit
in
iden
tifyi
ng t
en t
railb
laze
r ar
eas
to t
est
out
app
roac
hes)
.
It w
ill b
e im
por
tant
to
co-o
rdin
ate
good
pra
ctic
e ac
ross
the
se a
reas
to
min
imis
e bu
reau
crac
y.
28
56Th
e Re
gion
al C
o-or
dina
tion
Uni
t w
ill e
nsur
e th
at a
reas
with
alc
ohol
-rel
ated
RC
UQ
4/20
04p
robl
ems
are
taki
ng a
ctio
n to
tac
kle
them
by
aski
ng G
over
nmen
t O
ffice
s to
iden
tify
Delivery and Implementation
87
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
(co
nti
nu
ted
)
28
56(c
ontin
ued)
area
s an
d w
ork
with
the
ir C
rime
and
Dis
orde
r Re
duct
ion
Part
ners
hip
s t
o de
velo
p
app
roac
hes
as p
art
of e
xist
ing
stra
tegi
es:
this
sho
uld
be c
omp
lete
d by
Q4/
2004
.
29
56O
ne o
f th
e ob
ject
ives
of
the
Lice
nsin
g A
ct is
to
redu
ce a
lcoh
ol-r
elat
ed d
isor
der.
HO
, D
CM
S, O
DPM
Q4/
2006
So
eva
luat
ion
of t
he A
ct is
cru
cial
: th
e H
ome
Offi
ce a
nd t
he D
epar
tmen
t fo
r C
ultu
re,
Med
ia a
nd S
por
t w
ill w
ork
to e
nsur
e th
is h
app
ens.
The
Offi
ce o
f th
e D
eput
y Pr
ime
Min
iste
r w
ill a
lso
com
mis
sion
a s
tudy
to
rep
ort
by Q
4/20
06 t
o lo
ok
at t
he c
osts
for
loca
l aut
horit
ies
asso
ciat
ed w
ith t
he in
trod
uctio
n of
the
Li
cens
ing
Act
and
how
it is
wor
king
alo
ngsi
de t
he o
ther
mea
sure
s w
e ha
ve o
utlin
ed:
this
will
hel
p G
over
nmen
t to
dec
ide
whe
ther
reg
ulat
ion
is n
eede
d.
30
60U
nder
the
Lic
ensi
ng A
ct 2
003
selli
ng t
o un
der-
18s
can
alre
ady
lead
to
an a
utom
atic
H
OQ
2/20
04re
que
st f
or a
lice
nce
revi
ew.
From
Q2/
2004
, H
ome
Offi
ce w
ill b
uild
on
this
, lo
okin
g at
mea
sure
s to
sec
ure
tight
er e
nfor
cem
ent
of e
xist
ing
pol
icie
s of
not
sel
ling
to
unde
r-18
s, c
onsu
lting
with
the
pol
ice,
the
cou
rts,
and
with
you
ng p
eop
le:
i)en
surin
g th
at f
ull u
se is
mad
e of
exi
stin
g p
ower
s to
tac
kle
unde
r-ag
e dr
inki
ng,
incl
udin
g te
st p
urch
asin
g, a
nd,
whe
re t
here
is a
nti-s
ocia
l beh
avio
ur li
nked
to
alc
ohol
, ap
plic
atio
ns f
or p
reve
ntat
ive/
pro
hibi
tive
mea
sure
s su
ch a
sA
nti-S
ocia
l Beh
avio
ur O
rder
s;ii)
we
will
incl
ude
pow
ers
to t
ackl
e sa
les
to u
nder
-18s
as
par
t of
our
con
sulta
tion
on n
ew p
ower
s fo
r C
omm
unity
Sup
por
t O
ffice
rs;
iii)
we
will
con
sult
with
the
pol
ice
on m
akin
g m
ore
use
of p
ower
s to
tar
get
pro
blem
pre
mis
es;
iv)
Fixe
d Pe
nalty
Not
ices
for
dis
orde
r ar
e be
ing
rolle
d ou
t in
Eng
land
and
Wal
es f
rom
Janu
ary
2004
, al
low
ing
a m
ore
dire
ct r
esp
onse
to
alco
hol-r
elat
eddi
sord
er;
and
Alcohol
Harm R
eduction S
trategy
for
England
88
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
(co
nti
nu
ted
)
30
60(c
ontin
ued)
v)w
e w
ill c
onsi
der
intr
oduc
ing
Fixe
d Pe
nalty
Not
ices
for
bar
sta
ff w
ho s
ell t
o un
der-
18s.
31
60Th
e so
cial
res
pon
sibi
lity
sche
me
for
alco
hol r
etai
lers
(se
e se
ctio
n 6.
1)
Indu
stry
will
str
ongl
y en
cour
age:
i) be
tter
tra
inin
g fo
r st
aff;
and
ii)
an e
xpec
tatio
n th
at a
ll p
rem
ises
with
a li
cenc
e, o
n an
d of
f li
cenc
e, w
ill
mak
e it
clea
r th
ey d
o no
t se
ll to
or
for
unde
r-18
s –
for
exam
ple
, by
a c
lear
ly
disp
laye
d p
oste
r –
and
that
iden
tity
will
be
soug
ht a
s a
mat
ter
of c
ours
e,
build
ing
on t
he p
rovi
sion
s of
the
Lic
ensi
ng A
ct.
Reta
ilers
will
be
enco
urag
ed
to a
sk f
or a
PA
SS c
ard,
pas
spor
ts o
r dr
ivin
g lic
ence
s if
in d
oubt
.
32
62Th
e H
ome
Offi
ce a
nd t
he D
epar
tmen
t of
Hea
lth w
ill:
HO
, D
HQ
4/20
07
i) co
nsid
er e
stab
lishi
ng p
ilot
arre
st r
efer
ral s
chem
es f
or e
valu
atio
n w
ith a
n ai
m
of h
avin
g cl
ear
emer
ging
con
clus
ions
by
Q4/
2007
; an
d
ii)
enco
urag
e C
rime
and
Dis
orde
r Re
duct
ion
Part
ners
hip
s to
wor
k w
ith L
ocal
Crim
inal
Just
ice
Boar
ds t
o im
ple
men
t th
e co
nclu
sion
s of
tho
se s
chem
es if
ther
e is
a c
lear
cas
e fo
r ef
fect
iven
ess.
33
62Th
e H
ome
Offi
ce,
the
Dep
artm
ent
of H
ealth
and
the
Offi
ce o
f th
e D
eput
y H
O,
DH
, O
DPM
Q4/
2007
Prim
e M
inis
ter
will
con
side
r co
mm
issi
onin
g re
sear
ch t
o re
por
t by
Q4/
2007
to
exp
lore
the
effe
ctiv
enes
s of
div
ersi
on s
chem
es in
pro
tect
ing
rep
eat
offe
nder
s
and
com
batin
g al
coho
l mis
use
amon
g th
ese
offe
nder
s.
34
62C
rime
and
Dis
orde
r Re
duct
ion
Part
ners
hip
s w
ill b
uild
the
res
ults
of
this
res
earc
h H
OQ
4/20
07
into
the
ir p
lans
if t
here
is a
cle
ar c
ase
for
effe
ctiv
enes
s (f
rom
Q4/
2007
).
Delivery and Implementation
89
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
6:
ALC
OH
OL-
REL
AT
ED C
RIM
E A
ND
DIS
OR
DER
(co
nti
nu
ted
)
35
64Th
e H
ome
Offi
ce a
nd t
he D
epar
tmen
t of
Hea
lth w
ill,
from
Q2/
2004
:H
O,
DH
Q2/
2004
i)en
sure
tha
t th
e w
ork
to d
evel
op t
he M
odel
s of
Car
e co
mm
issi
onin
g fr
amew
ork
take
s ac
coun
t of
the
nee
d to
ens
ure
that
per
pet
rato
rs a
nd v
ictim
s of
dom
estic
viol
ence
rec
eive
hel
p f
rom
bot
h do
mes
tic v
iole
nce
and
alco
hol t
reat
men
t
serv
ices
, as
ap
pro
pria
te t
o th
eir
need
s;
ii)
exp
lore
the
pot
entia
l for
par
tner
ship
s w
ith a
lcoh
ol p
rodu
cers
and
sel
lers
to
pro
mot
e ke
y m
essa
ges
– fo
r ex
amp
le,
help
line
num
bers
to
vict
ims
and
the
mes
sage
tha
t do
mes
tic v
iole
nce
is u
nacc
epta
ble
to p
erp
etra
tors
; an
d
iii)
enco
urag
e lo
cal p
artn
ersh
ips
to c
onsi
der
usin
g m
oney
fro
m t
he F
und
(des
crib
ed
in s
ectio
n 6.
1) t
o su
pp
ort
loca
l dom
estic
vio
lenc
e p
roje
cts
and
sup
por
t se
rvic
es.
36
66A
lthou
gh p
olic
ies
have
wor
ked
very
wel
l, th
e D
epar
tmen
t fo
r Tr
ansp
ort
will
mon
itor
DfT
Q2/
2004
clos
ely
tren
ds w
hich
are
giv
ing
caus
e fo
r co
ncer
n an
d co
nsid
er w
heth
er m
ore
shou
ld
be d
one
to t
arge
t 18
-25
year
old
s, e
spec
ially
[fr
om Q
2/20
04].
37
66A
s p
art
of t
he p
rop
osed
soc
ial r
esp
onsi
bilit
y sc
hem
e, t
he in
dust
ry w
ill b
e en
cour
aged
Ind
ustr
y
to m
ake
mor
e p
rom
inen
t us
e of
the
exi
stin
g “I
’ll b
e D
es”
sche
me
and
to d
isp
lay
info
rmat
ion
abou
t dr
inki
ng a
nd d
rivin
g
CH
AP
TER
7:
SUP
PLY
AN
D I
ND
UST
RY
RES
PO
NSI
BIL
ITY
38
71G
over
nmen
t w
ill c
onsu
lt w
ith t
he in
dust
ry o
n th
e in
trod
uctio
n of
a t
hree
-par
t G
over
nmen
t an
dQ
1/20
05vo
lunt
ary
soci
al r
esp
onsi
bilit
y sc
hem
e fo
r al
coho
l pro
duce
rs.
This
will
(i)
stre
ngth
en
indu
stry
(p
rodu
cers
)in
dust
ry f
ocus
on
good
pra
ctic
e, (
ii) s
eek
a fin
anci
al c
ontr
ibut
ion
from
the
indu
stry
to
war
ds t
he h
arm
s ca
used
by
exce
ssiv
e dr
inki
ng,
and
(iii)
enco
urag
e p
rodu
cers
to
pro
mot
e go
od p
ract
ice
dow
n th
e su
pp
ly c
hain
. Th
e sc
hem
e w
ill b
e vo
lunt
ary
in t
he
first
inst
ance
and
sho
uld
be e
stab
lishe
d by
Q1/
2005
.
The
succ
ess
of t
he v
olun
tary
ap
pro
ach
will
be
revi
ewed
ear
ly in
the
nex
t p
arlia
men
t.
Alcohol
Harm R
eduction S
trategy
for
England
90
No
Pag
eA
ctio
nLe
ad R
esp
on
sib
ilit
yD
ate
CH
AP
TER
7:
SUP
PLY
AN
D I
ND
UST
RY
RES
PO
NSB
ILIT
Y (
con
tin
ued
)
38
71If
indu
stry
act
ions
are
not
beg
inni
ng t
o m
ake
an im
pac
t in
red
ucin
g ha
rms,
G
over
nmen
t w
ill a
sses
s th
e ca
se f
or a
dditi
onal
ste
ps,
incl
udin
g p
ossi
bly
legi
slat
ion.
CH
AP
TER
8:
DEL
IVER
Y A
ND
IM
PLE
MEN
TAT
ION
39
74Th
e M
inis
ter
of S
tate
for
Pol
icin
g an
d C
rime
Redu
ctio
n (H
ome
Offi
ce)
and
the
HO
, D
HQ
2/20
04Pa
rliam
enta
ry U
nder
-Sec
reta
ry o
f St
ate
for
Publ
ic H
ealth
(D
epar
tmen
t of
Hea
lth)
will
ass
ume
join
t re
spon
sibi
lity
for
deliv
ery
of t
he s
trat
egy
[fro
m Q
2/20
04]:
i) th
ey s
houl
d re
por
t q
uart
erly
to
an a
pp
rop
riate
Cab
inet
;
ii)
the
Cab
inet
Com
mitt
ee w
ill b
e su
pp
orte
d by
reg
ular
mee
tings
of
desi
gnat
ed
offic
ials
fro
m W
hite
hall
dep
artm
ents
with
an
inte
rest
to
ensu
re b
ette
r co
-ord
inat
ion
of p
olic
y, c
omm
unic
atio
ns a
nd r
esea
rch.
Thi
s w
ill b
e or
gani
sed
by D
H a
nd H
O o
ffici
als
and
chai
red
alte
rnat
ely
by t
he t
wo
min
iste
rs;
and
iii)
an e
xter
nal s
take
hold
er g
roup
will
be
crea
ted
to b
ring
an o
utsi
de
per
spec
tive
and
serv
e as
a s
ound
ing-
boar
d fo
r in
itiat
ives
.
40
76G
over
nmen
t w
ill h
ave
a cl
ear
com
mitm
ent
to d
eliv
er a
n ov
er-a
rchi
ng a
lcoh
ol h
arm
re
duct
ion
stra
tegy
fro
m Q
2/20
04.
This
will
be:
i) as
sess
ed a
gain
st in
dica
tors
of
pro
gres
s fo
r th
e fo
ur k
ey h
arm
s id
entif
ied;
ii)
set
agai
nst
a cl
ear
base
line;
iii)
sup
por
ted
by b
ette
r co
-ord
inat
ion
of r
esea
rch;
and
iv)
regu
larly
mon
itore
d.H
O,
DH
Q2/
2004
41
79Fr
om Q
2/20
04,
whe
re a
pp
rop
riate
to
loca
l nee
d, C
rime
and
Dis
orde
r Re
duct
ion
HO
Q2/
2004
Part
ners
hip
s –
incl
udin
g re
pre
sent
atio
n fr
om t
he lo
cal P
rimar
y C
are
Trus
t –
will
p
rovi
de a
co-
ordi
natin
g bo
dy f
or a
gree
ing
loca
l prio
ritie
s an
d de
term
inin
g fu
ture
dire
ctio
n. W
e w
ill n
ot b
e se
ekin
g co
mp
ulso
ry s
trat
egie
s fr
om lo
cal a
utho
ritie
s,
but
exp
ect
to s
ee m
easu
res
for
tack
ling
alco
hol m
isus
e em
bedd
ed w
ithin
exi
stin
g st
rate
gic
fram
ewor
ks.
Gov
ernm
ent
Offi
ces
will
wor
k w
ith a
reas
tha
t ha
ve id
entif
ied
par
ticul
ar is
sues
.
Strategy Unit, Admiralty Arch, The Mall, London SW1A 2WH
Tel: 020 7276 1881Email: [email protected]: www.strategy.gov.uk
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