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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

Wine

Spirits

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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)

4.7m(m=1.6mw=3.1m)

LOW TO MODERATEDRINKING

(0-14/21 units per wk)

26.3m(m=12.1mw=14.2m)

ABOVE DAILYGUIDELINES

(4-8/3.6 units max.daily in past wk)

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(8+/6+ units max.daily in past wk)

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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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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Education and Communication

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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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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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• 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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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; andthere 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.


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.


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

eduction S

trategy

for

England

78

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.


79

Alcohol

Harm R

eduction S

trategy

for

England

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Alcohol

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for

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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


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


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

).


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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