‘It’s not going to go away, that’s the main thing,’ says Alcohol Concern chief executive Eric Appleby of minimum unit pricing, following its much-anticipated non-appearance in last month’s Queen’s Speech (see news story, page 4). ‘I think, ultimately, we will get something like minimum pricing, but it’s clearly not going to be in the next six months.’
Alcohol policy is now at a point where there is a general understanding that action along those lines is necessary, he believes. ‘If you look at the 2012 [alcohol] strategy, that’s a step up from previous ones in that it does acknowledge the need for some population measures. All the evidence shows that price and availability are the key issues when it comes to reducing, not just consumption, but harm, and certainly those of us whose job it is to campaign on these things are not going to let them forget that. There’s still all to play for, really.’’
It will be a tough battle, however, as the ‘resources and power’ of the industry are huge, he acknowledges. While Scotland may be over the first legal hurdle in terms of implementing a minimum price, the industry has inevitably warned that it will be the first of many.
So what’s the best way to counter the industry’s influence – is it to just keep plugging away at the public health message? ‘You try to put the public health argument as strongly as you can but it’s tough, because it’s a general message rather than a very specific one,’ he says. ‘I think you just have to continue to point out that the industry has a vested interest. Whatever else they say, their legal duty is to make profits for their shareholders, and they do that by selling more booze. And governments have to be realistic in this and not involve the industry in policy making.’
He cites the recent statement from the World Health Organization (DDN, April, page 5) as one that government should heed – that the industry can ‘have a role in perhaps mopping up some of the problems they cause, but that shouldn’t be about them picking and choosing what they do,’ he says. ‘They need to put money into something like a blind trust to help deal with some of the consequences, but it should be up to the public health community and treatment services to decide what works best and what needs to be done.’
A new problem seems to have emerged, meanwhile, in the shape of Nigel Farage and UKIP. ASH has already cited them as perhaps part of the reason a government increasingly wary of being seen as ‘anti’ alcohol and tobacco dropped plans for plain cigarette packaging. Does Appleby think this is a real issue?
‘I think it is,’ he says. ‘Whether it was a factor in that particular decision, I’m less sure, but I think it is a factor. You’ve always got this iconic image of him with a pint in his hand, supposed to symbolise your average punter. A lot of that is to do with this idea of the public wanting politicians who look like real people instead of people who’ve just come through a political machine, and I think that is of some significance. It’s certainly going to make governments more nervous about taking measures on drinking.’
A key problem, he acknowledges, is that although campaigners have been very clear about how minimum pricing would target ‘a limited number of drinks that are sold very cheaply, largely in supermarkets’ – with no impact on the pub trade – getting that message across to a general public who, understandably, ‘aren’t engaged with the detailed niceties of policy,’ is tough. ‘We just have to keep making the point that it’s a very targeted measure about addressing harm – it’s not about telling everybody what they should do,’ he says.
When the alcohol strategy was published last year, Alcohol Concern stressed the need for more funding for treatment and advice services alongside action on price and marketing. How worried is he that alcohol won’t get the money if it’s not seen as a priority locally?
‘I think that’s all very much up for grabs,’ he states. ‘Theoretically, moving public health and alcohol into local authorities so it joins up with things like licensing and social care ought to be a very good move. Local authorities are, by and large, saying alcohol is a priority, but we’ve seen this before and we know that when it comes to the crunch, a) the money is short and b) they’re not experienced in commissioning alcohol services, don’t necessarily know an awful lot about it and perhaps don’t appreciate how the whole pathway thing works.’
While the drug sector is also concerned about loss of investment – and perhaps some of it potentially shifting to alcohol – there’s a danger that local authorities will ‘confuse and conflate’ the two, he says, and although there is a good deal of overlap between drug and alcohol services, it’s the differences that are key.
‘The early pathway of an alcohol career, if you like, is usually different to the pathway of a drug user – the nature of alcohol, the ubiquity of it, the different pressures in terms of socialising, all that sort of stuff you’ve got to provide for and try to get early interventions to stop people getting too far down the line,’ he says. ‘Obviously when you get to the dependent stage it’s very much the same, but at that early stage it’s a bit different and they need to understand the nuances of that. The worry is they’ll have neither the time nor the resources, because they’ve got a hell of a lot of other stuff on their plate as well.’
The sector needs to engage with local commissioners as far as possible, and give them ‘a sense of the spectrum of alcohol treatment’, he says. ‘Make sure they understand that you save money by putting that continuum of services in place – if you just put your money into the far end of it, you’re going to be spending a lot more than you need to. Obviously, identification and brief advice [IBA] is important, but there’s that tranche of people who are beyond IBA but aren’t severely dependent yet – there’s a lot to be achieved in that mild dependency area.’
This is his second stint as head of Alcohol Concern, having joined in the late 1980s as director of services and professional education, following a period setting up adult literacy schemes in the community. ‘The job was about trying to develop new local and community-based services, so in a sense the crossover was more about community services than it was specifically about alcohol,’ he says.
‘I didn’t start out with any sort of crusade. I recognised there was a problem but the more you get involved with it, the more you realise what a big issue it is. When it looked like I might actually get the job there was that thing of “do I want be seen as a professional killjoy?” but you do the job for about a week and you realise that you’re certainly not going to apologise for anything like that, because of the massive amount of harm and misery being caused out there.’
He ended up staying for 14 years, the result of nothing else seeming ‘as interesting, or with as many dimensions to it, or so important’. He’s now back as interim chief executive, a part-time post that’s partially the result of the organisation, like many charities, taking a major funding hit in recent years.
‘The world had changed and Alcohol Concern needed to change with it,’ he says. ‘My job is to set us up with a long-term sustainable future, and we’re well on the way to that. When I was last here we had just under 40 staff and now we have 11, so we have to be much more focused on trying to achieve change.’
While the organisation may be different, in terms of the wider policy field perhaps less has changed, he says. ‘There’s a lot of talk about alcohol policy and still nothing much gets delivered. But, on the other hand, I do think that having a focal point for campaigning – minimum pricing – has been important, because it’s provided the rallying point for those with an interest to come together and have a coherent and consistent voice.’
There are also many more bodies getting involved in the alcohol debate, he points out. ‘The Alcohol Health Alliance is made up of 30-odd organisations, and there’s a much more concerted and persistent interest in alcohol among children’s charities as well, for example. It is gaining depth, and part of the job is that we make sure that campaigning is coordinated and coherent.
‘Because governments like nothing more than a whole bunch of different people saying different things to them. It gives them an excuse to do nothing.’ DDN