Out of commission

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With the government’s long-awaited alcohol strategy showing no signs of materialising any time soon, the newly launched Commission on Alcohol Harm is hoping to fill in some of the gaps.

Read the full article in DDN Magazine

Alcohol related harm cost
The government estimates that alcohol related harm costs the NHS £3.5 billion a year.

It’s estimated that alcohol harm costs the NHS around £3.5bn a year, with alcohol-related hospital admissions up 20 per cent in a decade (see news, page 5). The cost to the wider economy, meanwhile, is thought to be anything up to £21bn, all of which makes it odd that we’ve had no new alcohol strategy since 2012 (DDN, April 2012, page 4).

In response to this, a new Commission on Alcohol Harm has been launched by the Alcohol Health Alliance (AHA) (see news, page 4). The commission will hold three oral evidence sessions across the country, with these and submitted written evidence feeding into a wide-ranging report.

‘I think it’s time to re-focus the public’s attention,’ AHA chair Professor Sir Ian Gilmore tells DDN. ‘The lack of a strategy is really harming the nation, and it’s timely in terms of the pressures on the NHS.’

AHA chair Professor Sir Ian Gilmore
AHA chair Professor Sir Ian Gilmore

While A&E departments used to feel the impact on Saturday nights, it’s now every night of the week, he says. ‘Then there are the chronic conditions and the links to cancer that maybe weren’t so evident when the evidence was last reviewed. I think the spotlight also needs to be put more on areas that are traditionally less well known, like domestic violence, children of alcohol-dependent parents, and foetal alcohol spectrum disorder. I think it’s time to look beyond the usual harms.’

The commission will make recommendations across the board, and not just about prevention – its scope also includes treatment services, which are ‘of major concern’, he says. ‘But in terms of prevention we wish to be evidence-based, and the evidence is around price, availability and marketing.’

When it comes to marketing, two areas that are perhaps ripe for reform are social media and the current system of self-regulation around labelling. ‘While the government hasn’t been receptive to regulation I think they are concerned about digital marketing and protecting children, and alcohol falls very much into that category – so we’ll certainly be making the case around the digital world,’ he says. ‘But also self-regulation doesn’t seem to work, and I think that’s something that’s likely to come out of the commission.’

Any effective alcohol strategy will need to address price, and one thing it’s easy to forget it is that the 2012 strategy did actually contain a commitment to minimum unit pricing (MUP). While that’s now in place in Scotland – albeit after a lengthy battle – and Wales, we’re still yet to see it in England. Gilmore believes the introduction of some sort of floor price is only a matter of time, however.

‘I think the evidence is overwhelming that price is the single biggest determinant of how much communities drink,’ he says. ‘There isn’t just one mechanism of tackling price, and I think the huge benefit of MUP is that it hits the cheapest drinks. Products like white cider have almost disappeared in Scotland since MUP, and very few moderate drinkers drink white cider – it tends to be the most vulnerable. So minimum unit price is certainly on our agenda as an important priority, in partnership with duty.’

The drinks industry’s first response ‘is always, “It’s nothing to do with price, we need to change the culture”’, he says. ‘But my response to that is the biggest change in culture in the last 20 years has been going from a country that drinks in pubs and bars to a country that drinks at home. About eighty per cent of alcoholic drinks except beer are drunk at home, and even beer is 50-50 whereas it used to be consumed overwhelmingly in pubs. That’s been driven by cheap supermarket drink.’

Access to treatment, meanwhile, is ‘worryingly inadequate’, he says, ‘and our impression is that it’s getting worse rather than better. Services are getting more fragmented and often put out to the lowest tender, and while I understand the reasons for moving public health into local government there have been casualties from that in funding terms.’

So what are his hopes for the commission? ‘What will we achieve? I don’t know. But we know from experience that we won’t achieve anything if we don’t try, and we think the time is right. The lack of government commitment, the evidence of real progress in Scotland, the pressures on the NHS – they all make the commission a timely exercise.’