Drink smart DDN hears about the results from three city-wide schemes aimed at reducing the supply of high strength beers and ciders Ipswich Simon Aalders, public health engagement manager, Suffolk Public Health The Ipswich ‘reducing the strength’ scheme was piloted in 2011, then launched in September 2012. Ipswich had 75 street drinkers and 40 per cent of violent crime was alcohol-related. Street drinkers were involved in almost daily call outs for anti-social behaviour. There were four murders in 18 months within the group, and street drinkers were suffering ill health from high alcohol consumption. The Constabulary, East of England Co-operative Society, Ipswich Borough Council, Suffolk County Council, homeless charities, drug and alcohol treatment agencies, street drinkers and the community have been essential to the campaign. The Licensing Committee supports the voluntary nature of the scheme and considers evidence regarding breaches of licensing conditions. Successes in Ipswich By December 2014, 100 out of 148 alcohol retailers in Ipswich had signed up to ‘reducing the strength’, up from 53 at launch. The East of England Co-op was a trailblazer, removing products above 6.5 per cent ABV. They experienced no loss of income. By March 2015, the street drinking group reduced from 75 to 14. Many accessed treatment, accommodation or returned to their local area. Antisocial behaviour dropped by up to 75 per cent. Crime is almost non-existent amongst the group. Our evaluation reports shows no loss of income for local traders who have signed up. The key principles to success are: increasing enforcement; reducing supply; and improving routes out of street drinking. Lisa’s experience Lisa is 39. After her mother died, her marriage broke down. She became alcohol-dependent and homeless. Her sons were taken in by family. Lisa was drinking three litres of super strength cider or ten cans of super strength lager everyday. Lisa developed diabetes, her liver function worsened and she has an alcohol-related skin condition. With treatment and support, Lisa achieved sobriety. She was housed and attended a NORCAS recovery programme, supported by the Anglia Care Trust and the police. She re-established contact with her sons. ‘I fully support ‘reducing the strength’. I was drinking huge quantities to block out my pain. I don’t want other people to suffer the serious effects from super strength alcohol. It can ruin your life,’ says Lisa. Challenges in Ipswich One retailer had many street drinkers as customers. Despite shoplifting and abuse, he resisted the scheme fearing loss of earnings. He was observed breaching his licensing regulations, selling alcohol to intoxicated people. He agreed to a voluntary removal of cheap strong alcohol, resulting in reduced disturbance and no profit loss. The main challenge now is that people think the problem is solved. The worst outcome would be for Ipswich shops to stock these products again, leading to an increase in street drinkers. We have established the Start Afresh group to maintain momentum. Brighton Jesse Wilde, senior business and partnership manager, Equinox Brighton ‘he Brighton ‘sensible on strength’ scheme started in November 2013. The worst hotspot had up to two-dozen street drinkers, with incidents of anti-social behaviour. Equinox Brighton’s street drinking audit in July 2013 counted 93 street drinkers over one week. Before ‘sensible on strength’, we regularly saw people consuming alcohol up to 9 per cent ABV. The key partners are Brighton and Hove City Council public health, Equinox Brighton, Sussex Police, street drinkers and alcohol retailers. Since the launch, St James St MACE have reported a ’better working environment, increased profits and new customers who had previously been put off’. Sainsbury’s and the local licensees association are part of the Alcohol Programme Board and have been supportive. Some other national chains have resisted the scheme because the products are legal. We are now at a critical point in Brighton, where many retailers have signed up, but some key off licences are holding out. Tim Nichols, head of regulatory services, Brighton and Hove City Council public health Brighton and Hove City Council’s Licensing Authority launched ‘sensible on strength’ to reduce the availability of cheap super-strength beers and ciders. We now have 123 retailers signed up. 82 per cent of high profile street drinkers have moved to alcohol below 6 per cent ABV. More clients are engaging with treatment centres, and the scheme is breaking up hotspot drinking areas. We have received significant positive feedback including from businesses on improved trading environments and from health professionals. Equinox Brighton’s street drinking audit in July 2014 showed a 22 per cent reduction in street drinking since the previous summer. ‘Sensible on strength’ was a key factor in this. Dr Tim Worthley, lead GP, Brighton Homeless Healthcare I care for many of the most entrenched street drinkers. We strive to combat the problems of severe alcohol dependence on the individual and the community. Despite our best efforts, a significant number of our patients die young each year due to alcohol dependence. I am consistently told by my patients that it is now much harder to obtain high strength lager and cider. Many now drink lower strength alcohol. This has reduced their number of seizures, their ‘confusional state’, and improved their liver function. They are now more able to access general medical care and care specific to their alcohol dependence. In my professional opinion, ‘sensible on strength’ has been one of the most significant public health measures in Brighton in recent times. Portsmouth Robert Anderson-Weaver, community safety project officer, Portsmouth City Council Portsmouth’s ‘reducing the strength’ campaign launched in November 2013. Groundwork started in September 2013, including a research questionnaire sent to all Portsmouth off licences. In Portsmouth, there were two main factors: \tStreet drinking and associated anti-social behaviour – on one Portsmouth road, for example, over 100 incidents were attributed to street drinkers in one month. \tHealth and wellbeing – approximately 40,000 people in Portsmouth were drinking above the recommended units. Portsmouth has one of the highest rates of alcohol-related hospital admissions in the south, costing an estimated £74 million annually, with £10 million NHS spend on alcohol harm. The Safer Portsmouth Partnership and Police licensing unit have taken the lead with ‘reducing the strength’, directing the campaign at the worst affected areas. They include alcohol nurses, paramedics, licensing practitioners, community wardens and police. Successes in Portsmouth There are 184 off licences in Portsmouth. Over 100 retailers have signed up. In some stores, this means removing one product, often targeted for theft. In others, it’s much higher. One retailer removed 17 products to reduce street drinkers and aggressive beggars targeting his store. Overall, street drinkers decreased by 39 per cent over 12 months. This shift resulted in a 43 per cent drop in incidents associated with street drinkers, with some individuals seeking help. Four have been the focus of ASBOs, breaking up problem groups. The campaign’s effects have been especially visible in areas where street drinking was most prevalent. In Cosham, street drinking incidents dropped by 81 per cent. In Albert Road, where aggressive begging was occurring daily, we have seen a 50 per cent reduction. A survey of 25 alcohol-dependent clients, conducted by the alcohol intervention team, found 60 per cent would find it easier to quit if super-strength alcohol was less available. The public response to the campaign has been excellent. Liver disease is one of the city's biggest killers. Men are 50 per cent and women 47 per cent more likely to die from the disease than the national rate. Community engagement activities have allowed residents to ask questions about the campaign and show support for retailers who remove super-strength products. This has been a great opportunity to educate the public on unit intake. Another breakthrough happened in 2014, with a large high street retailer removing super-strength products from over 20 Portsmouth stores. Challenges in Portsmouth One retailer sells a 7.5 per cent white cider cheaper than anywhere in the city: £7 for six litres (approx 45 units). This is 16p per unit, almost three times cheaper than health experts recommend, the equivalent of 45 shots of premium whiskey. Despite shoplifting and health harms, staff say the company would never remove this product due to sales. Their Portsmouth stores are in impoverished areas, with the Cosham store on a street with the largest amount of street drinking incidents in the city. We have shared evidence of problems near their stores, but they see the scheme as penalising responsible drinkers. The alcohol industry also sees the scheme as penalising responsible drinkers. We have invited producers, manufacturers and distributors to come and see our work to reduce alcohol harm, to show we have a thorough approach to conventional treatment-based initiatives. Not all strong alcohol is targeted by ‘reducing the strength’, just the products found at scenes of crime and disorder. The challenge now with ‘reducing the strength’ is to achieve consistency across Portsmouth, encouraging even more retailers to sign up. The campaign remains voluntary and issues with competition law hinder communication with the trade as a whole. For further information or to contact the Ipswich, Brighton or Portsmouth teams delivering these schemes, please email Charlotte Tarrant at Equinox Care: email@example.com.