Alcohol - Health Committee Contents


Conclusions and recommendations


History

1.  The history of the consumption of alcohol over the last 500 years has been one of fluctuations, of peaks and troughs. From the late 17th century to the mid-19th the trend was for consumption per head to decline despite brief periods of increased consumption such as the gin craze. From the mid- to the late 19th century there was a sharp increase in consumption which was followed by a long and steep decline in consumption until the mid 20th century. (Paragraph 29)

2.  The variations in consumption are associated both with changes in affordability and availability, but also changes in taste. Alternative drinks such as tea and alternative pastimes affected consumption. Different groups drank very different amounts. Government has played a significant role both positive and negative, for example in reducing consumption in the First World War as well as in stimulating the 18th century gin craze by encouraging the consumption of cheap gin instead of French brandy. (Paragraph 30)

3.  From the 1960s consumption rose again. At its lowest levels in the 1930s and -40s annual per capita consumption was about 3 litres of pure alcohol; by 2005 it was over 9 litres. These changes are, as in past centuries, associated with changing fashion and an increase in affordability, availability and expenditure on marketing. Just as Government policy played a part in encouraging the gin craze, successive Government policies have played a part in encouraging the increase in alcohol consumption over the last 50 years. Currently over 10 million adults drink more than the recommended limits. These people drink 75% of all the alcohol consumed. 2.6 million adults drink more than twice the recommended limits. The alcohol industry emphasises that these figures represent a minority of the population; health professionals stress that they are a very large number of people who are putting themselves at risk. We share these concerns. (Paragraph 31)

4.  One of the biggest changes over the last 60 years has been in the drinking habits of young people, including students. While individual cases of student drunkenness are regrettable and cannot be condoned, we consider that their actions are quite clearly a product of the society and culture to which they belong. The National Union of Students and the universities themselves appear to recognise the existence of a student binge drinking culture, but all too often their approach appears much too passive and tolerant. We recommend that universities take a much more active role in discouraging irresponsible drinking amongst students. They should ensure that students are not subjected to marketing activity that promotes dangerous binge drinking. The first step must be for universities to acknowledge that they do indeed have a most important moral "duty of care" to their students, and for them to take this duty far more seriously than they do at present (Paragraph 32)

5.  Since 2004 there has been a slight fall in total consumption but it is unclear whether this represents a watershed or a temporary blip as in the early 1990s. (Paragraph 33)

The impact of alcohol on health, the NHS and Society

6.  The fact that alcohol has been enjoyed by humans since the dawn of civilization has tended to obscure the fact that it is also a toxic, dependence inducing teratogenic and carcinogenic drug to which more than one million people in the UK are addicted. The ill effects of alcohol misuse affect the young and middle aged. For men aged between 16 and 55 between 10% and 27% of deaths are alcohol related, for women the figures are 6% and 15%. (Paragraph 64)

7.  Alcohol has a massive impact on the families and children of heavy drinkers, and on innocent bystanders caught up in the damage inflicted by binge drinking. Nearly half of all violent offences are alcohol related and more than 1.3 million children suffer alcohol related abuse or neglect. (Paragraph 65)

8.  The costs to the NHS are huge, but the costs to society as a whole are even higher, all of these harms are increasing and all are directly related to the overall levels of alcohol consumption within society. (Paragraph 66)

The Government's strategy

9.  We congratulate the Government on the impressive research it has undertaken and commissioned and its analysis of the effects and costs of alcohol. It has analysed the health risks and shown them to be significant and found the costs of alcohol to society to be about £20 bn each year. It has also commissioned research into the effectiveness of a range of policies for reducing consumption. (Paragraph 88)

10.  Unfortunately, the Government's Alcohol Strategy failed to take account of this research. Despite all the evidence to the contrary, in its 2004 Strategy the Government stated that alcohol was a problem for a small minority; we assume it meant that a small minority committed alcohol-related crime and were chronic alcoholics. We are pleased that it has subsequently recognised that the problem affects a significant minority as medical opinion indicates. (Paragraph 89)

11.  Unfortunately, too, the Government has given greatest emphasis to the least effective policies (education and information) and too little emphasis to the most effective policies (pricing, availability and marketing controls); in fact, by freezing the duty on spirits from 1997 to 2007 the Government encouraged consumption. (Paragraph 90)

12.  We are concerned that Government policies are much closer to, and too influenced by, that of the drinks industry and the supermarkets than those of expert health professionals such as the Royal College of Physicians or the CMO. The alcohol industry should not carry more weight in determining health policy than the CMO. Alcohol consumption has increased to the stage where the drinks industry has become dependent on hazardous drinkers for almost half its sales. (Paragraph 91)

13.  In view of the scale and nature of the problem, we agree with the health professionals that a more comprehensive alcohol policy is required, which makes use of all the mechanisms available to policy makers: the price mechanism, controls on availability and marketing and improvements in NHS services as well education and information. There is a relationship which needs to be addressed between how much we drink as a society and the number of people who drink too much. (Paragraph 92)

NHS policies to address alcohol-related problems

14.  Alcohol related-ill health has increased as alcohol consumption has increased, but there are no more services to deal with these problems. Indeed in many cases there are fewer, partly as a result of the shift in resources to addressing dependency on illegal drugs. The most effective way to deal with alcohol related ill-health will be to reduce overall consumption, but existing patients deserve at least as good a service as that provided to users of illegal drugs, with similar levels of access and waiting times. (Paragraph 142)

15.  Early detection and intervention is both effective and cost effective, and could be easily built into existing healthcare screening initiatives. However, the dire state of alcohol treatment services is a significant disincentive for primary care services to detect alcohol-related problems at an early stage before the serious and expensive health consequences of regular heavy drinking have developed. (Paragraph 143)

16.  The solution is to link alcohol interventions in primary and secondary care with improved treatment services for patients developing alcohol dependency. In time we believe such a strategy will result in significant savings for the NHS but will require pump priming and intelligent commissioning of services. Specifically, the NHS needs to improve treatment and prevention services as follows

treatment services:

Each PCT should have an alcohol strategy with robust needs assessment, and accurate data collection.

Targets for reducing alcohol related admissions should be mandatory.

Acute hospital services should be linked to specialist alcohol treatment services and community services via teams of specialist nurses.

There should be more alcohol nurse hospital specialists.

Treatment budgets should be pooled to allow the cost savings from reduced admissions to be fed back into treatment and prevention, with centrally provided 'bridge' funding to enable service development.

Access to community based alcohol treatment must be improved to be at least comparable to treatment for illegal drug addiction.

These improved alcohol treatment services must be more proactive in seeking and retaining subjects in treatment with detailed long term treatment outcome profiling.

Funding should be provided for the National Liver Plan.

prevention services:

Improved access to treatment for alcohol dependency is a key step in the development of early detection and intervention in primary care.

Clinical staff in all parts of the NHS need better training in alcohol interventions.

Early detection and brief advice should be undertaken in primary care and appropriate secondary care and other settings. Detection and advice should become part of the QOF.

Once detected patients with alcohol issues should progress through a stepped program of care; seven out of eight people do not respond to an early intervention and it is these people who go on to develop significant health issues.

Research should be commissioned into developing early detection and intervention in young people. (Paragraph 143)

Education and information policies

17.  Better education and information are the main planks of the Government's alcohol strategy. Unfortunately, the evidence is that they are not very effective. Moreover, the low level of Government spending on alcohol information and education campaigns, which amounts to £17.6m in 2009/10 makes it even more unlikely they will have much effect. In contrast, the drinks industry is estimated to spend £600-800m per annum on promoting alcohol. (Paragraph 154)

18.  However, information and education policies do have a role as part of a comprehensive strategy to reduce alcohol consumption. They do not change behaviour immediately, but can justify and make people more responsive to more effective policies such as raising prices. Moreover, people have a right to know the risks they are running. We recommend that information and education policies be improved by giving more emphasis to the number of units in drinks and the desirability of having a couple of days per week without alcohol. We also recommend that all containers of alcoholic drinks should have labels, which should warn about the health risks, indicate the number of units in the drink (eg 9 units in a bottle of wine), and the recommended weekly limits, including the desirability of having two days drink-free each week. We doubt whether a voluntary agreement would be adequate. The Government should introduce a mandatory labelling scheme. (Paragraph 155)

Marketing

19.  The current system of controls on alcohol advertising and promotion is failing the young people it is intended to protect. The problem is more the quantity of advertising and promotion than its content. This has led public health experts to call for a ban. It is clear that both the procedures and the scope need to be strengthened. (Paragraph 204)

20.  The regulation of alcohol promotion should be completely independent of the alcohol and advertising industries; this would match best practice in other fields such as financial services and professional conduct. In addition young people should themselves be formally involved in the process of regulation: the best people to judge what a particular communication is saying are those in the target audience. (Paragraph 205)

21.  The current controls do not adequately cover sponsorship, a key platform for alcohol promotion; the codes must be extended to fill this gap. The enquiry also heard how dominant new media are becoming in alcohol promotion and the particular regulatory challenges they present, including the inadequacy of age controls and the problems presented by user generated content. Expert guidance should therefore be sought on how to improve the protection offered to young people in this area. (Paragraph 206)

22.  Finally, there is a pressing need to restrict alcohol advertising and promotion in places where children are likely to be affected by it. Specifically:

—Billboards and posters should not be located within 100 metres of any school (there used to be a similar rule for tobacco).

—A nine o'clock watershed should be introduced for television advertising. (The current restrictions which limit advertising around children's programming fail to protect the relatively larger proportions of children who watch popular programmes such as soaps).

—Cinema advertising for alcohol should be restricted to films classified as 18.

—No medium should be used to advertise alcoholic drinks if more than 10% of its audience/readership is under 18 years of age (the current figure is 25%).

—No event should be sponsored if more than 10% of those attending are under 18 years of age

—There must be more effective ways of restricting young people's access to new media which promote alcohol

—Alcohol promotion should not be permitted on social networking sites.

—Notwithstanding the inadequacies of age restrictions on websites, they should be required on any site which includes alcohol promotion—this would cover the sites of those receiving alcohol sponsorship. This rule should also be extended to corporate alcohol websites. Expert guidance should be sought on how to make these age controls much more effective.

—Alcohol advertising should be balanced by public health messaging. Even a small adjustment would help: for example, for every five television ads an advertiser should be required to fund one public health advertisement. (Paragraph 207)

Licensing, binge-drinking, crime and disorder

23.  Alcohol-related crime and anti-social behaviour have increased over the last 20 years as a result of the development of the night time economy with large concentrations of vertical drinking pubs in town centres; under-age drinkers in the streets have also caused problems. The Alcohol Strategy 2004 recognised these problems and claimed that they were being addressed by a number of measures including the Licensing Act 2003. In addition, the alcohol industry established voluntary standards to govern the promotion and sale of alcohol. (Paragraph 248)

24.  The worst fears of the Act's critics were not realised, but neither was the DCMS's naive aspiration of establishing cafe society: violence and disorder have remained at similar levels, although they have tended to take place later at night. The principle of establishing democratic control of licensing was not realised: the regulations governing licensing gave the licensing authorities and local communities too little control over either issuing or revoking licences, as ACPO indicated. KPMG examined the alcohol industry's voluntary code and found it had failed. (Paragraph 249)

25.  Problems remained and the 2007 Strategy introduced new measures. Partnership schemes such as the St Neots Community Alcohol Partnership were established. The main changes are being introduced by the Policing and Crime Act 2009 which gives the police greater powers to confiscate alcohol from under 18s, introduces a mandatory code in place of the industry's voluntary code and has made it easier to review licences, giving local authorities the right to instigate a review. We support the introduction of mandatory conditions and urge the Government to implement them as a matter of urgency. (Paragraph 250)

26.  Despite the recent improvements, much needs to be done given the scale of alcohol-related disorder. It is of concern that section 141 of the Licensing Act 2003, which creates the offence of selling alcohol to a person who is drunk, is effectively not enforced despite KPMG's finding that this behaviour is frequently observed. We note the police and Home Office's preference for partnerships and training, but do not consider these actions should be an excuse for not enforcing a law which could make a significant difference to alcohol-related crime and disorder. We call on the police enforce s.141 of the Licensing Act 2003 more effectively. (Paragraph 251)

27.  We note the concerns of ACPO and other witnesses about the difficulties local authorities have in restricting and revoking licences. The Government has made some improvements in the Policing and Crime Act 2009, but must take additional measures. (Paragraph 252)

28.  In Scotland legislation gives licensing authorities the objective of promoting public health. Unfortunately, public health has not been a priority for DCMS. We recommend that the Government closely monitor the operation of the Scottish licensing act with a view to amending the Licensing Act 2003 to include a public health objective. (Paragraph 253)

Supermarkets and off-licence sales

29.  Over recent decades an ever increasing percentage of alcohol has been bought in supermarkets and other off-licence premises. Such purchases exceed those made in pubs and clubs by a large margin. The increase in off-licence purchases has been associated with the increasing availability of, promotions of, and discounting of alcohol. Heavily discounted and readily available alcohol has fuelled underage drinking, led to the phenomenon of pre-loading where young people drink at home before they go out and encouraged harmful drinking by older people. (Paragraph 279)

30.  Some areas have very large numbers of off-licences open for long hours. There are also too many irresponsible off-licences. Addressing this problem will require both better enforcement and improvements to the licensing regime. A public health objective in the licensing legislation would apply to off-licences as well as pubs and clubs and could be used to place limits on the number of outlets in an area. This aspect of the Scottish licensing legislation should be closely monitored with a view to its implementation in England. (Paragraph 280)

31.  Although they acknowledged that alcohol was a dangerous commodity, supermarkets told us that they used discounts and alcohol promotions because they were engaged in fierce competition with each other. In some cases, it is possible to buy alcohol for as little as 10p per unit. At this price, the maximum weekly recommended 15 units for a woman can be bought for £1.50p. This is not a responsible approach to the sale of alcohol. Retail outlets should make greater efforts to inform the public of the dangers of alcohol at the point of sale. (Paragraph 281)

32.  The Scottish Government has introduced controls on promotions including restricting alcohol to one aisle. These measures should be instituted in England. (Paragraph 282)

Prices: taxes and minimum prices

33.  The consumption of alcohol, like that of almost all other commodities, is sensitive to changes in price as all studies have shown. Because some countries with high alcohol prices have high levels of per capita consumption and vice versa some countries with low levels of consumption have low prices, it is sometimes implied that alcohol sales do not respond to price changes. This is economic illiteracy. Different countries, like different people and groups, respond differently to price, but they all respond. Studies have shown varying elasticities of demand. The increase in alcohol consumption over the last 50 years is very strongly correlated with its increasing affordability. (Paragraph 325)

34.  Increasing the price of alcohol is thus the most powerful tool at the disposal of a Government. The key argument made by the drinks industry and others opposed to a rise in price is that it would be unfair on moderate drinkers. We do not think this is a serious argument. The Sheffield study found that for the moderate drinker consuming 6 units per week a minimum price of 40p per unit would increase the cost by about 11p per week. At 40p per unit a woman drinking the recommended maximum of 15 units could buy her weekly total of alcohol for £6. (Paragraph 326)

35.  Opponents also claim that heavier drinkers are insensitive to price changes, but these drinkers will be most affected by price rises since they consume so much of the alcohol purchased in the country (10% of the population drink 44% of the alcohol consumed; 75% of alcohol is drunk by people who exceed the recommended limits). (Paragraph 327)

36.  We believe that the Government should introduce minimum pricing for the following reasons:

  • It would affect most of all those who drink cheap alcohol, in particular young binge-drinkers and heavy low income drinkers who suffer most from liver disease.
  • It is estimated that a minimum price of 50p per unit would save over 3,000 lives per year, of 40p 1,100 lives per year.
  • Unlike rises in duty (which could be absorbed by the supermarkets' suppliers and which affect all sellers of alcohol) it would benefit traditional pubs and discourage pre-loading. For this reason it is supported by CAMRA.
  • It would encourage a switch to weaker wines and beers. (Paragraph 328)

37.  However, without an increase in duty minimum pricing will lead to an increase in the profits of supermarkets and the drinks industry and an increase in marketing, promotions and non-price competition. The Treasury must take into account public health when determining levels of taxation on alcohol as it does with tobacco. Alcohol duty should continue to rise year on year above incomes, but unlike in recent years duty increases should predominantly be on stronger alcoholic drinks notably on spirits. (Paragraph 329)

38.  The duty on spirits per litre of pure alcohol was 60% of male average manual weekly earnings in 1947; in 1973 (when VAT was imposed in addition to duty) duty was 16% of earnings; by 1983 it was 11% and by 2002 it had fallen to 5%. We recommend that in stages the duty on spirits be returned in stages to the same percentage of average earnings as in the 1980s. Cider is an extraordinary anomaly; the duty on industrial cider should be increased. To protect small real cider producers, their product should be subject to a lower duty. Beer under 2.8% can be taxed at a different rate: we recommend that duty be reduced on these weak beers; although at present there a few producers of beers of this strength, the cut should encourage substitution. (Paragraph 330)

39.  In the longer run the Government should seek to change EU rules to allow higher and more logical levels of duty on stronger wines and beers; it should also seek to raise the strength of beer which can be subject to a lower duty rate from 2.8 to slightly higher levels. (Paragraph 331)

40.  The introduction of minimum pricing would encourage producers to intensify their marketing. This will make it all the more important to control marketing. (Paragraph 332)



 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2009
Prepared 8 January 2010