FRAMEWORK FOR ACTION
44. This section sets out a series of measures aimed at reducing alcohol-related harm in Scotland. They form the basis of a comprehensive strategic approach to tackling alcohol misuse and will contribute to achieving the following broad outcomes:
- reduced consumption
- supporting families & communities
- positive attitudes, positive choices
- improved support and treatment
45. Under each of these headings we outline those actions we are already committed to, as well as the new proposals on which we seek views. Together the aim of the measures is both to deliver long-term sustainable change and to address current problems.
46. There is strong evidence that increased consumption is driving increases in alcohol-related harm. Any comprehensive strategy must seek to reduce consumption if we are to be successful in reversing the negative trends in harm.
Proposals on which views are sought:
- We propose further action to end the promotion and loss-leading of alcoholic drinks in licensed premises and seek views on our proposals.
- We propose action to introduce minimum retail pricing and invite views on our proposals.
- We support the introduction of legislation to require licensed premises to offer measures of 125ml of wine and 25ml measures of spirits.
47. We are concerned that competition has had the effect of driving prices down to levels where alcoholic drinks can cost less than bottled water. Alcohol has become much more affordable and high strength alcohol products can often be bought very cheaply in comparison to lower strength alternatives. We consider that loss-leading ( i.e. below cost selling) is irresponsible and is ultimately contrary to the Licensing Objectives (listed in Annex E) set out under the new Licensing (Scotland) Act 2005.
48. We have already announced our intention to make regulations under the Licensing (Scotland) Act 2005 to ban promotions in off-sales premises that offer alcohol free or at a reduced cost on the purchase of one or more products or that sell alcohol below cost. The banning of such promotions is an important step but it will not automatically have an effect on the retail price of alcohol. As a consequence we need to do more to tackle the retail price of alcohol directly.
PROMOTIONS AND LOSS LEADING
49. We propose further action to end the promotion and loss-leading of alcoholic drinks in licensed premises and seek views on our proposals.
50. Competition between retailers has driven down the price of alcoholic drinks through extended promotion and loss leading. 41 Promotional strategies encourage additional or impulse buying and are often linked to particular seasonal or sporting events. Major grocery retailers have acknowledged using alcohol as a loss leader, in order to attract customers into the store and to increase overall sales. The Competition Commission found that the length of time products were sold below cost ranged from 8 weeks to 25 weeks. 42 As a result awareness of promotional activity is high amongst consumers and price discounts have become an expected part of buying alcohol as part of grocery shopping. 43
51. Promotions in off-sales premises are generally based on 'multi-buy' promotions which supply alcohol free or at a reduced cost if the customer buys in bulk, e.g. 'buy one, get one free' or '3 for the price of 2'. It is not uncommon for such offers to result in discounts of between 25-35% on wines and beers.
Restrictions already in place
52. The Licensing (Scotland) Act 2005, which will come fully into effect on 1 September 2009, already sets out a range of "irresponsible promotions" that will not be permitted from that date in respect of licensed premises in Scotland (Annex E contains further detail). Most of these requirements only have a practical effect in on-sales.
Further measures to end irresponsible promotions and below-cost selling
53. We consider that promotions offering free alcohol or a quantity discount for bulk buying, and below-cost selling which reduces retail prices to very low levels encourage additional or spontaneous purchasing and encourage increased consumption. We intend to bring off-sales into line with the restrictions already in place for on-sales. Retailers may argue that customers taking advantage of in-store alcohol promotions will drink their purchases over a long period of time and do no greater harm to themselves or others, however no evidence has been produced to support this view. We consider that promotions are contrary to the objective of the Licensing (Scotland) Act 2005, "to protect and improve public health". As over half of alcohol drunk in Scotland is bought from the off-trade, action to end these promotions could play an important part in reversing Scotland's alcohol culture.
We invite views on the following proposals:
That regulations should be made under the Licensing (Scotland) Act 2005 to:
- put an end to off-sales premises supplying alcohol free of charge on the purchase of one or more of the product, or of any other product, whether alcohol or not.
- put an end to off-sales premises supplying alcohol at a reduced price on the purchase of one or more of the product, or of any other product, whether alcohol or not.
- prevent the sale of alcohol as a loss-leader.
54. These measures should, subject to Parliamentary agreement, take effect from 1 September 2009 as conditions of the premises licence. A breach of the conditions would result in action being taken by the Licensing Board and could result in a licence being suspended for any period, or revoked.
MINIMUM RETAIL PRICING
55. We propose action to introduce minimum retail pricing and invite views on our proposals.
56. Given the link between consumption and harm and the evidence that affordability is one of the drivers of increased consumption, addressing price is an essential component of any long-term strategic approach to tackling alcohol misuse. The fact that the price is not linked to alcohol content may also have contributed to a drift towards higher strength products. We need to take action to ensure an end to 'pocket money pricing'.
57. Traditionally, there are two main ways in which governments take action to prevent alcohol being sold at irresponsible prices - taxation and minimum pricing. Many industrialised countries regulate alcohol price through the imposition of specific alcohol duties and sales taxes on alcohol. Such taxes explicitly signal that alcoholic beverages are to be treated differently from other consumer goods. Alcohol duty and taxation is currently reserved to the UK Parliament.
58. Minimum drinks pricing schemes in which alcoholic drinks prices are set at specific monetary amounts are not common, although the necessity of setting minimum drinks prices in addition to taxation as means of reducing alcohol consumption and alcohol-related harm is increasingly being considered in a number of countries. We consider that a minimum pricing scheme is desirable to ensure a minimum retail price is charged to consumers.
59. Alcohol pricing in off-sales premises changes constantly, but in comparison to on-sales premises, there is a wide range of products with very low prices. A snapshot of pricing in a major supermarket in March 2008 showed that:
- prices are highly variable, starting at around 16p per unit of alcohol for a relatively strong cider and 24p for supermarket own-label vodka/gin, up to around 90p per unit for premium products.
- for beer and lager, there is no clear correlation between product strength and price. Some 9.0% ABV strong lagers can cost the same as lager half that strength
60. We consider that directly linking product strength to retail price, by establishing a minimum price for a unit of alcohol, would contribute to reducing excessive alcohol consumption and, thereby, reduce alcohol-related harm in Scotland. It may also incentivise producers to develop lower strength products. And it should reduce the availability of high alcohol low cost drinks which often cause harm in our country. Minimum retail pricing could form the basis of a Scottish Alcohol Duty structure should the Scottish Government assume responsibility for taxation.
61. We consider the following principles should form part of any minimum pricing scheme:
- the scheme should apply equally to all premises selling alcohol. We do not see merit in creating a scheme that applies only to particular types of premises. The practical effect of minimum retail pricing on particular premises would depend on the prices charged before the conditions came into effect.
- price should be determined with reference to the alcoholic strength of the product rather than other factors, such as type of product. Establishing a direct link between minimum price and the alcoholic strength of the product is considered to be the most effective means of encouraging a reduction in consumption. If an alternative approach were to be taken, such as establishing prices for different product categories, this could create an unhelpful incentive for producers to develop new products with a high alcohol volume.
- minimum prices should be set independently of those connected either directly or indirectly with the manufacture, retail, supply or distribution of alcohol products or any other connected activity. The robustness of minimum retail pricing to reduce excessive alcohol consumption relies on it being seen as both fair to the alcohol industry and retailers but independent of those who profit from the production or sale of alcohol. We consider that minimum prices should be determined by Scottish Ministers.
- it should be straightforward to vary the levels at which prices are set. Scottish Ministers should be able to vary the minimum retail prices as appropriate while allowing the licensed trade a reasonable period of notice to implement changes.
- arrangements should be as straightforward as possible to minimise the burden on the licensed trade and to ensure compliance. Arrangements are already in place under the Licensing (Scotland) Act 2005 where Licensing Standards Officers monitor compliance with regulations and conditions, and breaches are reported to the Licensing Board.
62. Although we have not decided on a minimum unit price - and are not specifically consulting on that point in this discussion paper - a minimum price of, for example, 35 pence per unit (which is lower than the off-sales average price) would impact most on those products priced low relative to their strength such as white ciders. It would have no impact on premium-priced beer, wines and spirits.
We invite views on:
- the proposed principles on which a minimum pricing scheme for alcohol products should be established.
PROMOTING CHOICE IN STANDARD MEASURES OF ALCOHOL
63. We are concerned about the drift towards larger 'standard' measures of alcohol, both in terms of public health and consumer choice, and support the introduction of legislation to require licensed premises to offer 125ml measures of wine and 25ml measures of spirits.
64. It was noted earlier that many alcoholic drinks have become stronger in recent years and are often being sold in larger servings. This is particularly the case for wine. Current regulations state that wine that is not pre-packed must be sold by the bottle, by the glass in measures of 125ml, 175ml or multiples thereof, or by the carafe. A standard glass of wine used to be 125ml but increasingly the 175ml glass is becoming the standard with 250ml glasses (almost one third of a bottle) being large. As a result some retailers no longer serve wine in 125 ml glasses, forcing customers to buy wine in larger servings.
65. This also has implications in terms of unit awareness. We know that only 15% of people can correctly estimate the number of units in a bottle of wine 34 and many would wrongly assume that one glass of wine equalled one unit. In fact, there are approximately one and a half units of alcohol in a 125ml glass of ordinary strength wine (12% ABV), two units in a 175ml glass and three units in a 250ml glass.
66. The Licensing (Scotland) Act 2005 prevents promotions that encourage, or seek to encourage, a person to buy or consume a larger measure of alcohol than the person otherwise intended to buy or consume. This responded to concerns about up-selling where, for example, a customer is offered a larger measures than they asked for. Measures to support greater customer choice in the size of drinks available would complement this action. We note that a Private Members Bill - the Sale of Wine (Measures) Bill - has been introduced to the House of Commons to this effect.
SUPPORTING FAMILIES AND COMMUNITIES
67. We need to protect our children and young people from the harm caused by alcohol misuse by themselves and others and to support them to make positive choices. At the same time we need to reduce the impact of alcohol related crime and disorder on our communities, making them safer and stronger.
Proposals on which views are sought:
- We will review current advice for parents and carers and would welcome views on what information would be helpful.
- We propose action to raise the minimum legal purchase age for off-sales purchases to 21 and seek views on this proposal.
- We propose that a fee should be applied to some alcohol retailers to help offset the costs of dealing with the adverse consequences of alcohol and invite views on our proposals.
- We will arrange a Scottish survey of the incidence of Fetal Alcohol Syndrome ( FAS).
- We will work with our partners at national and local level to improve substance misuse education in schools.
- We will continue to support a number of third sector organisations to provide youthwork and/or diversionary opportunities.
- We will improve identification and assessment of those affected by parental substance misuse and sharing of appropriate information amongst agencies; and building capacity, availability and quality of support services.
- We will monitor the effectiveness of measures, within the new Licensing (Scotland) Act 2005, to control the availability of alcohol.
- We will consider the role of local authority trading standards officers in relation to enforcement in off-sales.
- We will continue to work with the national Violence Reduction Unit and local Community Safety Partnerships to ensure the effective and innovative use of prevention and enforcement measures.
- We will commission research to identify and evaluate models for designated places of safety.
- We will continue to call for a reduction in drink drive limit from 80mg to 50mg per 100ml of blood and the introduction of random breath testing.
CHILDREN, YOUNG PEOPLE AND FAMILIES
68. If we are to change Scotland's relationship with alcohol for good, we must address the needs of children and young people. We must prevent children and young people misusing alcohol in the first place, and be better prepared to intervene early with those who start to experiment, before their use becomes harmful or problematic. In addition, we must minimise the impact of parental alcohol misuse on children and young people. This will require a range of actions which educate all our young people, and their parents, about alcohol-related harm, while also targeting interventions at those we know to be most at risk.
69. We have established a set of key principles which underpin all our activity to support children and young people from their earliest years through to adulthood. These principles are embedded in: our joint policy statement with CoSLAEarly Years and Early Intervention; in our curriculum reform programme, Curriculum for Excellence; and in our developing Youth Framework. Our aim is to ensure that all children and young people are equipped with the skills, knowledge and opportunities to make healthy, safe and informed choices as they grow up. We want to help all young people build personal resilience and through Curriculum for Excellence encourage them to become successful learners, confident individuals, effective contributors and responsible citizens. We believe that by developing these skills our young people will be better equipped to question and challenge whether drinking alcohol is in their best interests.
70. We have already taken action in relation to pregnancy. Scotland's Chief Medical Officer, jointly with the other UK Chief Medical Officers ( CMOs), has issued clear advice that women who are pregnant or trying to conceive should avoid alcohol. We strongly support the voluntary agreement with the alcohol industry which encourages the inclusion of the CMOs' pregnancy advice on all alcohol products and would support action to make such labelling mandatory. At the extreme, alcohol use during pregnancy can result in babies being born with Fetal Alcohol Syndrome ( FAS), characterised by restricted growth, facial abnormalities and learning and behavioural disorders. The number of cases of FAS diagnosed each year is low, but it is thought that a greater number go undiagnosed. We will arrange a Scottish survey of the incidence of FAS.
71. The importance of parenting to a child's social, emotional and cognitive development cannot be overestimated. We are committed to providing early support to parents and have a range of policies and programmes that provide support for parenting either directly or indirectly. This includes funding for a range of national parenting projects which promote positive parenting skills and support to parents, especially at challenging times. The long-term Early Years Framework will address the need to build parenting and family capacity pre- and post-birth.
72. We know that a high proportion of under 18s have access to alcohol, with many drinking regularly and becoming drunk. In order to encourage parents to talk to their children about alcohol, NHS Health Scotland have published the guide "Alcohol: what every parent should know". This is available at: http://www.infoscotland.com/alcohol/files/Alcohol.pdf.
We will review current advice to parents and would welcome views on what particular information parents and carers would find helpful.
Children Affected by Parental Substance Misuse
73. Our approach to children affected by parental substance misuse is set out in detail in chapter five of our drugs strategy "The Road to Recovery: New Approach to Tackling Scotland's Drug Problem". The safety of children is paramount and current best estimates indicate that more than 65,000 children under 16 may be affected by parental alcohol misuse.
74. We will seek to improve identification and assessment of affected children and young people, sharing information amongst agencies where appropriate, and to build the capacity, availability and quality of support services. This work will ensure that those children at risk or in need of additional support are identified at early stages and receive appropriate care and support. In addition, we will support several Local Authority Getting It Right Learning Partnerships, within which practitioners will test how to apply ' Getting It Right For Every Child' principles to addressing the needs of children affected by parental drug and/or alcohol misuse. The intelligence generated through learning partnerships will inform national and local improvements in this area.
75. At the same time our record investment in alcohol services will mean significant improvements in access to appropriate treatment for parents resulting in positive benefits for children affected by parental alcohol misuse. The Child Protection Line (0888 022 3222), Scotland's 24-hour freephone gateway to child protection services, was launched in February 2007 as a means of simplifying the process for a member of the public to report child protection concerns, including those around children affected by parental alcohol misuse.
The School context: Substance Misuse Education in Schools
76. We recognise that it is vital that all young people have access to reliable information about alcohol and its harmful effects, if they are to make informed choices throughout their lives. Substance misuse education in schools is often the first line of prevention against alcohol misuse, providing opportunities to pass on facts, explore attitudes and, crucially, foster the skills needed to make positive decisions. While there is good practice in substance misuse education in schools, more can be done to increase its effectiveness. We will work with our partners at national and local level to improve the delivery of substance misuse education in schools in the context of Curriculum for Excellence.
More Choices, More Chances
77. One of our key aims is to improve the life chances of children, young people and families at risk. Stimulating young people to remain in education, employment or training post-school is the best way of ensuring their long-term employability and contribution to society. The ' More Choices, More Chances' strategy aims to reduce the proportion of young people not in education, employment or training and already identifies young people who are involved in drug or alcohol misuse as a key target group. It is accepted that these young people are more likely to be in need of more choices and chances in order to progress as successful adults. This can only be achieved through partnership working of all interested parties, and greater personalisation and choice of provision.
Alternatives to Alcohol
78. Positive leisure opportunities, such as youth work, provide life-enhancing experiences for children and young people and offer alternatives to behaviour focussed around drinking alcohol. Our national youth work strategy, " Moving Forward: A Strategy for Improving Young People's Chances Through Youthwork" recognises that youth work opportunities can engage young people who might otherwise become involved in risky behaviour, such as alcohol misuse, or those who are directly affected by alcohol misuse. We will continue to support a number of third sector organisations that work with these young people. The case studies in Annex F provide examples of this type of work. In addition, our developing Youth Framework aims to ensure that all young people, including those who are vulnerable and at risk, have the opportunities and support they need outside of school to fulfil their potential as confident individuals, effective contributors, successful learners and responsible citizens. Youth work will be a key strand within this.
79. The CashBack for Communities Initiative uses funds recovered under the Proceeds of Crime Act 2002 to expand young people's horizons and increase the opportunities they have to develop their interests and skills. It supports a range of sport, culture and arts activities that help them develop personally and physically. £8 million has been earmarked for the first phase of activity.
80. Further activity, being developed as part of the Scottish Government and Alcohol Industry Partnership, includes working with the Focus on Alcohol Angus project to pilot and gain SQA accreditation for the British Institute of Innkeeping Certificate in Alcohol Awareness for 13-16 year olds; opportunities to support youth diversionary activities in disadvantaged areas as a means to tackle alcohol-related anti-social behaviour; and the introduction of the Strengthening Families Programme ( SFP) to Scotland. The long term aim of the SFP 10-14 programme is to reduce alcohol, drug use and behaviour problems during adolescence using a 'whole family' approach.
Limiting access to alcohol and tackling problems
81. Protecting children from harm is an explicit objective of the Licensing (Scotland) Act 2005. It has already been used to enable the police to carry out test-purchasing operations whereby an underage person working with the police enters a licensed premises to buy alcohol. Where a premises fails a test-purchase, action can be taken by both the Procurator Fiscal and the licensing board. The Act also requires all licensees to operate on a no-proof no-sales basis so the onus is on the person making the sale to establish whether a customer is aged 18 or over.
82. Alcohol misuse can place a child at risk of abuse and fuel anti-social and offending behaviour. The Children (Scotland) Act 1995 contains a specific ground for referral where concerns exist about a young person's misuse of alcohol and/or drugs. In 2006-07 the Scottish Children's Reporter Administration ("Children's Hearings") received this type of referral in relation to 1,609 children. 44 Our focus on early intervention means a referral to the children's reporter should only be made where it is clear there is a need for a compulsory intervention to be made. The document " Preventing Offending by Young People - A Framework for Action" recognises that offending can be linked to substance misuse and commits delivery partners to develop evidence-based interventions for young people whose offending is linked to the misuse of alcohol or drugs.
RAISING MINIMUM PURCHASE AGE
83. We propose to raise the minimum legal purchase age to 21 for off-sales purchases and seek views on this proposal.
84. There is significant public concern regarding alcohol misuse and drunkenness amongst young people, and the related anti-social behaviour and crime which it can fuel. By continuing to allow access to on-sales premises, a supervised environment in which drinks measures are controlled whilst limiting access to off-sales, we hope to encourage more responsible drinking. Clearly such an approach must go hand-in-hand with improved enforcement of age of purchase in both on and off sales. This would, in turn, help to reduce underage drinking.
85. In virtually every country in the world where alcohol consumption is legal, there is threshold age above which buying and/or consuming alcohol is permitted. This varies from 16 to 21 years in different countries. In some countries, the minimum age of purchase differs between on and off sales or by the type of alcohol product being purchased. For example, in Sweden, the purchase age (for beverages over 3.5% ABV) is 20 but restaurants and bars can serve alcohol to those aged 18 or over and, in Norway, the minimum age to purchase spirits in shops is 20 but 18 for all other alcohol purchases. 45
86. In Scotland, the short term harms associated with impacts of alcohol misuse are higher in younger age groups than older age groups: e.g. alcohol-related attendances at Emergency Departments; alcohol-related assaults; and road accidents. 46 The increased levels of harm from accidents are likely to be linked to higher rates of binge drinking and drunkenness amongst younger drinkers 22 and links to other risky behaviours.
87. Evidence from other countries, mainly the US, suggests that raising the minimum legal drinking age reduces alcohol sales and problems among young drinkers. A review of 132 studies published between 1960 and 1999 found strong evidence that increasing the legal drinking age from 18 to 21 years can have substantial effects on youth drinking and alcohol-related harm, particularly road traffic accidents, often for well after young people reached the legal drinking age. 47 Studies have found that raising the drinking age from 18 to 21 decreases single vehicle night time crashes by 11-16% and is related to changes in other alcohol-related injury admissions to hospital. 48
88. Studies have shown that delaying the age of onset of drinking may also be important in reducing the risk of alcohol problems and dependence in later life. A US study showed that young people who had begun drinking before the age of 15 were four times more likely to develop alcohol dependence than those who began drinking at age 21. 49 In addition those who begin drinking in their teenage years are also more likely to experience alcohol-related injuries than those who begin drinking at a later age. 50
89. Although the primary purpose of raising the age of purchase to 21 would be to reduce alcohol-related harm amongst the 18-21 age group, an important secondary purpose would be to reduce access to alcohol by under 18s. While the legal age of purchase for alcohol is 18 years of age, a high proportion of under 18s do access alcohol, with many drinking regularly and becoming drunk. Half of all 15 year olds, who drank in the last week, deliberately tried to get drunk. 14 Of 15 year olds who had drunk alcohol, 30% had bought alcohol in a shop or supermarket and 19% in an off-licence compared with 11% in a pub, bar or club. In addition, 34% had bought alcohol from a friend, relative or someone else. 14
90. A voluntary scheme, established by West Lothian Council, in collaboration with Lothian & Borders Police and licensees, prevents the sale of alcohol to people under the age of 21 between 1700 - 2200 on Fridays and Saturdays with anyone up to age 25 requiring proof-of-age ID to buy at these times. The scheme aims to reduce instances of anti-social behaviour and proxy purchasing and is based on a similar project, operating in Cleveland, which led to a 65% reduction in anti-social behaviour. Initial results have been very positive. The number of calls about vandalism have halved from the same time period last year and the number of assaults has decreased by 57%.
The case for raising the minimum age
91. We recognise that effective enforcement of the minimum age of purchase is a crucial component of any comprehensive alcohol strategy - this is considered within the effective enforcement section below. But given the negative impacts associated with drinking by young people, both on the drinkers themselves and on communities, and the positive evidence from the US, we consider there is a case for raising the minimum age of purchase from 18 to 21 years old.
92. We consider there is a particular case to be made for maintaining the current age of legal purchase at 18 in on-sales premises but raising it to 21 for off-sales. The main arguments in favour of this approach are:
- alcohol is much cheaper and more widely accessible in off-sales than on-sales and, therefore, the measure would be likely to generally reduce the amount of alcohol purchased by young people.
- on-sales premises offer a more controlled drinking environment than off-sales, therefore, the behaviour of 18-21 year olds is more likely to be moderated. Also unsupervised settings are associated with increased drunkenness and risk of harm amongst underage drinkers. 51
- it could act as a particular deterrent for drinkers under 18 who are significantly more likely to purchase their alcohol from off- rather than on-sales. It will also reduce the opportunity for those aged under 18 to purchase alcohol by proxy through 18-21 years olds.
We invite views on whether we should raise the minimum age for off-sales purchases to 21 in Scotland.
FIFE ALCOHOL PARTNERSHIP GROUP
93. A key objective of the Scottish Government and Alcohol Industry Partnership is to work in conjunction with local community stakeholders to design, develop and implement a series of interventions within a geographically focused pilot area. This will establish the cumulative effect of a multi component and targeted approach to tackling alcohol harm and misuse. Fife was chosen as the pilot area for this work. The Steering Group for this study consists of representatives from Government, Fife Drug & Alcohol Action Team, Police, NHS, industry and the voluntary sector. The pilot will run for a minimum of two years.
94. It is an opportunity for the private, public and voluntary sectors to work together to develop, pilot and evaluate potential solutions. The pilot will implement a wide range of interventions to tackle alcohol misuse, in addition and complementary to existing local projects and initiatives. The project is currently in the early stages of scoping and initial research and potential interventions could include:
- Social Norms Programmes in educational and community settings
- Greater availability of low & no alcohol products
- Challenge 21 as standard practice
- Experiment with soft drinks pricing for drivers
- Bottle marking schemes
- More challenge of proxy purchase
- BII Schools Alcohol Awareness Project
- Theatre based education projects
- Diversionary activities
- Responsible retailing initiatives in Student Unions
- Nite zones
- Drink Drive initiatives
- Working with local media
- Taxi marshals
MEASURES TO CONTROL THE AVAILABILITY OF ALCOHOL
95. We will monitor the effectiveness of the measures, under the new Licensing (Scotland) Act 2005, to control the availability of alcohol and consider whether further measures are required.
96. The new Licensing (Scotland) Act 2005 comes into effect from 1 September 2009. It provides an overhaul of the existing licensing arrangements and introduces a range of significant new measures to protect communities from alcohol-related harm. It establishes five Licensing Objectives (listed in Annex E), including for the first time one on health.
97. This section outlines how the Act addresses the availability of alcohol. Given that the provisions of the Act will not come into force until September 2009, it would be premature to consider further revisions until the effectiveness of the incoming changes can be assessed. We will monitor the effectiveness of the new measures and consider in light of this whether further measures are required.
98. Effective enforcement of the new licensing regime will be key to its success. Licensing Standards Officers ( LSOs) are being recruited by local authorities and will have a key role in monitoring compliance with the Act and licence conditions. LSOs can visit licensed premises at any time and can make reports to the licensing board where they have concerns about the operation of a premises, allowing the licensing board to take swift action to protect the licensing objectives. Licensing boards also have new powers to take action against premises that breach licensing conditions including the power to suspend a premises licence (for any period) or revoke it. Ultimately it is for the licensing board to decide what sanction is most appropriate in response to a breach of licence conditions but it is clear that suspension or revocation of a licence is an effective measure to drive up standards and clamp down on irresponsible operators.
99. At present the police are responsible for enforcing the law. Test purchasing allows them to crack down on those premises selling alcohol to children and young people. We will also support the police in finding ways to effectively enforce the law in respect of third party purchasing and selling alcohol to someone who is drunk. While the police continue to be the main enforcement authority, consideration is being given to the scope for local authority trading standards officers also having a role in enforcement in relation to off-sales.
100. The number of licensed premises within an area can cause difficulties, particularly in respect of crime, disorder and public nuisance. From September 2009, licensing boards will be required to assess overprovision and establish an overprovision policy. Licensing boards have the ability to refuse new applications on the grounds of overprovision, for example, on the basis of the total number of premises in an area, or the number of premises of a particular type. This approach allows boards to respond to the negative impact that can arise from a large number of licensed premises in a particular area.
101. Availability of alcohol is determined not just by the number of premises, but by the hours which premises are open. There is a presumption in the Act against routine 24-hour opening of licensed premises; such applications must only be granted in limited, exceptional circumstances. The Act also prevents alcohol being sold for consumption off the premises between the hours of 22:00 and 10:00. Licensing boards will be required to include information on their licensing hours policy in their broader licensing policy. This should recognise that licensing hours are important not only to individual licensed premises but can have a wider impact on an area.
102. Through the Safer Streets initiative, we have supported local partners, in particular Community Safety Partnerships, to develop effective and innovative measures to tackle the effects of alcohol misuse in town and city centres. Much of this practice builds on the success of the Manchester City Safe Scheme and latterly the Glasgow 'Nite Zone' initiative. The general principle of this approach is that by gathering good quality intelligence, which can then be analysed and used by a range of agencies, alcohol-related disorder can be more effectively managed and ultimately prevented. There is no single approach; most schemes deploy a range of measures appropriate to local need. These can include:
- The effective use of by-laws to prevent street drinking
- Increased high visibility policing
- Dedicated areas of safety with extra police and support services (such as community wardens)
- On-street "triage" facilities to help lessen the burden on Emergency Departments
- Specialist licensing teams - best practice indicated that teams made up of police, fire service personnel and local authority officers have most effect.
- "Best Bar None" and other accreditation schemes
- Training for staff working in licensed premises - most commonly 'Servewise'
- Outreach services aimed at young people
- Taxi marshalling - either through police, wardens or private security staff and other taxi policies including dedicated pick up points and not allowing private hire to pick up off the street.
- Free bus routes or supported bus routes - again using police, wardens or private security staff on key routes.
103. Key to the success of this approach is ensuring longer term change in practice so that these innovative measures become part of mainstream activity and not simply a one-off campaign. There is evidence that this is happening across Scotland.
SOCIAL RESPONSIBILITY FEE
104. We propose that a fee should be applied to some alcohol retailers to help offset the costs of dealing with the adverse consequences of alcohol and invite views on our proposals. We do not intend that this would apply to small businesses where the sale of alcohol is incidental to the main purpose of the business and the amount of alcohol sold may be small.
105. The principle that the costs associated with the wider impacts of a commercial activity should be borne by those who benefit from it is well established and already applies, for example, in respect of environmental impacts. In our recent consultation on fee levels under the Licensing (Scotland) Act 2005, we sought views on whether local authorities should have a new power to apply an additional fee to licensed premises. This provoked a range of helpful comments and we are now moving on to raise more specific questions about the operation of a social responsibility fee.
106. Alcohol misuse and overconsumption and subsequent disorder and harm places a heavy burden on our public services from policing city centres at night, treating alcohol related injuries in Emergency Departments, and providing other services to respond to the consequences of alcohol misuse. We are aware that many town and city centres face their own unique problems with regard to the effects of alcohol misuse. Licensed premises play a vital part in the night-time economy but large numbers of people drinking within relatively compact districts can lead to anti-social behaviour and disorder, particularly if licensed premises have served customers who are already drunk.
107. It is wrong for the full burden of providing these services to continue to be met by the tax payer. Money available to Government is limited, and while businesses already pay business rates, we consider that some of the additional cost of providing services (for example, policing the night-time economy) should be met by those who profit from the sale of alcohol. The objective of a social responsibility fee would be for alcohol retailers to contribute financially to the furtherance of the Licensing Objectives set out in the Licensing (Scotland) Act 2005.
108. We do not consider that the uses to which social responsibility fees should be put should be set out nationally. Rather, local authorities should be able to determine priorities in their area and identify new or enhanced services, initiatives or projects where the use of additional money could best contribute to the achievement of the Licensing Objectives (some of these are set out above in "Safer Streets"). The fee should not become a direct alternative to established sources of funding but should provide an opportunity for local authorities and other public bodies to be innovative and creative in finding new ways of tackling and responding to the effects of alcohol misuse.
109. Beyond the principle of a social responsibility fee, consideration should be given to a number of other important points. It was first suggested that the fee should be applied to late-opening city centre premises to contribute to the additional policing costs which are necessarily incurred to deal with the adverse effects of alcohol misuse and subsequent disorder. The proposal has since been broadened out to include off-sales premises and the costs of other services.
110. Like the fees already introduced under the Licensing (Scotland) Act 2005, the level of fee should be proportionate to the size of the business. However, the current fees relate to the administrative costs of processing applications and running the licensing system. In relation to a Social Responsibility fee, bandings dependent on which sector sells the most alcohol might be more appropriate, especially as we are considering a fee to help address the negative effects associated with alcohol misuse.
111. This paper seeks views not on the general principle of a social responsibility fee, but on the detail of how it might work in practice. We are particularly interested in views on the criteria that should be used for determining premises that should be exempt from any fee.
We invite views on the following:
- What criteria should be used to determine the types of premises (or specific premises) that should be subject to the fee? ( e.g. late opening premises, or premises in a particular area) or conversely what criteria should be used to consider exemptions from the fee.
- How should the fee be determined? ( e.g. based on rateable values, alcohol sales turnover)
- Should a fee be applied to Occasional Licences as well as Premises Licences?
- Should a similar fee be applied to other premises licensed under separate legislation? If so, what types of premises should be subject to a fee?
- Are there any other comments you would like to make on the operation of a social responsibility fee?
DESIGNATED PLACES OF SAFETY
112. We will work with partners to identify the scale of the problem of drunk and incapable people requiring emergency support, evaluate existing models of support and identify good practice.
113. Longer term measures to reduce consumption and to change attitudes will, over time, reduce the number of drunk and incapable people on our streets, but action is needed now to address the current problem. The demands of providing care and support to individuals who are intoxicated and who may be a danger to themselves or others can reduce the capacity of emergency services to address other problems, with increased risks for those awaiting attention. In addition, police cells are inappropriate for the detention of drunk and incapable people who have no other cause to be there. There is, therefore, a need to identify more effective ways of dealing with such people.
114. There is little data available on the scale or profile of the problem, but we do know that the impact on the police, Scottish Ambulance Service ( SAS) and Emergency Departments can be significant. SAS, for example, report that in 2007 they attended an average of 73 incidents between 1-2am on Sunday mornings, compared with the normal hourly average of 38 incidents. On Hogmanay, incidents peaked at 150 between the hours of 02:00 - 03:00. 52
115. Some local provision already exists - including a protocol established between Fife Constabulary and the Scottish Ambulance Service and temporary arrangements established for large scale events, such as Edinburgh's Hogmanay - but provision is patchy. We consider that it is ultimately for local agencies to determine what arrangements are appropriate to meet local need. However, in order to assist them and to address the information gap, we have commissioned a research project, with input from a group involving the Association of Chief Police Officers in Scotland, SAS, Emergency Departments and local authorities. The project will seek to identify the scale and profile of the problem, evaluate existing models and identify the key elements of successful approaches plus any early interventions which may be successful in preventing people becoming drunk and incapable. If appropriate, some models may be piloted to test their effectiveness in a Scottish context. This will provide a range of options which can be adopted by local agencies in line with local need.
116. We will continue to press the UK Government to reduce the drink drive limit from 80mg per 100ml of blood to 50mg, and to give the police the power to carry out random breath tests.
117. Drink driving undermines efforts to make Scottish roads and communities safer, and continues to be the cause of too many collisions, injuries and deaths. In 2005, there were 990 casualties in Scotland as a result of accidents involving illegal alcohol levels. Of those casualties, 30 people were killed and 170 seriously injured. 7 Although this is a reduction of previous years, there are still too many people dying every year on Scotland's roads as a result of drink driving.
118. The existing limit has been in place since 1967. Most of the rest of Europe now has a lower limit than the UK. In a 1998 consultation paper, figures produced by the Department for Transport suggested that reducing the blood alcohol limit to 50mg per 100ml of blood could prevent 50 deaths and 250 serious injuries across the UK every year. 53 More recently, academics from University College London have suggested that as many as 65 fatalities per year could be prevented. 54
119. Research conducted on our behalf has indicated that a hard core of persistent drink drivers behave as they do because they consider the risk of being caught to be very low. 55 At present, the police have the power (under section 6 of the Road Traffic Act 1988) to require an individual to provide a breath sample only when they have reasonable cause to suspect that they have alcohol in their body, that they have committed a moving traffic offence or that they have been involved in a road traffic accident. The introduction of random breath testing would provide officers with the power to test any driver at any time and anywhere, regardless of whether they have committed another offence or have been involved in an accident, and in the absence of reasonable suspicion.
120. The Association of Chief Police Officers in Scotland, the British Medical Association and the Royal Society for the Prevention of Accidents have all called for a reduction in the drink driving limit to 50mg per 100ml of blood, and for the introduction of random breath testing. We agree that reducing the UK drink driving limit to bring it into line with most of Europe and introducing random testing would significantly raise the perceived risk of being caught and should act as deterrent to drink drivers. In combination, we believe that these actions would save lives and reduce the number of alcohol related accidents on our roads.
121. Powers in relation to road traffic law are currently reserved to the UK Government and Parliament. We have written to the Secretary of State for Transport, formally requesting that the drink driving limit is reduced and the police are given the power to carry out random breath tests. We will continue to press the UK Government on this issue.
POSITIVE ATTITUDES, POSITIVE CHOICES
122. Alcohol is an important part of Scottish culture and of our national identity and is enjoyed by the majority of adults in Scotland. However, many Scots are now exceeding sensible drinking guidelines and do not recognise them as a tool to help manage their alcohol use and the risks associated with it. We need to support change in public attitudes by supporting and encouraging more responsible drinking. We need to increase awareness and understanding in order to empower and enable individuals to make more positive choices about the role of alcohol in their lives.
Proposals on which views are sought:
- We propose action to further restrict the use of promotional materials within licensed premises and invite views on our proposals.
- We invite views on the desirability of introducing 'alcohol only' checkouts in off-sales premises.
- We will continue to work with health and industry partners to promote awareness and understanding of alcohol misuse and responsible drinking.
- We will promote the widespread use of workplace alcohol policies.
- We support measures to deliver improved alcohol product labelling.
- We will explore how best to tighten restrictions on alcohol advertising in relation to young people.
AWARENESS RAISING CAMPAIGNS
123. We will continue to work with partners to promote awareness and understanding of alcohol misuse and responsible drinking.
124. We want to empower and enable people to make informed choices about their alcohol use, by providing them with targeted, relevant and resonant information. We know that people often feel confused by different health messages from a variety of sources. This is why we are developing an overall Health Improvement Social Marketing Strategy which will link together a range of health improvement issues. The promotion of responsible drinking messages will be a key component of this.
125. Over the next two years we will focus on the health benefits of making positive lifestyle choices and of changing our behaviour. We intend to highlight the importance of positive mental wellbeing, which helps motivate us to make positive choices, e.g. about our alcohol use, and which can, in turn, be boosted by exercising these choices.
126. Many people mistakenly perceive alcohol misuse as only involving drunkenness and getting into trouble, and consequently feel reassured that their own levels of drinking are not problematic. But many Scots are drinking at levels that place them at increased risk. We also know that only a minority of us understand about units of alcohol and how they fit with the sensible drinking guidelines whilst only 15% of us can correctly estimate the number of units in a bottle of wine. 34 It is important, therefore, that we continue to raise public awareness of alcohol misuse through evidence-based social marketing campaigns using both advertising and direct engagement with the public.
127. We will build on the success of Scotland's first National Alcohol Awareness Week (held in October 2007) which brought government, the alcohol industry, health professionals and the third sector together for the first time to promote a joined up responsible drinking message and asked the nation ' does your drinking add up?'. Working through the Scottish Government & Alcohol Industry Partnership ( SGAIP), we will continue to promote joint responsible drinking messages and to encourage event organisers to employ responsible retailing practices.
128. We will continue to provide materials and funding to support the ADATs in their local marketing activity. We already produce a range of publications, developed in partnership with NHS Health Scotland, Alcohol Focus Scotland ( AFS) and the Scottish Association of Alcohol and Drug Action Teams ( SAADAT) and will consider the development of new titles, according to need.
ALCOHOL AND THE WORKPLACE
129. We will encourage the development of workplace alcohol policies, working through the Scottish Government and Alcohol Industry Partnership.
130. Establishing workplace alcohol policies can help employers to limit the effects of alcohol misuse on productivity by ensuring that employees are fit for work during working hours and by identifying employees with alcohol related issues. For employees it can help them access information and support to address problems early and provide assurance of fair and consistent procedures.
131. The majority (up to 75%) of people with alcohol problems are in employment. 56 In fact, those who are in employment are more likely to drink frequently and over the recommended guidelines than those without jobs. For women, those in employment are almost twice as likely as those who are unemployed to drink heavily on at least one day a week. 57 In Scotland, 45% of male and 28% of female heavy drinkers report that the after-effects of their drinking affected their work in the past and more than 6 million working days estimated to be lost in the UK each year due to alcohol related sickness absence. 56 While little data exists, a quarter of accidents at work are reported as being alcohol related. 58 In addition, around 50,000 people across the UK claim incapacity benefit due to alcohol problems with the highest proportions of the workforce claiming incapacity benefit or severe disablement allowance with a main diagnosis of alcoholism being mainly in Scotland. 59
132. Many responsible employers in Scotland have already introduced workplace alcohol policies. These companies have recognised that the costs associated with alcohol at work, the impact of current legislation, and the notable links between alcohol and ill health suggest that an alcohol policy is becoming an essential part of sound business practice. The Confederation of British Industry ( CBI), the Health & Safety Executive, the Scottish Trade Union Congress ( STUC) and the Federation of Small Businesses ( FSB) all encourage businesses to adopt such a policy.
133. To assist the 40% of employers who have no alcohol policy, as well as those who may wish to update and improve their current policy, we have developed, in conjunction with the Scottish Government and Alcohol Industry Partnership, a comprehensive and flexible workplace alcohol policy. This policy is freely available to any organisation in Scotland (via www.infoscotland.com) and is supported by Healthy Working Lives and endorsed by the STUC, CBI and Alcohol Focus Scotland. To support the introduction of such policies, SGAIP has also developed an alcohol awareness workshop for employees which can be delivered flexibly in-house by organisations themselves.
ALCOHOL PRODUCT LABELLING
134. We are fully supportive of improved alcohol product labelling to enable consumers to make more informed decisions and support the introduction of mandatory labelling in line with the current UK voluntary agreement.
135. Knowing the facts about alcoholic drinks allows us to make informed choices about what we drink. Information about alcohol units can help us to relate our intake to recommended daily and weekly guidelines. Nutritional information, such as calorie content, can also influence choice. In addition to information specific to a particular product, warning labels on alcoholic drinks can be a useful way of raising awareness about the potential health risks and responsibilities around drinking alcohol and may influence decisions about whether to drive or engage in other behaviours that could be impaired by drinking.
136. A number of countries have adopted this approach. The United States, for example, introduced mandatory warning labels on alcohol containers regarding alcohol and pregnancy, impairment of ability to drive or operate machinery and risk of health problems. Some States also require places that sell alcohol to display posters with health warnings. US research suggests that warning labels increase awareness of the messages that they contained (particularly amongst high risk groups such as young people, pregnant women and heavy drinkers). The labels also prompted more conversations among drinkers about the risks of drinking alcohol and recall of warning labels was associated with lower reporting of drunk driving. 60
137. European legislation already sets out a range of basic labelling requirements for alcoholic drinks, such as product name and alcohol content by volume. The European Commission has recently published a draft regulation on the provision of food information to customers 61 but the current draft continues existing exemptions for wine, beer and spirits from ingredient and nutrition labelling requirements. We would support their inclusion. Negotiations on the content of the new regulation will continue throughout 2008/09.
138. Last year, the UK Government reached a voluntary agreement with the alcohol industry regarding new labelling on alcohol containers and packaging bought or sold in the UK. As a result of the agreement, by the end of 2008, it is expected that the majority of alcoholic drinks labels will include the following elements:
- the drinks unit content (for beer, wine and spirits this will be given per glass and per bottle);
- the recommended sensible drinking guidelines;
- a sensible drinking message, such as 'Know Your Limits'; and
- the website or logo of the DrinkAware Trust ( www.drinkaware.co.uk) which provides sensible drinking messages.
139. The UK Government is also encouraging the industry to include Government advice on alcohol in pregnancy - ' Avoid alcohol if pregnant or trying to conceive'. During 2008, the UK Government will review the extent to which the industry has implemented the voluntary agreement and taken up the pregnancy message.
140. We are fully supportive of measures which deliver improved alcohol product labelling to enable consumers to make more informed decisions and support the introduction of mandatory product labelling in line with the current UK voluntary agreement, including the pregnancy advice. In order to lessen the potential impact on business and reduce confusion, it would be desirable to implement one system of product labelling across the UK and we will discuss with the UK Government the best way in which this could be achieved. However, we do not rule out further action on product labelling at a Scottish level.
RESTRICTIONS ON ALCOHOL ADVERTISING
141. We will explore how best to tighten restrictions on alcohol advertising in relation to young people.
142. The World Health Organisation ( WHO) recommend that restrictions on advertising and sponsorship should be part of a comprehensive alcohol policy. 62 There is growing research evidence to suggest that alcohol advertising has a contributory effect on levels of consumption and can support the development of pro-alcohol attitudes, particularly amongst young people. In 2007, a review of seven international research studies concluded that there is evidence to support an association between prior alcohol advertising and marketing exposure and subsequent alcohol drinking behaviour in young people. 63
143. Increased regulation of alcohol promotion activities could represent a precautionary approach, protecting young people from exposure to and potential influence from this material. It may also contribute towards the wider change in public attitudes and more responsible behaviours towards alcohol which we are seeking to promote in the same way as restrictions on the advertising and sponsorship of tobacco formed an important part of changing attitudes towards smoking.
144. In 2004, expenditure on direct advertising of alcohol in the UK was estimated to be around £200m. 64 Spending on indirect promotional activities - such as sponsorship, product tie-ins, contests and special promotions - is estimated to be around three times higher than spending on direct advertising. This suggests that the total value of promotional activity in the UK could be in the region of £600 - 800m per annum. 65
145. The large budgets allocated to the promotion of alcohol products suggest that alcohol companies believe that these activities promote sales. What is clear is that the current volume of alcohol product advertising, reinforcing how 'normal' and desirable it is to drink, far outweighs any public messages about the hazards associated with alcohol consumption.
Current restrictions on alcohol advertising & sponsorship
146. Within the EU, there are a variety of national restrictions and controls on alcohol advertising and mixtures of statutory and self-regulatory measures. All countries have at least one regulation and all, with the exception of the UK, have a ban of one form or another of one or more types of advertising. 66 The most common restrictions are watershed time bans for specific beverages and specific media. Norway has a total ban on the advertising of alcohol. In 1991, France introduced extensive restrictions, which included banning alcohol advertising on television and in cinemas and preventing alcohol sponsorship of cultural or sports events. Where advertising is permitted, content is strictly controlled and a health message must be included on each advertisement that 'alcohol abuse is dangerous for health'.
147. In the UK, alcohol advertising is regulated by a mix of statutory and self-regulation, though Ofcom and the Advertising Standards Authority ( ASA). In 2005, following a review and consultation by Ofcom, the statutory codes for broadcast advertising of alcohol were tightened in relation to content but they did not place any further restrictions on the volume of adverts. Subsequently, the Advertising Standards strengthened the self-regulatory regime for non-broadcast advertising to bring it broadly in line with the strengthened new broadcast rules restricting general appeal to young people and linking of alcohol with sexual content and/or irresponsible or antisocial behaviour. Research commissioned by Ofcom/ ASA to measure the impact of the new rules on the appeal of alcohol advertising to under 18s concluded that, in the period since the change, there has been an increase in those saying that the adverts make drinks look appealing and would encourage people to drink it. 67
148. The Portman Group, a body established by the drinks industry to promote responsible drinking, has a voluntary Code of Practice on the Naming, Packaging and Promotion of Alcoholic Drinks which requires that promotional activities should not appeal specifically to under 18s nor should they encourage excessive consumption; be associated with anti-social behaviour, illegal drugs or sexual success; or suggest that drinking leads to popularity.
Are further restrictions desirable to reinforce the message that alcohol is not an ordinary product?
149. Although we have no plans at this stage to introduce statutory restrictions on alcohol sponsorship we welcome the increase in the voluntary inclusion of responsible drinking messages at events with an alcohol sponsor, in line with the "Social Responsibility Standards for the Production and Sale of Alcoholic Drinks: Scotland". 68 Local Licensing Boards also have powers to regulate major events and, where necessary, to apply additional conditions (such as ensuring responsible drinking messages appear at events). We also welcome the recent change to the Portman Code which means that alcohol branding should no longer feature on children's replica shirts. 69 We are working with the industry to develop a voluntary code specifically on alcohol sponsorship and will monitor the impact of this and consider further regulation if necessary.
150. In terms of advertising more widely, given the reach of broadcast advertising (in particular television which represents almost half of total spend on alcohol promotion through the media 67), we consider this should be focus of further action. A recent survey found that the majority of TV alcohol advertising is scheduled prior to 9pm, with a particular increase between 3 and 5pm. 70 In addition the Ofcom/ ASA research found that, between 2005 and 2007, young people reported an increase in the amount of cider that they had drunk and that the proportion of television spend represented by the cider market increased from 1.8% in 2002 to 15.5% in 2006. 67
151. Given the appeal of alcohol adverts to young people, we consider that there should be further restrictions on the broadcasting of alcohol adverts at times which children and young people are likely to view them. The UK Government is undertaking a review of the evidence on the relationship between alcohol price, promotion and harm, due to report in summer 2008. This will include consideration of whether the current advertising restrictions are sufficient to protect children and young people in particular. We will therefore explore how best to deliver a ban on alcohol advertising before the 9pm watershed and in cinemas for films with a certificate below age 18. This approach is supported by the British Medical Association.
FURTHER RESTRICTING PROMOTIONAL MATERIAL IN LICENSED PREMISES
152. We propose action to further restrict the use of promotional materials within licensed premises and invite views on our proposals.
153. We have already introduced a statutory requirement which, from 1 September 2009, requires the display of alcohol for consumption off the premises to be confined to a single area of the premises and/or an area that is inaccessible to the public. This effectively eliminates cross-merchandising of alcohol with other products and means that customers will need to make a more conscious decision to go to that area if they intend to browse or buy an alcohol product. They will no longer encounter numerous alcohol displays as they select their everyday groceries.
154. In order to reinforce the above measures and to ensure that alcohol product displays are not just simply replaced by displays of promotional material depicting alcohol, we propose further action to restrict the use of promotional materials within licensed premises.
We invite views on whether regulations should be made, under the Licensing (Scotland) Act 2005, to extend the existing regulations to:
- prevent the display on licensed premises of promotional material relating to alcohol in a way visible to persons outside the premises.
- prevent the use on licensed premises of any special display designed to promote sales of alcohol for consumption off the premises.
- prevent on licensed premises any other promotional activity to induce the sale of alcohol for consumption off the premises.
SEPARATE ALCOHOL CHECKOUTS
155. We seek views on whether new regulations should be introduced to require that alcohol must be purchased through an 'alcohol only' checkout or checkouts in off-sales premises.
156. Alcohol displays scattered throughout stores encourage us to think of alcohol as an ordinary product. Because of the risks associated with alcohol use, it is important that we draw a distinction and that we discourage impulse buying of alcohol products. One means of doing this is by introducing separate checkouts for alcohol products.
157. As noted above, the introduction of regulations requiring that alcohol be confined to a dedicated area or areas of the premises mean the customer has to make a conscious decision to go to that area if they intend to browse or select an alcohol product. Separate checkouts would be a further extension to this policy and they are already in place for tobacco sales in many large supermarkets and other stores. In effect, this means a shopper wishing to purchase tobacco as part of their weekly shop must queue up twice and the store must process two separate transactions. Similar arrangements for alcohol sales could encourage shoppers to make conscious decisions about whether to purchase alcohol and help to emphasise that alcohol is not an ordinary product. In stores where alcohol is sold, a separate checkout or checkouts would be used for the sales of alcohol products. No other products could be processed through the 'alcohol checkout'.
158. We recognise that there may be consideration about where such requirements should apply. For example, it may not be appropriate to apply these requirements to small premises such as village stores and corner shops, which may operate with only one till point, to shops which primarily sell alcohol such as wine warehouses, or to pubs selling for consumption off the premises. In addition, given retailers' concerns about the difficulties faced by staff in challenging customers who appear to be under 18, should there be a requirement for staff operating separate alcohol checkouts to be at least 18 years old.
We invite views on:
- the desirability of creating separate checkouts for alcohol sales to help emphasise that alcohol is not an ordinary commodity;
- the particular criteria that should be applied in determining which types of premises should be subject to any such arrangements; and
- whether there should be a requirement for alcohol checkout staff to be at least 18 years old.
IMPROVED SUPPORT AND TREATMENT
159. There is strong evidence that early intervention with individuals whose drinking is likely to expose them to increased risk can be effective in helping them to reduce their alcohol intake. But many Scots don't realise that their drinking is placing them at increased risk. We need to improve prevention activity, identifying people whose alcohol use may be harmful without their being aware of it, and supporting them to make positive changes. Those with more serious problems, such as alcohol dependency, often require more intensive support to enable them to address their drinking. The provision of significant additional resources will enable us to ensure better and quicker access to services that meet their needs.
- We have committed a record additional £85m over the next three years to improve the identification, support and treatment of those who are misusing alcohol.
- We have established a new programme target for the delivery of brief interventions by the NHS.
- We will establish a comprehensive national training programme for staff involved in delivering brief interventions.
- We are working with a wide range of partners to ensure that local delivery is effective, efficient, accountable, and reflects both national and local priorities.
- We will develop a co-ordinated national alcohol and drugs workforce development plan to ensure that professionals involved in supporting those with alcohol problems have the necessary skills.
- We have developed an Action Plan on improving Mental Health in Scotland, which recognises the relationship between alcohol and mental health and ensures that this is taken into account in promotion, prevention, and support activity.
- We will work with partners to encourage the development of integrated care pathways for offenders and information sharing to ensure they receive continuity of alcohol support and treatment both in custody and in the community.
ENHANCING AND CAPACITY BUILDING IN SCREENING, BRIEF INTERVENTION AND TREATMENT SERVICES
160. We have committed record additional funding to support the identification, support and treatment of those who are misusing alcohol.
161. In addition to changing attitudes towards alcohol misuse, we need to build people's own capacity to improve their health and wellbeing. Many people may simply be unaware that their alcohol use is placing them at increased risk. Others may recognise they have a problem but need support to address it. We want to create the conditions in which individuals have the confidence, motivation and ability to make positive choices about their alcohol use and can access professional support and advice when required.
162. That is why we are making the largest ever financial investment towards tackling alcohol misuse - an additional £85.3 million over the next three years - on top of the current annual allocation of £12.3 million. The majority of this funding will be routed through NHS Scotland to deliver increased access to early intervention and treatment, and it will provide a significant step change in the level of screening for and diagnosis of alcohol misuse, support and advice, and, where appropriate, effective and timely treatment. NHS Scotland is uniquely placed both to deliver services directly through GPs and hospitals, and to work through ADATs, to commission services in line with local need, taking into account health inequalities. Funding to Boards has been allocated using a formula which takes account of deprivation, in order to impact on health inequalities in relation to alcohol-related harm, as well the numbers of drinkers who are at increased risk or dependent.
Delivering screening and brief interventions
163. We have established a new programme target for the delivery of brief interventions by NHS Boards and will also establish a comprehensive national training programme for staff involved in delivering brief interventions
164. As part of our approach to Better Health, Better Care, 71 the Government's programme to deliver a healthier Scotland by helping people to sustain and improve their health, we will expand screening to enable early identification of people who are misusing alcohol but may be unaware they are doing so, and delivery of brief interventions to help prevent them from developing problems.
165. There is strong evidence that screening and brief interventions are effective in helping people who are drinking at levels which put them at increased risk, but who are not alcohol dependent. 72 These tools are thought to work equally well for those deprived and marginalised groups in society. Clinical guidelines 73 are in place which recommend health professionals opportunistically screen people who may be at risk, during routine visits to their GP, antenatal clinics or accident and emergency departments. Where people are identified a simple, short advice session ('brief intervention') has been shown to be effective in helping them to reduce consumption over the medium term.
166. Several examples of good practice of delivering brief interventions exist, (Annex G sets out two examples in different settings). Also 'Keep Well', 74 targeted at 45-64 year olds in the most deprived areas of Scotland, provides health checks aimed at identifying individuals risk of preventable ill health particularly focusing on cardiovascular disease. Those found to be at risk are referred onto further services, including brief interventions on alcohol, which aim to address and reduce the individual's risk of future ill health. Despite this, brief interventions are not yet being provided on a systematic basis. Our aim is to ensure that screening and brief interventions are routinely available through the NHS. We have taken a number of actions to support NHS Boards in their delivery:
- by including alcohol screening and brief interventions as a Scottish Enhanced Service;
- by making delivery of screening and brief interventions in acute settings one of the priorities of our Health Promoting Health Service activity;
- by establishing Health Efficiency Access and Treatment ( HEAT) targets to measure their delivery;
- by establishing a comprehensive national training programme, through NHS Health Scotland, to ensure staff have the right skills to deliver brief interventions, as part of our wider workforce development activity (see page 53); and
- underpinning all this activity by making significant additional funding available.
167. We will also provide a further avenue for support and follow-up advice through the NHS 24 Helpline.
Building capacity in treatment services
168. For those with more severe or dependent drinking, or for whom alcohol related health harm is already a reality, more intensive treatment and support may be required. We know that provision of specialist services currently falls short of need and are funding research to establish the size of this shortfall. 75 Increasing routine screening for alcohol problems will have a knock on effect on the number of people identified with alcohol problems who require further specialist support. Our record investment over the next three years will, therefore, support significant improvements in prevention and treatment services. Services should be accessible and inclusive to fully address the needs of those with alcohol problems and support those affected by others' alcohol problems.
169. We expect NHS Boards to spend the majority of the additional prevention and treatment funding on such services, in line with priorities determined by Alcohol and Drug Action Teams ( ADATs). Service commissioning decisions will continue to be taken by NHS Boards and ADATs, in line with locally identified need, and taking into account health inequalities. Where appropriate, services should comply with the guidance contained in the Health Technology Assessment Report 3 on Prevention and Relapse in alcohol dependence. Services can be commissioned from the public, private or third sectors.
170. Alcohol problems cannot necessarily be treated in isolation, however. There are strong links between alcohol and mental health, homelessness, and the use of illegal drugs. In addition the needs of children affected by parental alcohol misuse, and wider family members need to be considered. It is important that the parental support services coordinate with those providing support to their children. An holistic, integrated approach to treatment and care is essential to deliver the best outcomes for those affected by alcohol related harm.
171. We will work with NHS Boards and ADATs to ensure that local delivery is effective, efficient, accountable, and able to deliver solutions to both national and local priorities.
172. Effective local arrangements for delivering services and activities are critical to the success of an effective national alcohol strategy. ADATs are responsible for co-ordinating multi-agency and multi-disciplinary strategy at a local level, identifying local priorities for action and working in partnership towards reducing the harm arising from substance misuse problems. A stock-take review of ADATs (published in July 2007) concluded that a partnership approach was essential to effectively tackling substance misuse, but highlighted a number of areas for improvement to ensure more effective delivery, in particular: variation in performance between ADATs; clarity about the role and purpose of ADATs; and accountability, particularly to central Government, who provide funding.
173. Our aim is to develop and put in place arrangements for delivery which, as far as possible, ensure:
- that all elements of the system are clear about their role, responsibilities and relationships with each other, to allow appropriate accountability to be expressed;
- that local strategic priorities are developed and implemented effectively, reflecting both national priorities and local circumstances;
- that resources are used efficiently and effectively, and that local partners can demonstrate to Government that this is the case; and
- that any local delivery structure is run in a professional and business-like fashion, with proper information management that can underpin accountability and reporting to Government and local communities.
174. A joint sub-group of the Scottish Ministerial Advisory Committee on Alcohol Problems and the Scottish Advisory Committee on Drug Misuse was established in January 2008 to drive the reform process. It will report in Autumn 2008, its remit is to:
- develop and propose an outcomes-based framework for assessing and managing performance at a local level;
- develop and propose a clear statement of the strategic functions which need to be carried out at a local level to deliver national alcohol and drugs misuse strategies;
- develop and propose robust accountability arrangements between central Government and partner organisations; and
- consider the role, structure and responsibilities of a national support function.
DEVELOPING THE ALCOHOL WORKFORCE
175. We will develop a co-ordinated national alcohol and drugs workforce development plan to ensure that professionals involved in supporting those with alcohol problems have the necessary skills.
176. Scotland benefits from an extensive infrastructure of third sector statutory organisations that are determined to tackle problems with alcohol misuse. A diverse range of professions, such as doctors, nurses, social workers, counsellors, housing officers and youth workers, may contribute to the care and support of those affected by alcohol misuse. We recognise that more could be done to support and strengthen the capacity of this workforce, through learning and development opportunities, in order to deliver measurable outcomes, against both national and local priorities and targets. The previous Administration committed, through the Updated Plan for Action on Alcohol Problems, to developing a co-ordinated national alcohol and drugs workforce development plan to support the learning and development required, and we will continue to progress this work. This will draw on the good practice currently available and that which is under development.
177. The plan will seek to: identify those with a role in addressing the impact of alcohol and drug related harm on individuals, families and communities; devise an approach that reflects the different levels of support provided by them; establish a set of key competencies across the workforce; and ensure the workforce has the necessary skills to address the wide ranging needs of clients. It will also provide an implementation framework to roll standards out across the workforce. In order to achieve this a local Training Needs Analysis Guide; a database of existing training and learning provision; a bank of learning materials; and a range of supporting resources, including a mapping of occupational standards and qualifications, and competency frameworks are likely to be produced.
178. A Steering Group, led by NHS Health Scotland, has been established to take this forward. The workforce development strategic plan will be published in late 2008, with implementation plans to follow in Spring 2009. This work will support a competent, confident, valued and responsive workforce to address the health and social support needs of individuals, families, carers and communities affected by alcohol and drug related harm.
MENTAL HEALTH & SUBSTANCE MISUSE
179. We are developing an Action Plan on improving Mental Health in Scotland, which recognises the relationship between alcohol and mental health and ensures that this is taken into account in promotion, prevention, and support activity.
180. We know that alcohol misuse can have a negative impact on the mental health and wellbeing of individuals and their family. Conversely mental health problems, such as psychosis, depression and even dementia, can contribute to increased alcohol use. Around half of all suicides had a history of alcohol misuse and, alcohol misuse is the primary diagnosis in 13% of Scottish psychiatric admissions. 2 The strong correlation between alcohol misuse and actual or potential mental health problems means that we must tackle the two together. But it is not only at the acute end that alcohol and mental health can be closely interlinked. Alcohol is a depressant and although its use can provide a temporary feeling of relaxation and wellbeing, its longer term effect can be to accentuate low mood, anxiety and depression.
181. Alcohol misuse can be a direct and/or indirect contributory factor in developing dementia and for those with an early diagnosis continued alcohol consumption can worsen functioning and lead to further and more rapid deterioration. The promotion of good mental health will have benefits by helping to prevent mental illness and associated alcohol and drug misuse. In addition, reducing alcohol misuse should have a positive effect on mental health.
182. We have already taken action to address these inter-linkages in developing services. We published 'Mental Health in Scotland: Closing the Gaps - making a Difference' which builds on the principles and recommendations of the Mind the Gaps and A Fuller Life reports. It supports joined up local delivery to improve awareness, support and service provision for people who have both mental health and substance misuse problems including Alcohol Related Brain Damage. The report recommends that NHS mental health services should have the lead responsibility for care of those whose needs are best met within specialist mental health care. But it also proposes the need for substance misuse services to develop knowledge, skills and capacity in psychological treatments to meet the mental health needs of their client group.
183. In addition, Towards a Mentally Flourishing Scotland: The Future of Mental Health Improvement in Scotland 2008 - 2011 proposes action on 3 main themes: promotion, prevention and support. People with alcohol problems and children whose parents have problems with drugs and/or alcohol are two of the priority groups for local and national action. An Action Plan is being developed for National and Local implementation from 2008 to 2011.
184. The recent Report for Scotland of the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness highlighted that in Scotland, as elsewhere, homicide is a crime committed by young men, with young men their most likely victims. In the cases studied, alcohol or drugs were often present and homicides were most often committed with 'sharp objects'. We will work with the findings and recommendations in this report and put this within the context of current and planned work in Scotland. Recommendations to ensure frontline staff are skilled and confident in assessing and managing alcohol misuse fit well with ' Closing the Gaps'. Further recommendations relating to services for those with a dual diagnosis are being taken forward through the standards for integrated care pathways for mental illness conditions that have been developed by NHS Quality Improvement Scotland. In addition, ongoing work to track admissions to both general and psychiatric hospitals through the Scottish Patients at Risk of Re-admission and Admission ( SPARRA) highlights the need to make better use of information on the multiple admissions of individuals which can often be related to alcohol or drugs.
ALCOHOL AND OFFENDERS
185. We will work with partners to encourage the development of integrated care pathways for offenders and information sharing to ensure they receive continuity of alcohol support and treatment both in custody and in the community.
186. The link between alcohol and crime - particularly violent crime and anti-social behaviour - is clear. Alcohol-related crime is estimated to cost Scotland £379m per year, cause misery to victims and their families and undermine our communities, particularly those that are most deprived. 1 Many of those who offend have alcohol problems not necessarily directly linked to their offending behaviour. The majority of those who offend and their victims come from disadvantaged backgrounds. 76 Intervening in a criminal justice setting can provide the opportunity to support those who are hardest to reach in the community and so tackle health inequalities. It brings benefits directly to the offender and their immediate circle and indirectly to those communities we most want to strengthen. There are particular challenges to engaging with offenders, particularly those who receive custodial sentences which need to be overcome.
187. An offender can travel a path which begins with contact with the police, moves through police custody and possibly to court. It can result in community based sentences, such as a probation order or community service order, or may result in imprisonment and subsequent release back into the community, with or without statutory supervision. Opportunities exist along these various routes to identify that someone has an alcohol problem; assess the nature of that problem and the individual's motivation to change; deliver appropriate interventions or direct them into specialist treatment and support. Conversely there are risks that the treatment and support which people receive can be disrupted as they move from one setting to another. If information about an offender's alcohol use is not shared between services as a matter of course, or in a timely way, opportunities to make a real difference are lost.
188. We want to encourage the development of integrated care pathways for individual offenders and to ensure information sharing protocols between agencies in order that offenders' alcohol issues are identified and appropriate interventions can be provided. Community Justice Authorities ( CJAs) have a key role to play here. The Scottish Prison Service ( SPS) and those who provide community based services should work together to ensure the identification of needs and continuity of care within and after prison for those in need of specialist support to overcome their problems with alcohol misuse. SPS should formally screen all prisoners for alcohol problems and, where appropriate, deliver brief interventions. We will fund a pilot project to enable them to evaluate the effectiveness of this work. We are also conscious of the need to improve our understanding of 'what works' in terms of alcohol interventions with offenders in a community setting, and will work with CJAs to learn the lessons from Scotland-wide experience.