Alcohol in Blackpool

BSafe Blackpool

The Blackpool situation

The scale……………………..• 50% of suicides are alcohol related

• 30% of fatal fires are alcohol related

• 15% of people have been drunk in work

• Alcohol is a key factor in child/elder abuse

What’s going on in hospital? • 14,000 people are admitted to Blackpool Victoria Hospital

each year

• equivalent of one ward occupied at any one time

• 40% of all A&E attendances and 75% @ weekend nights

• Single biggest cause of aggression & violence towards staff

• Principal reason for staff absence

All NW PCTs are in the national ‘worst half’ Hospital Admissions for Alcohol Related Harm (NI39)

0 500 1000 1500 2000 2500 3000

Central and Eastern Cheshire

North Lancashire

Western Cheshire

Trafford

Stockport

Cumbria

Bolton

East Lancashire

Oldham

Bury

Sefton

Blackburn with Darwen

Warrington

Blackpool

Tameside and Glossop

Central Lancashire

Ashton, Leigh and Wigan

Halton and St Helens

Wirral

Heywood, Middleton and Rochdale

Salford

Manchester

Knowsley

Liverpool

Per 100.000 population

2008/09

2007/08

Hospital Admissions for Alcohol Related

Harm (NI39) 2007/08 - 2008/09

Ranked in the bottom half nationally

Ranked in the bottom quartile

nationally

bottom nationally

. Data Source: (Centre for Public Health NW Public Health Observatory, derived from the Hospital Episode Statistics (HES)

And outside?• Some wards with 1 off licence for every 242 people

(including the new born child)

• The highest alcohol mortality rate in England

• Highest density of pubs outside of central London

• Large numbers of visitors coming with just one purpose

• High levels of domestic violence and violent crime

• One of the highest levels of teenage pregnancy

Blackpool Profiles

High Impact Changes

• Work in partnership

• Develop activities to control the impact of alcohol misuse in the community

• Influence change through advocacy

• Improve the effectiveness and capacity of specialist treatment

• Appoint an Alcohol Health Workers

• Provide more help to encourage people to drink less by increasing IBAs

• Carry out social marketing

• Cancer of the Larynx 29%

• Haemorrhagic Stroke 24%

• Fire Injuries 38%

• Alcoholic Liver Disease 100%

• Epilepsy 54%

Health risks Lip/Oral Cancer

28% Breast Cancer

7% Cardiac

Arrhythmias 25%

Spontaneous Abortion 22%

Intentional Self-Harm 34%

(Jones et al, 2008)

What is an Attributable Fraction?

Ethanol poisoning

2 X

Hypertension

10 X

Breast cancer

25 X

5% reduction required on NI39s not hospital admissions

37 Alcohol Related Hospital Admissions = 6 NI39s

2NI39s 2NI39s2NI39s

+ +

Alcohol Related Hospital Admissions per 100,000 population

Dynamic Modelling

Abstinent & low risk Increasing Risk Risky

net abst & low to increasing risk pa

net to risky pa

death abst & low death increasing risk death risky

reaching drinkingage pa

net to v high risk pa

death v high risk

stop inc risk pa

Very High Risk

stop risky pa

Binge drinkers

net to binge pa

stop very high risk

net binge to risky pa

stop binge pa death binge

Brief InterventionBrief Intervention

Increased Alcohol Liaison Nursing Service or Tier 3

and 4 aftercare and rehab services

Increased Alcohol Liaison Nursing Service or Tier 3

and 4 aftercare and rehab services

Identification and Brief Advice

Identification and Brief Advice

Enforcement Activity

Enforcement Activity

PricingPricing

Social MarketingSocial MarketingExtended Brief

InterventionExtended Brief

Intervention

Current Treatment provision

• Horizon service• Dickson Road/GP open access• Moving Forward Dickson Road• Recovery Springfield Avenue• Residential detox and rehab• Criminal Justice interventions• Outreach• Young People’s treatment – The

Hub

Criminal Justice Interventions

• Arrest Referral

• Conditional Caution

• Probation

• Alcohol Treatment Requirement

• Awareness Raising

Improve the effectiveness and capacity of specialist treatment

How are we doing

• 1300 receiving treatment in 12 month

• 400 at any one time

• 72% successful completion rate

• >150 require detox annually

• Low rehab rate

• Respected system

Hospital provision

• 4 Alcohol liaison nurses• Community on call service• All staff being trained in IBA• Emergency stabilisation provision

• Participation in NW Secondary Care Large Scale Change Group

• BFW Public Health Steering Group activity

Brief Advice

• Provided training in OBI over 1400 people

• Re tendered• New provider to deliver IBA

training to 900 people• Hospital staff IBA training

• Pharmacy IBAs

• GP Enhanced Service

altn8

• Long established in Blackpool• Re focused on pubs, clubs, party

• Posters• Media coverage• Polycarbonates• Music competition• Sobriety tests & Street activity

modr8

• New campaign aimed at home drinkers

• Unit measurers distributed

• Provided with training

NightSafe

• Police lead

• Alcohol & Crime focused

• Refreshed campaign twice in last 3 years

Night Time Economy activity

• Nightsafe

• Night Safe Haven

• Taxi Marshalls

• Altn8 Challenge

• Purple Flag ambition

New Strategy• Awaiting new national strategy

Safe, Sensible, Social. Significantly reducing alcohol harm:

An argument for minimum pricing in Blackpool

Steve Morton

Public Health Manager

Alcohol Harm Reduction Policy Officer

Affordability & Availability

• Alcohol responds to price increases like most consumer goods on the market

• As the price of alcohol has decreased in the UK, consumption has increased

• The ‘real price of alcohol’ over the past fifty years. Alcohol was 69% more affordable in 2007 than in 1980.

• Greater affordability of alcohol leads to an increase in consumption and an increase in the price of alcohol has an opposite effect.

• The increase in premises, especially in town and city centres, has led to more competitive practices

Price & Harm

• Over 250 studies have investigated not only the relationship between price and consumption, but the relationship between consumption and harm.

• A study examining the influence of the price of beer on violence-related injuries in England and Wales found that increased alcohol prices would result in substantially fewer violent injuries and reduce demand on trauma services

• Some groups of drinkers experience a greater impact than others.

• This is because hazardous drinkers tend to choose cheaper drinks

Taxation

• Taxation on alcohol has traditionally been used by governments to increase alcohol prices.

• Tax increases are easy to establish in law and to enforce in practice.

• However, using tax as a lever to lower consumption is not the option with the most impact.

• Retailers are able to undermine the impact of tax increases by refusing to pass on the higher costs

Minimum Pricing

• The aim of minimum pricing is to ensure that retailers are unable to sell alcohol below a baseline cost.

• Even when offering price promotions and discounts, the price per unit of alcohol must not fall below the designated minimum.

• The application of an across-the-board price ensures that drinkers do not switch to other types of alcohol with a lower per unit price

• Setting a minimum price by deciding a minimum price per unit rather than a minimum profit margin is the preferable option.

Based on University of Sheffield Research 2008

• Commissioned by HM Government

• We advocate a 50p per unit minimum price for alcohol, in line with the recommendations of the Chief Medical Officer.

• Setting a 50p level would result in a significant reduction in alcohol related harms.

• Moderate drinkers would experience only a negligible negative financial effect if minimum pricing was introduced.

The research found that a minimum price of 50p per unit of alcohol would;

• Reduce consumption per drinker by 6.9% on average.

• Reduce consumption per 11-18 year old drinker by 7.3%.

• Reduce consumption per 18-24 year old hazardous drinker by 3%.

• Reduce consumption of harmful drinkers by 10.3%.

• Reduce consumption of moderate drinkers by 3.5%.

50p Minimum Price Chart

Beverage No. Units Current price £

Current price per unit £

50 per unit price

Difference £ Difference %

Jacobs Creek Chardonay

9 6.79 0.75 £4.50 -2.29 -33.7

Sainsbury’s Basic Wine

8.3 2.49 0.3 4.15 +1.66 +66.7

Stella Artois 440ml

2.2 0.92 0.41 1.10 +0.24 +22

Sainsbury’s Basic Lager

0.8 0.23 0.29 0.40 +0.17 +73

Guinness 440ml

1.8 1.27 0.70 0.90 -0.37 -0.29

Magners 500ml

2.3 1.36 0.59 1.15 -0.16 -11

Sainsbury’s Basic Cider 2L

8.4 1.18 0.14 4.20 +3.02 +255

Smirnoff Ice 1.2 1.04 0.87 0.60 -0.44 -42

Archers Snapps 70cl

14.7 11.29 0.77 7.35 -3.94 -34

WKD 275ml 1.24 1.08 0.87 0.62 -0.56 -51

Sainsbury’s Basic Vodka

28 6.41 0.23 14.00 +7.59 +118

Legislation

• Any involvement by alcohol producers or sellers in fixing prices is a breach of EU and UK competition law.

• However, it is possible if minimum prices are imposed on licensees by law or at the sole instigation of a local authority

• Initial advice was ‘Don’t bother!’

• Second set of legal advice– Possible to use By Laws– Not anti competitive – Utilise Wellbeing By aw legislation– Support with enforcement Bylaw

The journey so far (Blackpool)

• 2006 – Blackpool Town Centre Pub Watch agree a £1.50 minimum price voluntary code (operates Thurs-Sun) and is well maintained.

• 2006-today – On sales licencees work with police and NHS to support Nightsafe & altn8

• 2009 – carried out research on feasibility of minimum pricing

• Presented to CDRP who agreed to support in principle and agreed action plan

• Presented to Health Overview and Scrutiny Committee who support in principle

• Presented to Acute Trust Board who support in principle

• Presented to Licencing Committee who support in principle

• Tested effectiveness on System Dynamics Model

• Worked with Our Life to develop DPH letter published in Times

• Sought support from LAN, Safer Lancashire Partnership, and regional DPHs

• Met with police Superintendant who supports initiative

• Cross authority scrutiny committee determined that we should advocate for national legislation

The start of the journey 2006

• Blackpool Town Centre Pub Watch agree a £1.50 minimum price voluntary code– Operates Thurs-Sun– Well maintained– Industry support Nightsafe– Industry support altn8

– Does not effect off sales

Our Proposal

• This parliament should, as a most important measure, introduce a minimum price per unit of alcohol, in both the on and off-trades.

• We recommend a minimum price of 50p per unit of alcohol.

• The resulting reduction in crime, health harms, lost productivity and unemployment makes a strong case for the introduction of a minimum price for alcohol.

• Minimum pricing will not negatively impact on the visitor economy as retailers targeting visitors are already retailing alcohol well above these minimum levels.

Abstinent & low risk Increasing Risk Risky

net abst & low to increasing risk pa

net to risky pa

death abst & low death increasing risk death risky

reaching drinkingage pa

net to v high risk pa

death v high risk

stop inc risk pa

Very High Risk

stop risky pa

Binge drinkers

net to binge pa

stop very high risk

net binge to risky pa

stop binge pa death binge

Test Effectiveness using Modelling

39

EnforcementActivity

+ Pricing+

+

--

- -

Scottish experience

• Plan to introduce via primary legislation• Under sold benefits• Did not have all party support for political reasons

associated with other elements of bill• Proposal rejected• New parliament with overall majority reintroducing• Introducing primary legislation in next term• Introduce minimum pricing via secondary

legislation• It will happen

North West

• Cheshire and Merseyside have drafter bye law

• Manchester have fully drawn up proposal

• David Cameron has supported local introduction

Lobbying

• Raising profile of subject at every opportunity locally

• Letter from Regional DPHs to The Times published

• Response to letter by Secretary State of Health published in The Telegraph

• Meeting with Conservative Front bench in Westminster

• Written to Justice Secretary seeking conversation

Our Action Plan

• Seek full political endorsement

• Chief Constable to discuss with the Home Secretary during regular meeting.

• Raise awareness and understanding amongst population to seek support.

• Debate subject with opponents.

• Continue Lobbying.

• Work with Lancashire Colleagues on an NHS QIPP.

• Following advice from above processes develop new Alcohol Licencing Policy to include minimum pricing and if possible introduce legislation.

Still doubting?

• 2 weeks ago the petrol industry announced a 15% reduction in petrol sales since 2008

• We never envisaged being able to stop people driving petrol guzzlers.

We need to do something

• It needs to be big• And we need to start ASAP

• We are seeking to introduce a bye law in Blackpool and encourage neighbouring authorities to join in.

• The more requests for Bye laws received at Westminster the more likely we are to receive national legislation