Policy responses and statements
Background: This discussion paper sets out the Scottish Government's strategic approach to tackling alcohol misuse. It illustrates the scale of alcohol-related harm in Scotland and how addressing this can help to deliver a Wealthier and Fairer, Safer and Stronger, Healthier and Smarter Scotland. Increasing trends in alcohol consumption mean that many Scots are now drinking above sensible guidelines. Over recent years, increased consumption has been influenced by factors such as a decline in the relative cost of alcohol; increased availability; and changing cultural attitudes. Excessive alcohol consumption is closely linked to harm: the more we drink, the greater the risks. It is clear that alcohol misuse is no longer a marginal problem. Nor is it one that affects only binge drinkers or those who are dependent on alcohol. Many actions are already underway which will contribute to tackling both the underlying causes of, and the negative effects resulting from, Scotland's complex relationship with alcohol. These include the Government Economic Strategy, its policy statement on Early Years and Early Intervention, and Equally Well, the Ministerial Taskforce on Health Inequalities report. But the evidence shows that more direct and effective action to tackle alcohol misuse is needed if we are to maximise our potential as individuals, families, communities and as a country. To deliver the long-term sustainable change required it essential that Government works in partnership with a wide range of partners. Based on knowledge and understanding of alcohol misuse, its drivers, and evidence-based interventions, sustained action is required in four broad areas:
The Framework for Action sets out measures to reduce alcohol-related harm in Scotland, forming the basis of a comprehensive strategic approach which will contribute to achieving a successful and flourishing Scotland. The sections set out key actions already underway; existing commitments for action; and new proposals on which views are invited. In particular, the Scottish Government sought views on:
COMMENTS ONSCOTTISH GOVERNMENTCHANGING SCOTLAND'S RELATIONSHIP WITH ALCOHOL: A DISCUSSION ON OUR STRATEGIC APPROACHThe Royal College of Physicians of Edinburgh (RCPE) welcomes the opportunity to respond to this Scottish Government consultation on alcohol misuse. The RCPE, as one of the founding Colleges and host of Scottish Health Action on Alcohol Problems (SHAAP), endorses the SHAAP response to this consultation exercise and offers the following additional comments. GENERALThe RCPE would wish to congratulate the Scottish Government on bringing forward strategic and wide-ranging proposals to tackle the increasing adverse health effects of excessive alcohol consumption in Scotland. In particular, the RCPE would wish to acknowledge the significant recognition that the scale of excessive alcohol consumption, and accompanying adverse health effects, in Scotland now requires to be tackled by adopting a population-based approach. Over 1 in 4 men and 1 in 10 women in Scotland are now drinking at levels hazardous to their health and it can no longer be argued, by industry of others, that attempts to reduce the harm caused by alcohol should be directed only at problem drinkers rather than at a population level. IRRESPONSIBLE PROMOTIONS AND BELOW COST SELLINGQuestion 1 We invite views on our proposals to make regulations, under the Licensing (Scotland) Act 2005, to:
The RCPE fully supports the proposals to put an end to irresponsible drinks promotions in the off-trade sector. The Licensing (Scotland) Act 2005 already includes regulations to curtail irresponsible drinks promotions in the on-trade sector and we believe it was anomalous and a weakness of the original legislation that such regulations were not applied equitably to the off-trade sector. It is essential to close this loophole in the Act by applying such regulations to the off-trade sector. There is strong evidence to demonstrate a correlation between the price of alcohol and the level of alcohol consumed. In recent years competition between retailers (principally the four largest supermarket chains) has driven down the price of alcohol in the off-trade sector to the extent that a unit of alcohol can be purchased for as little as 16p. The report from the Competition Commission last year documented the extent to which alcohol is now being sold by retailers as a loss leader, via ‘deep discounting’, throughout Scotland and the rest of the UK. Whilst the price of alcohol has continued to fall (alcohol is now 62% more affordable than it was in 1980), consumption of alcohol at home has increased and indicators of alcohol-related harm are showing alarming upward trends. Given the extent of alcohol-related harm in Scotland, we believe it would be irresponsible and highly damaging to allow the continued sale of alcohol by retailers as a loss-leader. MINIMUM RETAIL PRICINGQuestion 2 We invite views on whether a minimum pricing scheme should be based on the following principles:
The RCPE strongly supports the proposal to introduce minimum retail pricing and would refer to the SHAAP report on ‘Alcohol: Price, Policy and Public Health’1 which provided a comprehensive review of the evidence on the relation between the price and level of alcohol consumed. The RCPE believes that the minimum price of alcohol should be determined by the alcoholic strength of product rather than the type of product. There is a precedent for such linkage in the form of the level of tax applied to alcohol by volume. We also believe this would be the fairest and most equitable approach for retailers and producers and the easiest approach for consumers to understand. In addition, we would echo the following statement made in the SHAAP response to this consultation – “This is an optimal arrangement from a public health point of view, as not only will minimum pricing raise the average price of alcohol with an expected resultant reduction in demand, but higher prices for higher-strength alcoholic drinks give a financial incentive for drinkers to drink and producers to produce lower-strength products. The alcohol content of a beverage is also an objective measure and thus if used as the basis of a minimum pricing scheme is less likely to be susceptible to legal challenge on competition grounds than if the scheme used other less objectively measurable criteria, such as the perceived appeal of a specific beverage to a particular group of people. SHAAP commissioned two independent legal opinions for our policy report on price and the legal advice confirmed that minimum pricing was possible under both UK and EU competition law. However, setting minimum prices independently of those who profit from the production or sale of alcohol is a necessary condition for a minimum pricing scheme if it is not to fall foul of UK and EU competition law. From a public health perspective, if the purpose of minimum alcohol pricing is to alleviate alcohol-related harm, then those setting the prices need to be knowledgeable in the objectives and principles of public policy. Minimum prices therefore need to be determined by Scottish Ministers. It is important that Ministers have the ability to vary the level at which prices are set to take account of changes in the costs of living so that the effect of minimum prices in prohibiting the sale of very cheap alcohol is maintained.” INFORMATION FOR PARENTSQuestion 3 What particular information do you think parents and carers would find helpful to enable them to support their children to make positive choices about alcohol? In recent years Scotland has experienced a significant increase in the number of young people presenting with early signs of alcoholic liver disease. The number of young people presenting at hospital with acute effects of excessive alcohol consumption is also of concern. It would seem clear that young people are not receiving adequate information or responding to existing information which may be provided about, in particular, the chronic effects of excessive alcohol consumption, and that much work has still to be done to counter the often glamorous associations with alcohol conveyed by industry marketing material. Evidence has shown that health education messages around the world have, to date, had little impact on reducing alcohol consumption and are unlikely to be successful alone, particularly without wider cultural and societal change. It is essential that such health educational messages are, therefore, seen as an addition to wider regulatory measures rather than as an alternative. Particular areas in which existing information provision may be insufficient for parents and carers include –
MINIMUM LEGAL PURCHASE AGE FOR ALCOHOLQuestion 4 Do you think that the minimum age for off-sales purchases should be raised to 21 in Scotland? Whilst this proposal may not have as strong an evidence base as other areas of alcohol research, such as the link between price and consumption, evidence from other countries, most notably the US, would suggest that increasing the minimum legal drinking age from 18 to 21 could reduce alcohol consumption in this age group. We are also aware that there is evidence that many young people in Scotland ‘pre-load’ on alcohol purchased in an off-licence prior to going out for an evening and we have noted with the interest the successful voluntary scheme piloted in West Lothian in which retailers did not sell alcohol to anyone under 21 on Friday and Saturday evenings. On balance, the RCPE would support the above measure provided that it forms part of a comprehensive alcohol policy, containing a wide-ranging series of measures, aimed at reducing overall alcohol consumption. Furthermore, we believe it may be wise to extend the West Lothian pilot project in a few more geographic areas around Scotland before determining if this could be rolled out nationally. In addition to the above, we believe it is essential that enforcement of the existing minimum purchase age for alcohol is strengthened in the on-sales sector with incremental penalties (up to and including revocation of license) for licensees who offend repeatedly. SOCIAL RESPONSIBILITY FEEQuestion 5 What criteria should be used to determine the types of premises (or specific premises) that should be subject to a ‘social responsibility fee’? (e.g. late opening premises, or premises in a particular area)? What criteria should be used to consider exemptions from the fee? And how should the fee be determined? (e.g. based on rateable values, alcohol sales turnover)? The RCPE supports the principle of the social responsibility fee (or the ‘polluter pays’ principle), but believes that the proposal currently lacks sufficient detail to enable further comment at this time. We believe it would be sensible and fair to apply a social responsibility fee equitably to the licensed sector, retailers and producers of alcohol. In addition to investing in communities adversely affected by alcohol, a proportion of the income generated by the social responsibility fee could be ring-fenced to fund further research into alcohol misuse. Question 6: Should a fee be applied to Occasional Licences as well as Premises Licences? - Question 7: 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? As stated in our answer to Question 5, we believe that the social responsibility fee should be applied to the licensed sector, retailers and producers of alcohol. PROMOTIONAL MATERIAL IN LICENSED PREMISESQuestion 8 Do you agree that regulations should be made, under the Licensing (Scotland) Act 2005, to extend the existing regulations to:
The RCPE fully supports the proposals to extend regulations to restrict alcohol-related promotional material in licensed premises and believes that such amended regulations will form a vital part of the Scottish Government’s overall alcohol strategy. SEPARATE ALCOHOL CHECKOUTSQuestion 9 Do you think that there should be separate checkouts for alcohol sales? What criteria should be applied in determining which types of premises should be subject to any such arrangements? The RCPE strongly supports the recognition that alcohol is “no ordinary commodity”2, which conveys a compelling health message. It recognises, however, that there is, as yet, little evidence base to recommend separate checkouts which could prove controversial to implement and there is a case for a locally based pilot to assess the impact. Question 10 Should there be a requirement for alcohol checkout staff to be at least 18 years old? The RCPE has, through SHAAP and the Scottish Intercollegiate Group on Alcohol, argued for some time that all staff selling alcohol should be aged 18 or over. This is already the case in the on-sales sector and it is important that such a regulation is applied equitably to the off-trade. OTHERDrink Driving The RCPE strongly welcomes and supports the Scottish Government’s commitment to press the UK Government to reduce the drink drive limit from 80mg per 100ml of blood to 50mg, and to give the police power to carry out random breath tests. Health Inequalities Those living in the most deprived communities in Scotland are around six times more likely to be admitted to hospital (and to die) due to alcohol misuse than those from the most affluent areas. The RCPE welcomes the recognition in the consultation document of the part played by social deprivation and health inequalities. The RCPE also recognises that the proposal to apply a social responsibility fee may go some way towards investing in communities disproportionately affected by the burden of alcohol misuse, but that the Scottish Government does not intend to set out the uses to which such fees should be put at a national level (favouring determination of such matters by local authorities). Whilst supporting the principle of local delivery and autonomy, the RCPE is concerned that such an approach could lead to fragmented, and inconsistent, investment in local communities, thus reducing the potential health gain and the reduction in health inequalities to be achieved. Licensing: Understanding the Public Health Objective The RCPE and SHAAP are concerned that local licensing boards and forums may not fully appreciate what the public health objective means in terms of their own practice and procedure. Many of the measures in the document which seek to put controls on the supply side and regulate the market rely on the provisions of the Licensing (Scotland) Act 2005 which provides a robust legislative framework for implementing the measures. The extent to which boards are engaging with public health interests remains unclear as does the involvement of public health representatives in local forums. Licensing: Evaluation of the Measures The RCPE would be interested to know what measures the Scottish Government has put in place to evaluate the implementation of the licensing legislation. Having introduced this innovative legislation, it is vital that sufficient resources are in place to ensure that the legislation is implemented and evaluated. In this regard, it would be desirable to re-convene the National Licensing Forum (with appropriate medical and public health representation) to oversee the implementation of the new legislation and to ensure that local licensing boards fully understand their responsibilities in relation to the public health objective. Building Capacity in Treatment Services The RCPE and SHAAP welcome the significant resources that the government has made available to local health boards to build capacity for screening and brief interventions (SBI) in alcohol and the commitment to ensuring that SBI are routinely available through the NHS, but we believe that the related training and technical support needs to be strengthened in order to support implementation. We would refer to the SHAAP response for more detail regarding this area. References
Copies of this response are available from: Lesley Lockhart, Tel: 0131 225 7324 ext 608 [9 September 2008]
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