Alcohol misuse is causing huge damage to the nation’s health and its finances. With minimum pricing finally a reality in Scotland, what does the future look like for the rest of the country? DDN reports.
According to the most recent figures from the Office for National Statistics (ONS), the number of ‘alcohol-specific’ deaths in the UK stands at more than 7,300 (DDN, December/January, page 5). While the death rate does appear to have plateaued in recent years, it’s still higher than at the turn of the century and ONS stresses that the narrow definition of ‘alcohol-specific’ means those numbers will be a conservative estimate.
Much has been made of the fact that fewer young people seem to be drinking, but those that are, are drinking a lot. Death rates among older people, meanwhile, are rising steeply – by around 50 per cent since 2001 among men aged 70-74, for example. As this issue’s Alcohol and Health supplement points out, it can be decades before the damage done to a liver by heavy drinking manifests any symptoms, and often when it’s too late.
Clearly, then, there’s no cause for complacency, and while calls for better labelling (DDN, February, page 5) have yet to show results, the battle to introduce minimum unit pricing (MUP) has finally been won, albeit after a five-year fight (DDN, December/January, page 4). MUP became law in Scotland last month, and Wales is also moving to introduce it (DDN, November 2017, page 4). So are we likely to see it in England?
‘We will have to wait and see,’ director of policy at Alcohol Research UK and Alcohol Concern, Dr James Nicholls, tells DDN. ‘I think it’s unlikely in the short term, not least because the government is tied up with Brexit. They have announced that a new alcohol strategy will be developed, but as regards MUP it sounds like that will only involve a review of the evidence. They are also waiting to see what the outcome is in Scotland, where we now have the opportunity to see how the policy plays out in the real world.’
All eyes will be looking north of the border, not least because up to now everyone has had to rely on modelling predictions for MUP, Nicholls points out. ‘That modelling is detailed and extensive, but wasn’t a crystal ball. Now that the policy is in place, everyone is looking to see how it plays out.’ One very interested party, of course, is the drinks industry. Its battle with the Scottish Government went to the European Court of Justice and the Supreme Court, but it still lost, which means it’s unlikely to mount any legal challenges to Welsh or English plans. ‘The legal process leading up to the Supreme Court decision was lengthy and thorough, so I think the legal questions are largely resolved,’ he says.
The fact that it was so lengthy has led to criticism that the 50p level set is now too low, with the Scottish Lib Dems arguing 60p would better reflect the impact of inflation (DDN, March, page 5). Is that fair comment? ‘There is a very extensive evaluation taking place in Scotland, which will look at the impact of the 50p price on different types of drinkers, on retail practices, and on health outcomes,’ Nicholls states. ‘That’s a good thing – policies should be evaluated, and we should be prepared to adapt our view of them in line with what we find. The most important thing, at this stage, is to try and ensure the evaluation is robust and impartial – we can then develop our views on the future of MUP in the light of that understanding.’
While MUP may be a positive development, for those struggling with an alcohol problem it clearly isn’t a silver bullet. Access to effective help is vital, and the recent report The hardest hit spelled out that the treatment system is at crisis point (DDN, May, page 4). One of the reasons identified was lack of political support – is that simply down to competing local priorities for limited funds, or is it a fundamental failure to see the bigger picture?
‘I think it’s very hard to make the case for better investment in substance use treatment generally, and alcohol treatment in particular,’ says Nicholls. ‘It’s not really a popular cause, and there is often still the sense that this is government spending money on people who have brought problems on themselves. However, aside from the ethical responsibility to support people struggling to overcome dependency, disinvestment is clearly a false economy. If people can’t get the support they need that doesn’t mean their problems disappear – often those same people will end up as repeat visitors to A&E or to other social services, all of which has enormous cost implications. We are calling for concerted government action to tackle the crisis in alcohol treatment both because it is the right thing to do and because disinvestment in the system leads to enormous costs further down the line.’
As the government does finally seem to have committed to delivering a new alcohol strategy, what should be in it? Alongside action on marketing regulation and pricing his organisation wants to see a ‘commitment to meaningful action on helping vulnerable people – not just those needing help with problem drinking, but the families and communities affected by that,’ he says. ‘That not only means more money for treatment, but support for better skills development and commissioning.
‘For that reason, we are asking the government to look at the introduction of a levy on alcohol to plug the funding gap – we want better support for the range of services who encounter alcohol issues in their daily work, improved pathways into treatment, and more effective use of brief interventions.’