alcohol licensing and public health: achieving our
TRANSCRIPT
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Alcohol licensing and public health:
Achieving our objectives together
Friday 6 February 2015
London
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Introduction Madeleine Rudolph
Alcohol and Drugs Programme Manager
Public Health England, London
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Welcome Hugh Morris
Chair, London Drug and Alcohol Policy Forum; City
of London councillor
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Alcohol licensing
and public health 6th February 2015
Guildhall, London
Yvonne Doyle MD MPH Regional Director for London Health Adviser to the Mayor of London
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Aims of the event
To ensure a common understanding of the full nature of the challenges from
harmful drinking in the various parts of London
To work with partners towards a shared view of how public health skills best
play into the alcohol licensing agenda
To use this understanding and enhanced alliances to further reduce harm from
alcohol in London
5 Note: Alcohol harm is one of the seven PHE national priorities in 'From evidence into action' Oct 14
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6
Public health and the Licensing Act 2003 –
guidance note on effective participation
by public health teams
“PHE is keen to maximise the impact of public health within the local licensing
regimes and ensure that public health:
performs its role as a responsible authority effectively
is a consideration in local licensing policies
is represented in licensing forums and partnership groups
shares data and evidence with other responsible authorities”
LGA and PHE, October 2014
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% of obese
adults1
% of obese/
overweight
adults1
% of obese
Children2
% of obese/
overweight
children2
% reaching
recommended
physical
activity level3
% of
population
who smoke4
% of population
consuming 5+
drinks in one
occasion5
Suicides per
100,000 pop.6
Hong Kong - 19 7b 27b 40 13 6 11.8
Johannesburg - 59 - - 21 - - -
London 20 57 22 37 57 18 14 7.5
Madrid 8 42 2c 15c 23 28 14 2.7
New York 24 56 21d 39d 56 16 20 6.0
Paris 7 40 5e 16e 38i 40 15j 8.1
São Paolo 16a 47a 7f 25f 62j 15 - 5.4
Sydney 12 38 10g 29g 56 16 24 8.6
Tokyo 4 25 - 10 32k 20 - 21.3
Toronto 12 41 12h 32h 47 17 13k 6.9
7
Relatively ‘healthiest’ city
Relatively ‘unhealthiest’ city
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Making the Link between Licensing and Public Health
Dr Kay W Eilbert DPH Merton
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What is the Public Health Interest in Licensing
To enable people to be healthy and make healthy choices, we need to reduce the risks in the environment to health and increase healthy options
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Evidence Bigger Impact from Working on Wider Environment
Frieden, TR. 2010. A framework for public health action: the health impact pyramid American journal of public health, Vol. 100, No. 4. (April 2010), pp. 590-595
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London Healthy High Street Group Our Vision
• Our vision is to make London’s high streets vibrant and diverse places to visit, shop and enjoy, where the healthier option is the easier choice.
Who we are
• We are a public health network supported by and advised by local authority colleagues (licensing, environmental health (food safety, trading standards) and town planning), Public Health England and GLA.
What do we do
• share learning and expertise on often complex problems affecting more than one borough
• push the boundaries of what is possible and share the risks
• develop joint products that enable us to move forward together to make London’s high streets healthier
• identify where action is required at a higher level and advocate as a group for change.
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HHS Examples of Work
As part of the LHIN,
• Worked on the use of town planning restrictions to prevent further saturation of ‘hot food takeaways’, promoting healthier catering and establishing ‘cumulative impact zones’ for betting shops. Local resources produced by the group include:
• Fast food saturation
• http://www.lho.org.uk/viewResource.aspx?id=18208
• Betting shops
• http://www.lho.org.uk/viewResource.aspx?id=18207
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HHS - Alcohol and Licensing Work • Focus on tackling the impact of alcohol licensing on the high streets by
– developing a shared understanding of how Council regulatory approaches can be used to create healthier physical environments and
– incorporating planning & licensing into the JSNA to inform the development of local Health & Wellbeing Strategies.
• Work with Safe Sociable London Partnership
– Review of best practice across London for Statement of Licensing Policy
– List of potential conditions to use in responding to licensing applications
– Data tool to identify whether licensing applicants are located in high problem areas
• Work together across boroughs to
– Develop professional responses to consultations
– Lobby upwards where local action ineffective
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HHS - Next Steps
– Develop similar work for planning as SSLP licensing work
– Develop a toolkit that brings together the planning and licensing work for Public Health, licensing and planning colleagues
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Contact us:
Healthy High Street Lead: Jin Lim
e.mail: [email protected]
LDsPH Lead: Dr Kay Eilbert
Email: [email protected]
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Public Health and the Licensing
Act 2003
Madeleine Rudolph PHE London - Alcohol and Drugs Team February 2015
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“To be clear, this is not about stopping responsible drinking or
adding burdens on business. This is about promoting the
responsible sale and consumption of alcohol. This is about taking
alcohol related harms seriously.”
Section 182 Revised Guidance, Home Office, October 2014
17 Public Health and the Licensing Act (2003)
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Licensing and Health “Health bodies may hold information which other responsible authorities do
not, but which would assist a licensing authority in exercising its functions.
This information may be used by the health body to make representations in
its own right or to support representations by other responsible authorities,
such as the police.
Such representations can potentially be made on the grounds of all four
licensing objectives.
Perhaps the most obvious example is where drunkenness leads to
accidents and injuries from violence, resulting in attendances at emergency
departments and the use of ambulance services. Some of these incidents
will be reported to the police, but many will not. Such information will often
be relevant to the public safety and crime and disorder objectives.”
Section 182 Revised Guidance
18 Public Health and the Licensing Act (2003)
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Context • Legislative changes – health as a Responsible Authority
• Revised Home Office Section 182 Guidance
• Public Health move to Local Authorities (and PH grant)
These changes have created better opportunities to work together
Currently,
• progress has been made in working towards shared objectives
• there is variation in knowledge and experience in relation to both licensing
and public health
There is no London answer – variation in issues, aims and ambitions – but
sharing learning and experience remains valuable
19 Public Health and the Licensing Act (2003)
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Published October 2014:
20 Public Health and the Licensing Act (2003)
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Purpose of the Guidance • Practical ways to maximise the effectiveness of public health engagement
in licensing
• Introduce public health to licensing and licensing to public health
Responds to reported lack of understanding
Supports partnership working
• How public health could contribute to the current licensing process
Provide tailored information, reduce concerns and confusion
Reducing feeling of need to wait for a health licensing objective
Current case studies
• Provides a prompt for conversations with other responsible authorities
• Can support a stock take to review current health engagement in licensing
.
21 Public Health and the Licensing Act (2003)
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Your local system
• Is public health a consideration in local licensing policies?
• Is public health represented in local licensing forums and partnership
groups?
• Does public health share data and evidence with other responsible
authorities?
• How can we work together to maximise the effectiveness of health
contributions?
22 Public Health and the Licensing Act (2003)
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Statement of Licensing Policy
What public health can do:
• engage with the licensing authority to find out when the SLP is to be reviewed and
what the review process will be
• conduct a health-impact assessment of alcohol in the local area; or, where one has
been completed, assess its relevance to licensing
• engage with and collect the local views of the community and wider public health
community
• investigate the health data for the area, including the wider public health and local
alcohol profiles for England (LAPE) data
• engage the health and wellbeing board (HWB) in the consultation process to identify
issues that would benefit from the support of licensing
We will hear more about this from Matthew Andrews and Colin Sumpter
23 Public Health and the Licensing Act (2003)
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Cumulative Impact Policies
Public health might add:
• treatment data, including the number of people in the area in structured alcohol
treatment
• deprivation in the area
• data on alcohol consumption in the local area
• statistics from the local alcohol profiles for England (LAPE)
• Information from a study commissioned specifically for this purpose
Example later from Colin Sumpter and Matt Egan (Islington)
24 Public Health and the Licensing Act (2003)
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Responding to applications As a responsible authority, the DPH may, where they have appropriate evidence:
• make relevant representations on the likely effects of the grant or variation of a
premises licence on one or more of the licensing objectives
• make relevant representations on the review of a premises licence where problems
occur after the granting or variation of the licence
• issue an application for the review of a premises licence
• take a key role in identifying and interpreting health data and evidence
SSLP guidance and experience from Lambeth and Islington
25 Public Health and the Licensing Act (2003)
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Guidance and Licence Conditions
The DPH may:
• bring together operators, responsible authorities and the community to address the
impact of licensed premises on local populations
• engage with elected members - local knowledge to pinpoint hotspots of local alcohol
harm or high levels of consumption
• engage with the applicant to clarify public health concerns, potentially leading to the
incorporation of conditions which address these concerns
• use information, expert opinion and local intelligence from stakeholders and
agencies, such as alcohol treatment providers, homeless hostels and safeguarding
children services, which often have little engagement with local licensing processes
• ensure licence applicants are asked to demonstrate local knowledge (Police Reform
and Social Responsibility Act, 2011)
Next we will be hearing from Sue Holden – South Leeds alcohol licensing guidance
26 Public Health and the Licensing Act (2003)
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Local Licensing Guidance
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How did this all start?
• Joint Strategic Needs Assessment 2012, NHS Leeds highlighted issues in South Leeds
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JSNA 2012, NHS Leeds
• If you live in LS10 or LS11 you can expect your life expectancy to be lower than that of residents in other areas in Leeds
• 10 years lower than in Wetherby
• Alcohol misuse, obesity, smoking contributory factors
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Alcohol misuse and violence
• 14,000 domestic related incidents reported to the police in 2011
• 4,000 in City and Holbeck Division (28.6%)
• Domestic violence accounted for 33.6% of violent crimes in same Division
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Alcohol related admissions to hospital
Holbeck South Leeds
Leeds Average
Alcohol specific admission (/1000)
17.6 10.9 6
Alcohol attributable admission (/1000)
30.8 24.6 18.7
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Obesity
• National Obesity Observatory’s Report on Obesity
• Alcohol consumption can lead to increase in food intake
• Excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis
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Summary
• Area of deprivation
• Diverse area
• Low numbers of pubs
• High numbers of off licences and takeaways
• Nearly every corner shop sells alcohol
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• Obesity higher than the Leeds average
• Smoking rates are almost double the Leeds average
• Diabetes, COPD, CHD higher than the Leeds average
• Admission for alcohol related conditions are high
• Mortality rates for under 75 are much higher than the Leeds average
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Local concerns
• The wide and obvious availability of alcohol
• The contributory factor in possible link between violent crime and domestic violence and exacerbated by the availability of alcohol
• The higher proportion of premises licensed for alcohol for consumption off the premises
• The ease at which persons with mental health or alcohol dependancy problems to obtain alcohol
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Local concerns
• The ease at which people who are already drunk can obtain alcohol
• The normalisation of alcohol abuse and effect on children
• The supply of alcohol to children
• The accumulation of premises providing takeaway food and off sales of alcohol
• Littering of food wrappers and waste food originating from takeaways
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How do we make a change?
• Council and NHS Leeds formed multi-agency group
• Planning
• West Yorkshire Police
• Licensing
• Health
• Domestic Violence team
• Treatment services
• Youth services
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Licensing
• All actions must be appropriate to promote licensing objectives
• Crime and disorder
• Public safety
• Public nuisance
• Protection of children from harm
• No public health objective
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How do you consider health harm?
• Liaison
• Responsible retailing
• Affect change through providing information
• Cajoling, convincing, educating
• With support from the Police, Health and Environmental Health
• Consider crime & disorder and protection of children from harm
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Extract from S182 Guidance
The applicant must have regard to: □ The layout of the local area and physical environment
including crime and disorder hotspots, proximity to residential premises and proximity to areas where children may congregate
□ Any risk posed to the local area by the applicants’ proposed licensable activities and any local initiatives (for example, local crime reduction partnerships or voluntary schemes including local taxi-marshalling schemes, street pastors and other schemes) which might mitigate potential risks
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It goes on to say…
It is expected that enquiries about the locality will assist applicants when determining the steps that are appropriate for the promotion of the licensing objectives…
… The majority of information which applicants require should be available in the licensing policy statement in the area. Other publicly available sources which may be of use to applicants include:
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• the Crime Mapping website;
• Neighbourhood Statistics websites;
• websites or publications by local responsible authorities;
• website or publications by local voluntary schemes and initiatives; and
• online mapping tools.
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Will this work?
• Many applicants do not have English as their first language
• Many applicants do not have easy access to this information
• Interpretation of crime mapping websites, neighbourhood statistics may be difficult
The council can help with this.
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Local Licensing Guidance - Aim
• To provide guidance for applicants
• To provide the information required by the S182 Guidance
• To encourage business to take responsibility for the reduction of health harms
• To provide guidance for Licensing Committee
• To highlight the application is in a sensitive area and provide potential conditions
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Local Licensing Guidance - Aim
• To go further than we can through the legislation to encourage and foster responsible retailing
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How was it written?
• Collated health data
• JSNA2012
• Local information
• National information
• Collated information from partner agencies
• Environmental health
• Police
• Collated licensing profile data
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Consultation and approval
• Guidance does not need full consultation
• Was placed on website for comment during policy consultation
• Approved by Licensing Committee working group
• Endorsed by Licensing Committee
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How does it work in practice?
• Dialogue with applicants
• Meet face to face, phone, email
• Agree measures to go in operating schedule
• If measures agreed, no representation
• If not, representation submitted based on licensing objectives and goes to hearing
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Measures - Crime and disorder
• The display of alcohol will be in a designated area of the premises which is supervised directly by staff from the counter area
• The display of high strength beers, ciders and lagers of 7.5% alcohol by volume (abv) or higher shall be in an area accessible only by staff
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Measures - Prevention of public nuisance
• Staff will make hourly checks around the premises and remove any litter, including takeaway wrappers, can and bottles
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Measures - Protection of children
• There will be no window display posters or similar advertising containing any reference to alcohol on the premises shop frontage or the highway abutting the premises.
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What is the outcome likely to be?
• Refusal only in exceptional circumstances
• Must take the least onerous approach
• If subcommittee convinced by the representation:
• Conditions
• Reducing hours
• Removal of activities
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Example of successful liaison
• Asda
• Agreed that alcohol would be stored away form entrances
• Venus Foods
• Agreed to display health information
• Agreed not to promote alcohol in windows
• Agreed multiple sales of alcohol to individuals will be risk assessed in relation to alcohol harm
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What’s next?
• New local licensing guidance for other areas
• Local Licensing Guidance developed for inner west and inner east areas
• Streamlined approach with applicants
• Less time consuming
• Just as effective
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Lessons Learned
• Needs ongoing involvement from partners to review applications and make representations
• Can be a ‘way in’ to speak with business owners at a time when they are compliant
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Public Health Licensing Approach in London
Safe Sociable London Partnership
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Why Licensing?
• Managing availability is one of the most effective ways to reduce harm.
• New arrangements have brought Public Health into the sphere.
• There is a lot of scope to improve the effectiveness of licensing through data and partnerships.
• Its all about prevention.
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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So What have we done about it?
• Firstly, we established a London Licensing Network to bring together all the people involved in licensing in London to tell us what they wanted.
One of the key things we were told was that there was a significant need for data - so we developed a data pack in
conjunction with key partners.
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Licensing Information Pack 2013 • Produced by the Safe Sociable London
Partnership
• Designed to help local teams gain a more
accurate picture of the impacts of alcohol in
their local area
• Includes a series of innovative case studies
that highlight how local teams are already
working together
• Includes links to data sources to ensure that
teams have all the necessary information
they require when making licensing
decisions
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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• Secondly we talked to Director’s of Public Health about what they wanted.
They wanted an easy process to be able to respond consistently
and effectively to licensing applications, without taking up too much time and resource
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Step 1: Identifying Criteria • A set of criteria was developed based upon local licensing and public
health priorities to identify where applications are clearly ‘green’ or ‘red’.
• This was based on both the application and local priorities • The role of RAs including public health is to comment on
applications and make representations to the licensing authority if they think the application threatens of the statutory licensing objectives
• The licensing objectives under the 2003 Licensing Act are:
• the prevention of crime and disorder • public safety • the prevention of public nuisance • the protection of children from harm.
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Step 2: Scanning Tool Working with Greater London Authority we developed a
scanning tool that allows local partners in public health to identify what types of data they have and what the data says about the local environment in which the licensed premise sits
To provide a snap shot of the data/area – Bulls eye chart
– Dashboard
From this public health teams can drill down into the data and see what evidence is available to make a response
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Step 3: Data
Providing access to data through:
– Data Pack
– GLA’s Safe Stats website
– Other local data and information
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Step 4: Decision Matrix We developed a decision matrix to help DsPH
to decide if they want to make a response and options for what the response could be.
Things to consider: – Enough data/Evidence
– Who else is making a rep
– Discussion with applicant
– Conditions/Objections
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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This tool is useful but…..
• Need to have an understanding of Licensing
• Linking to the objectives
• Need to be confident to present the information and your representation
• Need to know your local Statement of Licensing Policy
• Guidance from Licensing and Police colleagues
• Talk to your population
• weigh up the options
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Consultation
This tool was developed through consultation with partners including licensing officers, police and public health
This tool will bring consistency, certainty and a way to access and use evidence that will make public
health’s role easier to engage with
Safe Sociable London Partnership Care about others, care about yourself, care about your drinking
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Public Health and Licensing: Our Approach
February 2015
Colin Sumpter
Public Health Strategist
Camden and Islington Public Health
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Outline
• The Camden and Islington context
• Range of approaches employed locally to tackle alcohol harm
• Partnership working
• Supply-side interventions:
– Influencing the Statement of Licensing Policy
– Making representations as a responsible authority
• Getting started with Public Health involvement
• Conclusions
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Alcohol consumption
Lower Risk: 56%
Abstainers: 21%
Source: Local Alcohol Profiles England (LAPE) 2014
6%
16%
Alc
ohol inte
rventions
• Cumulative Impact Policies
• Representations
• Late Night Levy
• Reducing the Strength
• A&E Data Sharing
• Treatment system
• Alcohol Awareness Training
• IBA
• Campaigns (AAW, DJ, Freshers)
• Don’t Bottle It Up
Supply
D
em
and
Harm
Increasing Risk:
Higher Risk:
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Alcohol and Public Health
• As a public health issue the long term health impact of alcohol
consumption is the ‘iceberg’ under the visible ‘tip’ of acute issues
which are primarily focused on by other responsible authorities
• Evidence base that reducing availability and affordability of alcohol
reduces consumption: 3,000 licensed premises in Camden and Islington
Emergency
admissions Assaults
Family breakdown
Chronic Liver
Disease
Alcohol-related
admissions Long-term
mental health
ASB/Noise
Cancers
Alcohol
Dependency
High blood
pressure Obesity
Lost productivity
and unemployment
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Achieving our shared goal
Shared goal across authorities: Reducing alcohol harm
• Supply-side interventions for public health are entirely reliant on
partnership working, nothing can be achieved alone.
• Vital partners for licensing process include:
– Licensing
– Community Safety / Police
– Acute Health / Ambulance
– Trading standards
• This work is most effective through a combination of policy making
and systematic application review
• Public Health can also provide skills and impetus to ad-hoc projects
that work toward this goals such as Reducing the Strength projects,
Responsible Retailer Schemes or other new initiatives
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What facilitates partnership working?
Committed and interested senior Councillors / Leader / Police
Engaged Directors of Public Health and Public Protection
Named, active and well connected PH and Licensing leads
A well-established local evidence base
Regular action and activity!
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“Islington has one of the highest concentrations of licensed
premises in the country. We have some of the worst health
problems associated with excessive alcohol consumption. And we
have more crime, nuisance and family difficulties caused by alcohol
than most other parts of London. We are taking a firm stand to fix
these problems with a mix of sensible licensing policies and
rigorous enforcement”
Councillor Paul Convery, Lead Member for Community Safety
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STATEMENT OF LICENSING
POLICY
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Influencing Islington’s SoLP
Alcohol Summit, September 2012
Licensing Policy developed, 2013
Consultation period
SoLP Launch, Feb 2013
Monitoring and Implementation
Alcohol Summit, September 2016
APHR on Alcohol, May 2012
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Kingdon Model of Policy Making
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Cumulative Impact Policies and Framework Hours
• Public (The borough residents want the issue to be tackled):
– Feedback from residents that Night Time Economy harm was growing
• Problem (Alcohol harm is recognised as an issue in the borough):
– Annual Public Health Report raised the profile of alcohol harm
– Alcohol Summit collated evidence in the round of rising alcohol harm
• Policy (There is an effective intervention available):
– Successful, popular but very small CIP in previous SoLP (Clerkenwell)
– Rebalancing’ of the Licensing Act in 2012
– End of the Olympics – more time available!
• Political (Those in power are willing to implement it):
– ‘New senior police officer with an aim to ‘Reclaim the Night’
– Change of Council political leadership
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Consultation approach
• By law before determining its policy a licensing authority must consult:
responsible authorities; licence holders; businesses; and residents
• Islington chose to expand this through active engagement
• Dedicated communications plan was developed to reach:
– Internal: Email to councillors; Safer Islington Partnership; staff newsletter
– Health bodies: Public Health; CCG; Mental Health Trust; Business
Improvement Districts; Chamber of Commerce
– Licensees and businesses: Pubwatch; Town Centre Management
– Residents: contacted all residents who had ever made representations;
website front-page; resident magazine; twitter
– Resident meetings: Ward Partnerships; Safer Neighbourhood Panel;
Housing ASB
– Neighbouring boroughs
• Result: 500 responses, the large majority strongly in favour of
introduction
• Challenge in getting positive responses to validate approach
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Public Health influence on the SoLP
• Public Health consultation response set out the case for Health
– Matt will cover in some more detail the evidence used
• ‘Alcohol and Health’ included as an appendix to the overall policy,
written by Public Health
Wider health evidence influenced the development of the policy and made
it stronger from the public health point of view
BUT
Still have to rely on evidence from the tip of the iceberg when we look at
individual applications…
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REVIEWING APPLICATIONS
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Public Health approach to applications
• Notified of all licensing applications: Get on all mailing lists
• To be relevant, must have regard to the potential impact on the
licensing objectives:
– The prevention of crime and disorder;
– Public safety
– The prevention of public nuisance; and
– The protection of children from harm
• Also can speak to Cumulative Impact Policy but only in
conjunction with one or more licensing objective.
• Objectives don’t explicitly include public health, but public health
shares the aims of all the objectives.
• Can ask for rejection, amendments or conditions
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Representations: Spreadsheet tool
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Representations: Spreadsheet tool
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Making Representations
• The licensing tool is a data analysis tool, not a decision making tool
• Always discuss potential representation with licensing and Police
• If a representation is agreed to be appropriate, summarise facts on 2 sides of A4
• Set borough context briefly, focus primarily on small area statistics
• Employ the wording of the licensing objectives, e.g.:
– Public Safety: Alcohol-related crime and violent crime, and alcohol-related
ambulance callouts by Lower Super Output Area (LSOA)
– Protection of Children from Harm: Review due to sales to under-age focus
on health harms in children and the importance of an alcohol-free childhood
• Make clear statement of grounds at outset, include evidence but make clear
recommendation at end (two bullet points)
• If required, at Licensing Committee you will be required to summarise it in a short
presentation
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Results
• Looked at and logged a lot of applications, learnt a lot about the
borough’s licensed premises, made good connections
• Also, made 15 representations to date:
– 6 applications refused
– 4 applications had hours of sale reduced
– 3 revoked after review
– 2 voluntarily withdrawn
• 4 appeals to date:
– 1 decision upheld, 1 partially upheld, 1 revocation amended to suspension, 1
appeal voluntarily withdrawn (Sainsbury’s – first dry supermarket).
• Licensing colleagues tell us they’re receiving fewer, but better,
applications
• Sometimes, we have to say we have no evidence!
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Conclusions
• Responsible authorities have the same objective: Reduce alcohol harm
• Have a named contact in PH (operational level). Find out who your
partners are and make connections. Attend licensing meetings whether
submitting evidence or not.
• Focus on strengths of PH: Evidence and professional judgement
• Put in hard groundwork on getting policies in place: SoLP; CIPs;
conditions; etc. – be ambitious in what is put forward in policies
• Don’t be nervous about putting in representations and don’t be afraid of
going to appeal – there is nothing to lose and much to gain
• Future efforts could include joint-funded posts building on joint-resourced
projects and the lobbying for health as a licensing objective
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School for Public Health Research 06/02/2015
Cumulative Impact Policies In
Action: Evaluating a complex intervention to prevent
alcohol related harms
Health as a licensing objective for Cumulative Impact
Policies
This is an outline of independent research funded by the
National Institute for Health Research’s School for Public Health Research (NIHR SPHR).
The views expressed are those of the author(s) and not necessarily those of the NHS, the
NIHR or the Department of Health.
February 6th, 2015
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School for Public Health Research
• Charlotte Ashton
• Matt Egan
• Daniel Grace
• Janice Gibbons
• Jan Hart
• David Humphreys
• Karen Lock
• Fred Martineau
• Elizabeth McGill
• Sarah Milton
• Triantafyllos Pliakas
• Colin Sumpter
Collaborators
This work was supported by the National Institute for Health Research
(NIHR)’s School for Public Health Research (SPHR). The views
expressed are those of the author(s) and not necessarily those of the
NHS, the NIHR or the Department of Health.
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School for Public Health Research
• Efforts to reduce alcohol-related harms based
on the view that “less is best”
– Controls on affordability
– Controls on the physical availability
• Controls on availability
– Restrictions in hours and days of sale
– Limits on number of outlets (outlet density)
• International evidence supports use of
controls on alcohol availability (Martineau et
al., 2013)
Controlling alcohol availability
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School for Public Health Research
• Restrictions on the physical availability of
alcohol:
– Stronger powers to control density
– Health as a licensing objective
– Early morning restriction orders (EMROs)
• Aiming to “empower local areas to make
decisions for themselves”
• Local licensing has a potentially
important role in public health problems
related to alcohol
The 2012 Alcohol Strategy
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School for Public Health Research
Research Methods
• Mixed Methods research
• Qualitative analysis, informed by
Institutional ethnography, has
included:
– documentary analysis, non-
participant observation (e.g.,
licencing committee meetings),
individual and focus group
interviews
• Informing our Quantitative analysis
examining the effects of CIPs (on
applications, social and health harms
etc.)
Example of representations
drawn upon in licencing
meetings
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School for Public Health Research
Islington: Second Wave of CIZs
“I think that we probably took perhaps a bit
more of a flexible approach, a longer term
approach…we did have in our minds that
there would be dispersion when we drew
the boundaries up. We thought about having
a ward-based approach but that just didn’t
give us the right fit…It was easier
administratively but didn’t sort of meet our
objectives…and obviously we had to keep
our eye on the evidence…” (Islington
Council, emphasis added)
– Islington Introduced in 2011 (purple) and
2013 (blue)
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School for Public Health Research
Alcohol Related Harms by CIZ
Failed underage test purchases/sq km
5 - 1
0
10 -
15
15 -
20
20 -
25
25 -
30
30 -
35
Non-duty alcohol seizures/sq km
0 - 3
3 - 6
6 - 9
9 -
12
12 -
15
15 -
18
Alcohol-attributable ambulance callouts/sq km
100
- 150
150
- 200
200
- 250
250
- 300
300
- 350
350
- 400
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School for Public Health Research
Alcohol Outlet Density by CIZ
Total number of licensed premises/sq km
0 - 5
0
50 -
100
100
- 150
150
- 200
200
- 250
250
- 300
300
- 350
Number of on-licensed premises/sq km
0 - 5
0
50 -
100
100
- 150
150
- 200
200
- 250
250
- 300
300
- 350
Number of off-licensed premises/sq km
15 -
20
20 -
25
25 -
30
30 -
35
35 -
40
40 -
45
45 -
50
50 -
55
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School for Public Health Research
CIZs and licence applications
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School for Public Health Research
• Outlet Density (primary)
• Opening Hours
Other Possibilities:
• Availability of some products?
– e.g., removal/not selling superstrength beer or cider
• Commitment to other alcohol related initiatives?
– e.g., enhanced training of staff regarding not selling to
minors
• Affordability?
What are the mechanisms by which
CIPs operate?
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School for Public Health Research
• Local Economy
• Crime & Disorder
– Public Nuisance, Public Safety,
Violence & Drink Driving
• Child Protection
• Health
• New premise applications
– in other areas within and outside
borough (‘Spillover’)
What are the Intermediate and
Long Term or Ultimate Effects?
(Pub Signs,
London,
2014)
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School for Public Health Research
Islington CIP logic model for analytical
framework
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School for Public Health Research
Define the
intervention and the
research question(s):
Engagement /
qualitative research
with stakeholders
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School for Public Health Research
IMMEDIATE
OUTPUTS
Is intervention
achieving its basic
functions?
Quants: pre and post
data on licenses and
license applications
Qual: more
detailed look at
license
application and
decision making
process
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School for Public Health Research
INTERMEDIATE
OUTCOMES
Short term consequences on
the alcohol retail
environment
Quants: number and type of
on and off licenses in area.
Quantified trading
standards.
Qual: richer data
on outlet,
marketing and
‘responsibility’
behavours
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School for Public Health Research
POPULATION OUTCOMES
Short term consequences on
people’s behaviours.
Quants: alcohol attributed
ambulance call outs and
crime or anti-social
behaviour
Qual:
understanding
how target
populations
perceive and
respond to
changes
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School for Public Health Research
LONG TERM OUTCOMES
(problems attributing these
to the intervention)
Quants: alcohol hospital
admissions and chronic
conditions
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School for Public Health Research
Concluding Thoughts
• Enforcing a CIP is possible but requires work
– evidence production, commitment and
involvement of diverse actors etc.
• Some contested understandings of CIPs remain
– on grounds of evidence, purpose etc.
• Understanding intermediate and long term effects
complex question requiring additional quantitative
analysis
– Where and how health enters the equation
demands further reflection
– Need to consider link of CIPs with other alcohol
related policies & interventions
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School for Public Health Research
Questions & Comments
If you have further questions
or comments please contact me:
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Panel Q&A
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Workshops
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Event summary Alison Keating
Head of Alcohol and Drugs Team
Public Health England, London
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Alcohol licensing and public health:
Achieving our objectives together
Friday 6 February 2015
London