Alcohol Framework 2018

Section 3 – Measuring Progress

32. The 2009 Framework has been underpinned by a comprehensive and robust approach to data and intelligence gathering to inform policy objectives, and we will ensure this continues, covering public health surveillance, research, evaluation and evidence synthesis.

33. The Scottish Government continues to use a range of targets and indicators to measure health outcomes, including a Local Delivery Plan (LDP) standard^[46] for Alcohol Brief Interventions. We will continue to closely monitor alcohol-related hospital admissions, alcohol-specific deaths and alcohol-related deaths. In particular, we will look at deaths due to Chronic Liver Disease and cancer. Chronic Liver Disease mortality rates decreased from a peak in 2003 until 2012. Thereafter, the rate remained relatively stable until 2015, and a 12% increase was observed in 2016^[47]. The Hospital admissions, deaths and overall burden of disease attributable to alcohol consumption in Scotland study^[48] found that, in 2015, there were 3,705 alcohol-attributable deaths, 28% of which were due to cancer.

34. We will also continue to ask the population about alcohol consumption in the annual Scottish Health Survey^[49]. Although, as previously mentioned, the consumption data in this are self-reported, and underestimates actual consumption, (in common with all surveys on consumption) it is valuable in providing data on trends and drinking patterns. We will continue to work with NHS Health Scotland to use retail sales data^[50] to provide a fuller picture of the total amount of alcohol being sold in both the on and off-trade. This provides valuable information on how much alcohol is being purchased, with consumption for potentially drinking at home increasingly making up the largest share of total sales, since at least 2000.

35. Through our work with NHS Health Scotland, we will continue to track affordability of alcohol, because this is a direct driver of consumption and alcohol-related harm. We will also look further, with NHS Health Scotland, at the data we may measure on availability of alcohol, and on marketing of alcohol, and how these relate to consumption and alcohol-related harm.

36. We will continue to monitor alcohol-related statistics arising from the criminal justice system, for example alcohol-related offences, and use these to inform and tailor our ongoing approach.

MESAS: Monitoring and Evaluating Scotland’s Alcohol Strategy

37. In 2016, NHS Health Scotland published the final in a series of independent assessments from the MESAS programme – Monitoring and Evaluating Scotland’s Alcohol Strategy^[51] – which together evaluated the impact of the 2009 alcohol strategy.

38. This report, providing conclusions on the work to date as of early 2016, set out a number of recommendations about our approach to inform future thinking. It suggested the Scottish Government should:

• ensure actions are based on evidence of the most effective (and cost-effective) interventions;
• take account of the wider socioeconomic determinants of health;
• persevere with difficult actions, such as on pricing and availability;
• incorporate the learning on implementation facilitators when developing new interventions;
• improve local data collection; and
• ensure effective and proactive monitoring of data.

39. The MESAS Final Report also recommended that the Scottish Government focused its future research on:

• strengthening the use of natural experiment designs to evaluate policy;
• better understanding of the differences in drinking between Scotland and England & Wales and the relationship with harm;
• understanding the linkages between policy intent, legislation, social attitudes and changing social norms;
• understanding the mechanisms underpinning a ‘vulnerable cohort’;
• understanding the factors that facilitate initiation and continued engagement with specialist alcohol treatment and care services; and
• examining the relationship between alcohol price, consumption and harm within Scotland and the rest of the UK.

40. The Scottish Government accepts these recommendations and will consider how best to give them effect during this next phase of the Framework.

41. In 2019, NHS Health Scotland will conduct an evaluability assessment of this Framework and, subject to the outcome of that work, will continue to evaluate the actions in this document within the MESAS programme. At that time, NHS Health Scotland will also consider whether any changes or updates are required to the logic models and the outcomes. Future work will include the Scottish Government giving regular updates on progress, and NHS Health Scotland publishing an annual MESAS report which analyses relevant data. The MESAS programme will also include undertaking or commissioning work on specific commitments of this Framework.

42. NHS Health Scotland is also leading on the evaluation of minimum unit pricing as part of the ongoing MESAS programme. The minimum unit pricing evaluation is wide ranging, and comprises in-house elements and a number of commissioned studies. It is complemented by research and analysis being led by other academic organisations, such as the Medical Research Council Social and Public Health Sciences Unit at the University of Glasgow. The minimum pricing evaluation is being progressed in alignment with the Scottish Parliament’s priorities, as set out in the Alcohol (Minimum Pricing) (Scotland) Act 2012 (the 2012 Act)^[52].

43. The minimum pricing evaluation must consider the effects of minimum pricing on:

• the licensing objectives (set out in section 4 of the Licensing (Scotland) Act 2005^[53]);
• sellers and producers of alcohol; and
• a range of people and stakeholders, potentially taking into account age, gender, social and economic deprivation and alcohol consumption.

44. The minimum pricing evaluation must include consultation with:

• representatives of sellers and producers of alcohol; and
• a range of people and stakeholders, including those working in health, crime prevention, education, social work and children and young people.

45. Scottish Ministers are required to report to the Scottish Parliament on the effects of minimum unit pricing after five years of operation; in other words, after 1 May 2023. If the Scottish Parliament wishes for minimum unit pricing to continue, it will need to make provision for this to happen before the sixth year of operation, i.e. by 30 April 2024.