Alcohol Framework 2018

Section 4 – Action Plan

Reducing consumption

Affordability and sales

Minimum unit pricing of alcohol

46. In May 2012, the Scottish Parliament passed the Alcohol (Minimum Pricing) (Scotland) Act 2012 which provides for a minimum price per unit of alcohol. Its implementation was delayed by a legal challenge but, following a unanimous UK Supreme Court judgment in November 2017^[54] which found minimum pricing to be lawful, the policy was implemented on 1 May 2018.

Minimum Unit Pricing
from May 1, 2018
For more information visit:
minumumunitpricing.scot

47. The Scottish Parliament set robust evaluation requirements for the policy, including a report to Parliament five years after implementation. Parliament will vote on the policy’s continuation before its sixth year; this is known as the ‘sunset clause’. The Scottish Government has asked NHS Health Scotland to oversee the minimum unit pricing evaluation programme, as part of its MESAS programme, working with a wide range of stakeholders. Further details can be found in Section 3. We recognise the calls, from the Health and Sport Committee and from across the Scottish Parliament Chamber, to ensure the minimum unit price remains appropriate. Indeed, many wished to see a higher initial unit price than 50 pence. We will keep the unit price under consideration, and monitor it regularly as indicated to Parliament at the time of implementation, and consider new data as they become available. We will then review the unit price following two full years of operation, in other words, after 1 May 2020.

Action 2: we will evaluate the impacts of minimum unit pricing during its first five years of operation (2018 to 2023).

Action 3: we will review the minimum unit price following two full years of operation, after 1 May 2020.

Online and telephone sales

48. The way we buy alcohol has evolved in recent years, with online and telephone sales providing new channels for alcohol purchase. We will therefore carry out new research in order to better understand the shape of this growing market, and any particular issues which may arise for national policy.

Action 4: we will scope research into online and telephone alcohol sales to better understand these growing markets and any issues arising as a result.

Availability and licensing

Improving implementation of overprovision policy

49. Scotland has a well-established licensing regime which regulates alcohol sales. It is underpinned by five licensing objectives, one of which is protecting and improving public health.

50. Licensing Boards must publish a licensing policy statement which, amongst other duties, requires Boards to promote the five licensing objectives, and to make a proactive assessment of overprovision in their area. Following local government elections in 2017, licensing policy statements are currently being updated and are due to be published in November 2018.

51. The MESAS Final Report^[55] found that, while the public health objective and overprovision statements have influenced practice, they have proven difficult to operationalise. This was informed by an earlier, in-depth look at licensing as part of MESAS in 2013: An evaluation of the implementation of, and compliance with, the objectives of the Licensing (Scotland) Act 2005^[56].

Recent changes

52. The Scottish Parliament made a number of changes, through the Air Weapons and Licensing (Scotland) Act 2015^[57] (the 2015 Act), to improve the operation of the licensing regime.

53. The 2015 Act amended the period of a policy statement to ensure that it aligns better with local government elections. This enables new Boards to take stock, gather evidence and set a policy statement that reflects their own views and aspirations.

54. The 2015 Act made clear that Boards could assess overprovision for their whole geographical Board areas, not just for smaller localities, given that health indicators are most often demonstrated over entire Board areas. Furthermore, the 2015 Act made it possible for Licensing Boards to take into account the licensed hours of licensed premises in localities, when assessing if there is overprovision.

55. Through the 2015 Act, the Scottish Parliament legislated to ensure Licensing Boards provide greater clarity about how they carry out their business. As well as imposing a duty on Boards to report annually on their income and expenditure, Boards must also now publish an annual report on the exercise of their functions. We are sympathetic to the calls made for industry to be required to provide alcohol sales data to Licensing Boards to help inform local licensing policies and decisions. The minimum unit pricing evaluation includes a study which is analysing licensing data. We will be interested to see findings from this work, because access to good quality data on licensing is important both for local areas and to inform the national picture.

Updating statutory guidance

56. With the changes made following the 2015 Act, the necessary toolkit is now in place to allow local Licensing Boards to take decisions informed by public health drivers. The statutory guidance which accompanies the Licensing (Scotland) Act 2005 does not now reflect the current legislative position, so we are updating this guidance and will consult on its content.

Action 5: we will update the statutory guidance on the Licensing (Scotland) Act 2005 to provide clarity for Licensing Boards on implementing the five licensing objectives, including the public health objective, and the overprovision statement. A full public consultation will be held in 2019.

57. The Scottish Government is keen to observe the impacts of the new licensing policy statements in 2018. We will keep the licensing system under review to ensure Licensing Boards have the tools they need to take health harms into account when making decisions about their local areas. We recognise that the availability of alcohol within our communities has a considerable impact on work to help tackle inequalities.

Action 6: we will keep the licensing system under review to ensure it can deliver for public health, commissioning research as necessary. Once new Licensing Policy Statements have bedded-in, from 2019 we will revisit the findings of the 2013 MESAS study An evaluation of the implementation of, and compliance with, the objectives of the Licensing (Scotland) Act 2005, focusing on evaluating the operational effectiveness of the public health licensing objective in light of the changes made since to alcohol licensing.

Empowering communities

58. Local communities have an important voice in local licensing decisions. However, the regime itself is not easily understood, formal in many instances and can be seen as bureaucratic.

59. The Scottish Government funds Alcohol Focus Scotland to work on the ground with local communities to try to improve their interaction with the licensing system and to support a range of partners to engage effectively. Alcohol Focus Scotland has produced the Alcohol Licensing in Your Community toolkit^[58], which provides practical advice for people who want to have a say about how alcohol affects their community. This is part of our wider funding for Alcohol Focus Scotland to help improve awareness of the licensing system and to support an availability work programme. This will include analysing the new Statements of Licensing Policy and Annual Functions Reports in 2019.

60. The Community Empowerment (Scotland) Act 2015^[59] requires Community Planning Partnerships (CPPs) to produce Local Outcomes Improvement Plans (LOIPs). CPPs have a key role to play in tackling the social determinants of health. This provides a further opportunity for local areas to consider the impacts of alcohol and work towards the changes that they wish to see.

61. The Local Government and Communities Committee of the Scottish Parliament held an evidence session about local community engagement in licensing on 23 May 2018^[60]. We will be ready to consider the Committee’s views during any future consideration it may give the matter.

Action 7: we will continue to support Alcohol Focus Scotland to build awareness at a local level so that local communities, Health and Social Care Partnerships and Alcohol and Drug Partnerships can be effective in influencing the licensing regime.

Voluntary measures on availability

62. Alongside the licensing system, the Scottish Government also works with the alcohol industry on voluntary measures from time to time. For example, we have worked jointly to increase availability and awareness of the 125ml wine measure in the on-trade. Proactive promotion of 125ml measures is now being integrated into the Best Bar None scheme, which promotes good practice and safer drinking environments in the on-trade.

63. We also welcome industry initiatives which seek to prevent underage drinking, such as the You’re Asking For It proxy purchase campaign, which began in Lanarkshire and is now expanding to many other areas across Scotland.

Action 8: we will work with the alcohol industry on projects which can impact meaningfully on reducing alcohol harms; but not on health policy development, on health messaging campaigns or on provision of education in schools and beyond the school setting.

Positive attitudes, positive choices

Attractiveness: marketing and advertising

Alcohol marketing: children and young people

64. Restricting alcohol advertising is one of the three WHO ‘best buys’ to reduce alcohol consumption and related harms across the whole population. Restrictions on alcohol marketing ensure that vulnerable groups, such as children and young people, and those recovering from alcohol dependence, are specifically protected from the impacts of alcohol marketing. There is a compelling case for taking an approach to alcohol marketing which protects children. We know that, in Scotland, children as young as ten can readily identify alcohol brands, logos and characters from alcohol advertising^[61]. Evidence shows that alcohol advertising seen by children and young people is associated with both the initiation of drinking and with heavy drinking. Reviews of longitudinal and cohort studies^[62] observing children provide the strongest evidence for the impact on alcohol consumption of alcohol marketing. These studies report consistently that exposure to alcohol marketing is associated with an increased likelihood that children will start to drink or – if they already drink – drink greater quantities. This evidence supports policies that seek to protect children from exposure to alcohol marketing.

65. We know that children still spend large amounts of time watching television^[63]. A recent study demonstrates that UK prime time television remains a constant source of exposure to alcohol imagery for young people and that commercial adverts for alcohol are commonly aired before the 9pm watershed^[64]. In the UK, children can see alcohol adverts in cinemas before films which are certified as suitable for children (i.e. below certificate 18+), despite alcohol being an age-restricted product.

66. Unfortunately, powers over broadcast advertising are reserved to the UK Parliament. We have urged the UK Government to develop an approach which protects children and young people from exposure to alcohol advertising, but the changes we would like to see have not been delivered. The UK Government has committed to consulting on introducing a 9pm watershed on television advertising of products high in fat, sugar and salt as part of Childhood Obesity: a plan for action Chapter 2^[65]. We would ask that our children and young people are protected from alcohol advertising in the same manner. We will continue to press for the changes we believe are required and, if the UK Government remains unwilling to act, we will press for the powers to be devolved to the Scottish Parliament.

Action 9: we will press the UK Government to protect children and young people from exposure to alcohol marketing on television before the 9pm watershed and in cinemas – or else devolve the powers so the Scottish Parliament can act.

67. There is certainly scope to take action to protect children and young people within the powers currently available to the Scottish Parliament. In the UK at present, there are industry-run self-regulatory codes which seek to limit children’s exposure to alcohol marketing and advertising across various media. These work on the basis of preventing advertising placement where 25% of the audience of, for example, a publication or event comprises children.

68. These codes still permit large numbers of children and young people to be exposed to alcohol marketing, and they do not apply to public spaces where exposure is entirely indiscriminate, because in public spaces children are considered to comprise less than 25% of the overall population. While it has been welcome that some alcohol businesses have undertaken not to place marketing and advertising within certain distances of schools, the reality is that children and young people travel around their neighbourhoods, villages, towns and cities for many reasons. As they do so, they are exposed to alcohol marketing and advertising in public spaces.

69. Everyday alcohol has become the norm in Scotland, and that is true of all kinds of settings where children and young people are present. We have more thinking to do in Scotland, on how we can all contribute to giving children alcohol-free spaces to grow up, and to thrive, free from alcohol-related harms, and pressures in childhood. Part of this could include further promoting alcohol-free events such as mindful drinking festivals and non-alcohol events at colleges and universities. Consultation and engagement would take place on the appropriateness of a range of potential measures.

70. While public spaces seem an obvious starting point for reducing children and young people’s exposure to alcohol marketing, we are mindful of the vast range of marketing channels they experience, including digital and online routes.

71. We recognise that the marketing landscape has undergone substantial change due to the increasing prevalence of the internet and the frequency of social media usage. This has presented new more interactive methods that advertisers can utilise, such as games, rewards and giveaways, peer to peer sharing and personalised messaging. Our young people tend to spend increasingly more time online and are far more likely to be active on social media specifically. In order to protect them from this harmful exposure, we will ensure that we are taking account of current international policy approaches and will consider the potential for digital marketing being an area where restrictions may be required, and what sort of measures or restrictions would be appropriate.

Good practice

72. There are many examples of good practice in other European countries. Norway has a long standing comprehensive ban on alcohol advertising, whilst Finland and Estonia have recently made bold and innovative progress on regulating digital advertising. Most recently, Ireland has taken progressive steps towards restricting alcohol marketing, passing the Public Health (Alcohol) Act 2018^[66] in October 2018.

73. We hear the calls for restriction of alcohol sponsorship of events, and sporting activities in particular. The Scottish Women’s Football Team is an exemplar here, taking a stance against alcohol sponsorship. We applaud the Team for the stance they have taken and would encourage other sports teams to diversify their sponsorship away from the alcohol industry. The Irish legislation is another good example of addressing

alcohol promotion within the sporting world, including sports areas within its outdoor advertising ban.

Action 10: we will consult and engage on the appropriateness of a range of potential measures, including mandatory restrictions on alcohol marketing, as recommended by the World Health Organization, to protect children and young people from alcohol marketing in Scotland.

Education, awareness raising and behaviour change

Alcohol and Drug Education Programmes

Education in schools

74. Our approach to providing substance use education is the same for both alcohol and drugs. We must give the next generation the tools they need to make healthy choices about substances. Through the Health and Wellbeing component of Curriculum for Excellence^[67], Scottish schools aim to provide helpful, engaging information about substances, and, crucially, empower children and young people to make positive decisions about their health. It is also important that education includes the impact of alcohol on sexual risk taking, and focuses on the need to be confident that consent has been given for any sexual activity^[68].

75. Health and wellbeing indicators have an important place within the National Improvement Framework for Scottish Education^[69], and we will continue to look at how we can best emphasise their importance going forwards. Following work with stakeholders, in 2017 Education Scotland published health and wellbeing benchmarks for schools, including substances^[70]. These benchmarks set out clear statements about what learners need to know and be able to do to achieve a particular level of learning. More recently, Education Scotland has published a report on the findings of a thematic inspection carried out as part of the review of Personal and Social Education (PSE) in schools^[71]. This initially indicates improvements could be made in providing PSE within Curriculum for Excellence.

76. Around 68% of 15 year olds say they have received lessons or discussions in class on alcohol^[72]. While this is encouraging, there is still room for improvements to increase the number of 15 year olds that have access to a learning experience which is based on best practice.

77. The Scottish Government is committed to taking steps to ensure that Initial Teacher Education (ITE) prepares students to enter the profession with consistently well-developed skills to teach areas such as literacy, numeracy and health and wellbeing. The initial phase of this work is being taken forward through the development of a new self-evaluation framework to support universities to evaluate their ITE. The General Teaching Council for Scotland is also reviewing its Professional Standards for Registration to work as a teacher in Scotland, which includes reference to the requirement for teachers to understand and apply the curriculum as it applies to health and wellbeing.

78. In the last few years, we’ve seen some encouraging trends regarding alcohol use among young people. In 2015, SALSUS^[73] (Scottish Schools Adolescent Lifestyle and Substance Use Survey) reported the proportion of 13 and 15 year olds who drank alcohol in the last week was the lowest since the survey series began monitoring drinking behaviour in 1990 (4% of 13 year olds and 17% of 15 year olds). However, we know there is more to be done and we are taking forward a range of activities to make further progress.

79. We have continued to take forward substance use education work in Scottish schools through Curriculum for Excellence and the Choices for Life^[74] programme. In these, children and young people learn about a variety of substances including alcohol, medicines, tobacco, solvents and other drugs and explore the impact risk-taking behaviour has on life choices and health. Choices for Life is primarily a schools-based education programme on alcohol, drugs and tobacco, funded by the Scottish Government and delivered in partnership with Police Scotland and Young Scot. The programme includes an information website for young people and their parents, teachers and carers.

80. In December 2016, the Scottish Government published a literature review on ‘What works’ in drug education and prevention^[75]. The key findings are consistent with other reviews of the evidence of effectiveness of substance use prevention programmes. The publication acknowledged that some popular and well-meaning approaches, for example using lived experience testimonials, are associated with no, or negative, preventative outcomes. Stand-alone, mass media campaigns are also considered ineffective. The literature review found that children and young people benefit from prevention models that are delivered in a supportive environment, which use non-fear arousal techniques, and which provide the freedom to learn about alcohol and drug use within a broader conversation about choice and risk, rather than standalone input.

81. In addition, for those most at risk from harm, targeted prevention interventions are most effective, alongside a whole school approach. These are most effective in interactive structured sessions, with booster sessions over several years, and should be of sufficient intensity and duration to influence change. Approaches that combine social and personal development and resistance skills with normative education techniques have also been shown to be effective.

82. The research highlighted increasing interest in peer led models and the use of social influence methodology. This is supported by research conducted in partnership with the Scottish Youth Parliament, and has also shown that the tone of substance use education should be neutral, based on fact and that young people should be involved in the design, development, and dissemination of the information as young people are more likely to respond better to advice and information from their peers^[76]. This has provided an informed basis for our overall approach to prevention activity both in and outwith schools.

83. Following the What Works report a rapid review mapping exercise^[77], conducted in 2017, concluded that the quality of substance use education and local practice in education had to be made more consistent throughout Scotland. To help achieve better consistency the Scottish Government has produced a guidance summary of key findings^[78] to support commissioners and practitioners in developing education and prevention strategies in line with the evidence.

84. Also following the What Works report, the Scottish Government commissioned a review of Choices for Life and found that although the programme engaged with large numbers of young people, there were variations across Scotland and inconsistencies in both the delivery, setting and frequency of sessions. It was observed that there was some evidence of good practice, although ineffective approaches remained, alongside a lack of structured delivery guidance or lesson plans.

85. Taking all of this into account, the Scottish Government considers a new approach is required to universal substance use education for young people in schools.

Action 11: we will revise and improve the programme of substance use education in schools to ensure it is good quality, impactful and in line with best practice.

Broadening our universal approach

86. Our education system provides a window of opportunity to equip our children and young people with the life skills to make informed choices relating to their health and wellbeing. However we recognise that, for some, traditional education methods are not working or not appropriate and these children and young people can be more at risk. We need to go beyond classroom based interventions to ensure we provide a universal approach to alcohol and drug education that is delivered in different and innovative ways. This includes, but is not limited to, considering Youth Groups, Community Learning and Development, looked after and accommodated children, excluded children and those in touch with services.

Action 12: we will develop education-based, person-centred approaches that are delivered in line with evidence-based practice to aim to reach all of our children and young people including those not present in traditional settings, such as Youth Groups, Community Learning and Development, looked after and accommodated children, excluded children and those in touch with services.

Online and outreach education and information

87. The dynamic growth in digital platforms used by young people present new challenges and opportunities in substance use education and prevention. They are increasingly the route through which young people obtain information and misinformation, about alcohol and drugs, as well as a growing and constantly evolving supply route.

88. We have a responsibility to our young people to provide accurate and reliable information about the risks of substance use, as well as providing them with the skills and knowledge to question the information they find online and the resilience to challenge and resist misinformation and pressure through social media.

89. The Choices for Life programme includes an information website for young people and their parents, teachers and communities. The Scottish Government Know the Score website also provides advice on drugs and their risks. It is updated in partnership with Crew, a third sector drug service based in Edinburgh. The Drinkline website provides advice on alcohol and its risks. It is operated under contract with the Scottish Government.

Action 13: we will develop our current online resources to ensure they provide accurate, evidence-based, relevant and up-to-date information and advice, around alcohol and drug use; and how to access help.

Awareness raising – new national campaign

90. Awareness raising campaigns can be useful tools as part of a wider package of measures. We have, previously, taken forward a number of social marketing campaigns which have sought to empower and enable people to make informed choices about alcohol, by providing them with relevant information. We plan to develop a new campaign which promotes the messages of the UK CMOs’ lower-risk drinking guidelines during 2018, and we will launch this nationwide in 2019.

91. We will ensure that national-level work can be tailored towards interventions that reflect local need, and will work with a range of national and local partners, including Health and Social Care Partnerships, Alcohol and Drugs Partnerships and third sector partners. As we work together to roll out components of our campaign work and support the ongoing delivery of health messaging at the local level, we will ensure that work is targeted in ways which can help us to reduce health inequalities.

92. We will continue to pursue opportunities to drive, and to participate in, social marketing work, collaborating with partners including the third sector. We will engage our local partners in all nationally commissioned social marketing work.

Action 14: we will initiate national marketing work, with partners, promoting the messages of the UK CMOs’ lower-risk drinking guidelines during 2018, and we will launch this campaign nationwide in 2019.

Awareness raising – product labels

93. The health information presented on alcohol product labels and packaging is really important. This information can help consumers to make informed choices and to make positive health choices.

94. The Scottish Government’s long-standing preference has been for a mandatory regime governing labeling. A level playing field, where information is provided and presented in a consistent way, would be most straightforward for consumers. However, to date, we have been supportive of the strengthened self-regulatory option within the UK, given that there has not been a consensus amongst the UK administrations in favour of legislation and that there are advantages for industry from a UK-wide approach.

95. We were supportive of the UK Government’s Responsibility Deal pledge which aimed to ensure that over 80% of products on shelf will have labels with clear unit content, CMO guidelines and a warning about drinking when pregnant by December 2013. Whilst the pledge delivered improvements, results varied, the target was not wholly met, and there are no current plans for longer-term monitoring.

96. Crucially, it is important that this information is on-pack, where the consumer will clearly see it at the point of purchase, rather than online where it is far less accessible. Consumers are increasingly coming to expect this kind of information. It is right that we should expect the same degree of information provision as we do in the food sector.

97. Some Scottish and UK alcohol producers are now rolling out the new CMO lower-risk drinking guidelines^[79] on product labels – namely C&C Group, which makes products like Tennents and Magners; Whyte & Mackay and supermarket own brand products. We commend these producers for taking the initiative and doing the right thing. We are clear that all alcohol producers should update to the revised CMO guidelines, placed physically on product labels and packaging. This should be accompanied by advice about not drinking in pregnancy, as set out on the Scottish Government website^[80]. The UK Government has set a deadline for industry of September 2019 to update all labels with the revised guidelines.

98. Progress towards all product labels displaying the right information – including the CMO guidelines – has simply not been good enough. Too many alcohol producers are finding ways to avoid placing the updated CMO guidelines on labels. Instead, they should be taking a responsible approach to informing consumers on physical labels, at the point of purchase, under their corporate social responsibility policies, as the majority did in the past before the guidelines were updated. For these reasons, while we would prefer to regulate on a UK-wide basis, if insufficient progress is made by the time of the UK Government’s deadline of September 2019, the Scottish Government will be prepared to consider pursuing a mandatory approach in Scotland.

Action 15: we will press alcohol producers to place health information on physical product and packaging labels – and will be prepared to consider pursuing a mandatory approach in Scotland if the UK Government’s deadline of September 2019 is not met.

99. We are supportive of voluntary initiatives from the industry to provide clear nutritional information on individual product labels and packaging, given many people do not realise the calorie content of alcoholic drinks.

100. In its March 2017 report^[81], the European Commission recommended a self-regulatory approach to providing nutrition information on alcohol product labelling, suggesting a one-year time-frame for implementation. The European Commission is currently considering the alcohol industry’s responses, which varied in approach. We will consider our approach further once the Commission’s response is available.

Awareness raising – low-alcohol product labels

101. The Food Labelling Regulations (FLR) 1996 (as amended) set out in law the rules for describing alcoholic drinks containing 1.2% alcohol by volume (ABV) or less. These rules on the use of low alcohol descriptors aimed to protect and inform consumers. The FLRs were mostly revoked in December 2014. However, a sunset clause in Schedule 4 of the Food Information (Scotland) Regulations 2014 (as amended) provides for the continued use of the national measures for low alcohol descriptors contained in FLR. These remaining national measures are due to be revoked on 13 December 2018.

102. The four low alcohol terms/claims on drinks can be summarised as follows:

• Low alcohol – product must be 1.2 % ABV or lower;
• Non-alcoholic – cannot be used in conjunction with a name associated with an alcoholic drink except for communion or sacramental wine;
• Alcohol-free – product must be 0.05 % ABV or lower; and
• Dealcoholised – product must be 0.5 % ABV or lower.

103. Food Standards Scotland (FSS) has consulted Scottish stakeholders for their views on the future of these descriptors^[82]. FSS will consider the responses and look at the relevance of these descriptors, their ease of being understood by consumers and potential methods of retaining these (or similar) terms after December 2018.

Awareness raising – relationship between alcohol and cancer

104. The relationship between alcohol consumption and seven types of cancer has been further established in recent years. The Committee on Carcinogenicity^[83] concluded in 2016 that ‘drinking alcohol increased the risk of getting cancers of the mouth and throat, voice box, gullet, large bowel, liver, of breast cancer in women and probably also cancer of the pancreas’. These risks start from any level of regular drinking and then rise with the amounts of alcohol being drunk.

105. As noted in the Introduction section, the Hospital admissions, deaths and overall burden of disease attributable to alcohol consumption in Scotland study^[84] found that, in 2015, there were 3,705 alcohol-attributable deaths, 28% of which were due to cancer. NHS Health Scotland will re-run this valuable analysis at regular intervals, to ensure we have the best intelligence available on the impact that drinking alcohol has on Scotland’s incidence of cancer.

106. Scottish Health Action on Alcohol Problems (SHAAP) ^[85] produced a valuable guide on alcohol and cancer in 2013, which sets out information on the relative risks of alcohol consumption and opportunities for healthcare professionals to offer advice on those risks.

107. We recognise the importance of raising awareness of the very serious health risks that drinking poses; that is why our Cancer Strategy Beating Cancer: Ambition and Action^[86], published in March 2016, highlighted alcohol risks and the importance of measures to encourage and support people to reduce their risk of cancer by living healthier lives.

108. Through the implementation and development of our public health actions on alcohol, we will work to change this perception and shift cultural attitudes towards alcohol as a cancer risk factor, as well as doing the same on smoking, poor diet and physical inactivity.

Action 16: we will work with partners to raise awareness of the links between alcohol consumption and cancer.

Behaviour change – Alcohol Brief Interventions (ABIs)

109. An Alcohol Brief Intervention (ABI)^[87] is a short, structured conversation about alcohol consumption with an individual, that seeks in a non-confrontational way to motivate and support them to think about or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm.

110. ABIs are a Local Delivery Plan Standard^[88] and are delivered across a range of settings. At least 80% of delivery is through priority settings: Accident and Emergency, Primary Care and Antenatal. The remaining 20% is delivered through wider settings which include but are not limited to: Criminal Justice, Keep Well service, Pharmacy, Dentistry and community services.

111. ABIs are an evidence-based and cost effective intervention and, since the beginning of the programme in 2008, we have seen over 834,000 interventions delivered across a range of settings.

112. Quality of delivery and impact are paramount. We have supported the expansion of the ABI evidence base and encouraged appropriate planning and delivery of ABIs in wider settings. We also support a focus on communities where deprivation is greatest. The evidence of effectiveness is strongest in primary care settings, and General Practice services in lower income areas have a crucial role to play in ABI delivery. Other settings can play a role too, and the expansion of ABI delivery to 20% in wider settings also includes Pharmacy, Dentistry and wider community services, facilitating a range of ABI routes into lower income communities.

113. Reducing health inequalities is a key priority and we recognise there is a link between excessive alcohol consumption and offending behaviour. We are encouraged to see a range of evidenced and informed frameworks and guidance, which includes substance use and ABI Delivery in Police Custody, Prison and Community Justice settings which creates opportunities for detection and interventions such as ABIs and signposting into treatment and recovery services.

Action 17: we will review evidence on current delivery of Alcohol Brief Interventions to ensure they are being carried out in the most effective manner, look at how they are working in primary care settings – where the evidence is strongest – and whether there would be benefit in increasing the settings in which they are delivered.

Supporting families and communities

114. We are also publishing a new overarching strategy which brings together all our support for individuals, for families and for communities affected by alcohol and drugs. This means that much of the ‘Supporting Families and Communities’ theme of the original 2009 Alcohol Framework is developed within that new overarching strategy, including all of our support for Health and Social Care Partnerships, Alcohol and Drugs Partnerships, justice partners, and a range of third sector organisations engaged in hands-on support for individuals, children and families. This includes support for Scottish Families Affected by Alcohol and Drugs^[89], which supports adults aged over 16 years; provides a free national Helpline for anyone concerned about someone else’s alcohol or drug use; provides workforce development support for alcohol and drugs professionals; and runs an asset-based community development programme.

Fetal Alcohol Spectrum Disorder – prevention, diagnosis and support

115. Fetal Alcohol Spectrum Disorder (FASD) is the leading known worldwide preventable cause of neurodevelopmental disorder, together with learning and behavioural difficulties, caused by maternal use of alcohol during pregnancy. It potentially has lifelong implications and not only affects babies and children but also young people and adults, and their families who will be living with the impact of the condition. Current prevalence data suggests at least 2% of the population^[90] could be affected. Considerable work has been carried out over recent years in this area and, since 2012, the CMO message in Scotland has been that avoiding alcohol when trying to conceive and while pregnant is the safest option for the developing baby. This has now been endorsed by the other UK CMOs and reflected in the revised lower-risk drinking guidelines (published in 2016). Alcohol Brief Intervention methodology is being used to screen for alcohol use during pregnancy and referral for help to reduce intake is widely available.

116. We have undertaken a range of measures to reduce the harm caused by alcohol consumption in pregnancy across Scotland, through increased awareness of the risks and national training and awareness for professionals across multi-agency sectors and will continue to support local areas to develop appropriate diagnostic and treatment management provision.

117. The Ayrshire FASD diagnostic pilot has been a really good example of positive work in one local area^[91]. Rather than establishing FASD specific services and systems, our aim is to support the current system to be much more responsive to the needs of individuals, families and communities affected by FASD, through integrating FASD diagnosis and support through overarching neurodevelopmental pathways. We welcome the new SIGN guideline on FASD screening, identification and diagnosis which will be available shortly.

118. We aim to improve support for individuals and caregivers to give all children the best start in life and throughout their life course. We will continue to build on our progress to date and move to implement the next phase of actions which will include:

• Continuing to raise awareness and focus on prevention through national and local strategies including preconception messaging;
• Improving early identification, assessment and diagnosis through upskilling of all practitioners, professionals and partners working with women, children and families within 3 years;
• Working to set up a third sector hub that will focus on both preventing instances of FASD arising in the first place and supporting families following diagnosis;
• Standardising education and training provision and input to all health and social care professionals, education, third sector and across the youth and criminal justice system within 3 years;
• Improving recording of accurate alcohol use during pregnancy and supporting appropriate information sharing to aid diagnosis at any stage within 3 years;
• Improving surveillance through national and local data collection systems and methods;
• Commissioning research to determine the most effective approaches to prevention, along with initiatives to establish overall FASD prevalence, neurodevelopmental profiles, outcomes and the impact of early identification and support; and
• Including parents/carers, children and young people affected by FASD, along with front-line staff to improve their experience of multi-agency assessment and ongoing support to better meet their needs.

Action 18: we will continue to prevent and reduce the harm caused by alcohol consumption in pregnancy through increased awareness of the risks, increased awareness of, and improved diagnosis and support for, Fetal Alcohol Spectrum Disorder.

Positive Alternatives and Safer Communities

119. The link between alcohol consumption and the risk of injury is well documented^[92]. Participatory and diversionary activities to engage, direct and support people into alternative lifestyles can make a significant impact in reducing the risks associated with and addressing higher-risk alcohol use.

CashBack for Communities

120. Over the last 10 years, the Cashback for Communities^[93] programme has redirected the funds recovered from criminals under the Proceeds of the Crime Act back into our communities. An investment of over £92 million has delivered nearly two million activities and opportunities for young people across all 32 local authorities in Scotland. The Cashback programme supports young people to expand their horizons and increase the opportunities they have to develop their interests and skills. Working through partnerships with Scottish sporting, arts and business associations, the programme provides positive alternative activities for young people in our communities. The Cashback programme is changing lives for the better, and is having a direct impact on helping to steer vulnerable young people away from alcohol and drugs.

Reducing Unintentional Harm

121. Through our ambition to build safer communities across Scotland, we continue to work with partners to reduce unintentional harm, including: Police Scotland, Scottish Fire and Rescue Service, Royal Society for the Prevention of Accidents (ROSPA), Child Accident Prevention Trust (CAPT), the Scottish Community Safety Network, as well as COSLA and the local partnership networks. Through this ambition, we collectively share messages and support initiatives and approaches that focus on reducing unintentional harm. We know that families living in deprived areas are more likely to experience unintentional harm^[94], which can be influenced by higher-risk alcohol use and problematic drug use. Our partnership work continues to try to address this inequality gap.

122. Over the last five years, we have provided ROSPA with almost £600,000 in funding to undertake work around home and community safety as well as supporting projects that help improve child safety. There have also been specific initiatives in the NHS Greater Glasgow and Clyde area. We also support the Child Accident Prevention Trust (CAPT) to deliver community education campaigns raising awareness of serious childhood accidents and how to prevent them.

123. Looking ahead, we are working in partnership to develop and deliver an unintentional harm online hub that will gather and share examples of local activity that is directly reducing unintentional harm. This online tool is due to be launched in 2019 and will be available to partnerships in the first instance. In recognising the direct link between the impact of alcohol on keeping safe, the hub will provide a number of examples that can support healthier and safer living.

Supporting Community Capacity – Inspiring Scotland’s Link Up programme

124. Inspiring Scotland’s Link Up^[95] programme is active in nine communities across Scotland that are experiencing significant inequalities. In adopting a people-centred approach to build the capacity of the most disadvantaged and vulnerable people and communities, it provides one to one support to help people become involved and to achieve sustainable change in their lives. Through increasing social interaction and connections, building trust and positive relationships within the local area and giving individuals the support, confidence and skills to choose alternative life-course, the programme has supported those most vulnerable and has brought a positive impact on reducing the harm from drugs and alcohol use.

Action 19: in recognising the link between community safety and alcohol, we will continue to work with partners to build awareness and resilience to both reduce harm and improve life choices.

Preventing alcohol-related violence and crime

Violent crime, alcohol and deprivation

125. WHO is clear that alcohol and violence are linked in a number of ways, with a strong association between alcohol consumption and an individual’s risk of becoming a perpetrator or victim of violence. Our 2017 Justice in Scotland: Vision and Priorities^[96] reflects this relationship.

126. The Scottish Crime and Justice Survey (SCJS)^[97] collects data on whether victims believe offenders were under the influence of alcohol at the time of an offence. It indicates that offenders were believed to be under the influence of alcohol in just over two-fifths (42%) of violent crime incidents in 2016/17, where victims were able to say something about the offender, down from 63% in 2008/09 and 56% in 2014/15. However, it will be important to monitor these results in the future, as these findings are based only on incidents where the respondent could say something about the offender(s), which fell from 98% of incidents in 2014/15 to 87% in 2016/17.

127. Nevertheless, these findings coupled with a decline in the number of SCJS violent crime incidents said to have taken place in and around pubs and bars may suggest that alcohol is decreasing in prominence as a factor in violent crime overall – although it remains a factor in a sizeable proportion of incidents.

128. The 2016/17 SCJS also found that the risk of being a victim of violent crime was higher for adults living in the 15% most deprived areas in Scotland, compared to those living in the rest of Scotland, a consistent finding in recent years.

Connecting health and justice outcomes

129. Violence prevention is an important part of making Scotland healthier and tackling inequalities. For national and local policy makers and practitioners, integration across Health and Justice approaches and systems is crucial to reducing violence, reducing crime and reducing reoffending. We have comprehensive strategies and initiatives to reduce and prevent violence, including alcohol-related violence. However, we must also recognise that the underlying causes of health inequalities, and of crime including violence, are often socio-economic. It is therefore paramount that we use all levers at our disposal to tackle social injustice across our communities.

Getting It Right for Every Child

130. As previously mentioned, prevention is at the core of our approach to Getting It Right For Every Child (GIRFEC)^[98]. GIRFEC focuses on improving outcomes and supporting the wellbeing of our children and young people, by offering the right help at the right time from the right people. This includes preventing higher-risk alcohol use and a preventative approach to offending involving children and young people.

Our Youth Justice Strategy

131. The youth justice strategy Preventing Offending: Getting it Right for Children and Young People^[99] provides a strong focus on advancing the whole system approach and improving life chances, and helps puts GIRFEC into practice. Alcohol and substance use interventions are a common feature of Early Effective Intervention and diversion programmes, and improving health and wellbeing is a key priority under the life chances theme. Targeted support is also being provided through the Children, Young People and Families Early Intervention Fund, which funds Scottish Families Affected by Alcohol and Drugs^[100], an organisation which supports those affected by higher-risk alcohol use or problematic drug use of a family member.

Scottish Violence Reduction Unit

132. We are continuing to invest in the Scottish Violence Reduction Unit (SVRU)^[101], which promotes a public health approach to violence prevention. The SVRU works directly with communities to foster cohesion and reduce violence by helping them make the changes that they want, to empower them to make decisions and take responsibility for their environment and community.

Mentors in Violence Prevention

133. We are continuing to fund the delivery of Mentors in Violence Prevention (MVP) programme^[102] across schools in Scotland. This is a peer education programme that gives young people the chance to explore and challenge the attitudes, beliefs and cultural norms that underpin gender-based violence, bullying and other forms of violence. It addresses a range of behaviours including name-calling, sexting, controlling behaviour and harassment. It includes issues around alcohol and consent and uses a ‘bystander’ approach where individuals are not looked on as potential victims or perpetrators but as empowered and active bystanders with the ability to support and challenge their peers in a safe way.

Medics Against Violence

134. We support the work of Medics Against Violence (MAV)^[103], which includes a number of senior clinicians working with the VRU in schools to raise awareness amongst young people about the consequences of violence from a medical perspective. Linked to the Curriculum for Excellence, alcohol forms a prominent part of the MAV input, and young people are helped to understand the effects of alcohol on their ability to assess risk, to anticipate trouble and to make sensible decisions.

Navigator

135. We have also invested in the Navigator^[104] programme, a violence interruption intervention which is based in four Emergency Departments (Glasgow Royal Infirmary, Queen Elizabeth University Hospital Glasgow, Edinburgh Royal Infirmary and University Hospital Crosshouse, Kilmarnock) where intervention and support is tailored to the needs of the patients who present at emergency departments who have been affected by violence. This programme aims to reduce violent offending and resulting injuries, increase support for victims of violent crimes and reach patients who would ordinarily not engage with statutory services. Many of the patients Navigator encounters have issues with alcohol, and often the way to help those individuals avoid further violent encounters is to help them address their alcohol-related harms.

Braveheart Industries

136. The SVRU is also supporting abstinence based employment via Street and Arrow, part of Braveheart Industries, a social enterprise^[105]. This model employs and mentors a number of people who have significant offending histories, providing them with support, training and opportunities to positively re-engage with society. Crucial to the delivery of the programme is the abstinence-based ethos, as many of the clients’ offending histories are intrinsically linked to alcohol.

Safer environments and promoting best practice

137. We have worked with our partners to encourage safer drinking environments in the night time economy. This includes the continued delivery and development of Best Bar None^[106] initiatives, which have been operating in Scotland since 2005, and are designed to raise the standards of licensed premises and address alcohol-related crime, anti-social behaviour and violence in the night time economy, with premises now participating in 58 towns and cities across Scotland. Currently over 400 premises have been accredited in Scotland within locally co-ordinated schemes, and most recently Edinburgh Airport joined the list of venues with accredited status.

138. Best Bar None follows the five high level objectives set out in the Licensing (Scotland) Act 2005: the prevention of crime and disorder; securing public safety; the prevention of public nuisance; protecting and improving public health; and the protection of children from harm. In so doing, Best Bar None supports a number of initiatives including ‘Ask Angela’ and ‘Keep Safe – I am me’ as well as messaging to encourage safe responsible drinking and wider safety.

139. Police Scotland and SVRU also regularly deliver awareness inputs to staff from the licensed trade (which also extends to security staff and taxi marshals) using the ‘Bystander Approach’^[107] as a creative prevention tool designed to raise awareness, challenge attitudes and open dialogue in relation to sexual violence and vulnerability. Their ‘Who are you’ film focuses on the night time economy and is utilised as part of these training inputs to identify vulnerability and provide staff with the tools to prevent incidents.

Developments in technology

140. Police Scotland has invested in technology to support a preventative approach which has been developed in collaboration with partners participating in the Violence Prevention Strategy Group. In 2016, ‘Innkeeper’, a new National IT solution for Liquor and Civic Licensing, was introduced to be used in conjunction with a Business Intelligence Toolkit, which is a series of products used by all local policing divisions in Scotland since April 2015.

141. These products use management information data to identify crime and incident trends in small geographical areas to allow resources to be deployed early to the right places at the right times for preventative purposes. The products are being continuously improved with new iterations being added, for example a new ‘Licensing Admin’ tool has been designed to specifically capture all activity at or near licensed premises, both on and off-sales, to identify issues directly related to premises and to enhance the information on Innkeeper to facilitate appropriate engagement with members of the licensed trade.

Road safety

142. We have also acted to reduce alcohol-related harm on Scotland’s roads after the Scotland Act 2012 provided the Scottish Parliament with the power to set the drink drive limit in Scotland. New legislation to reduce the drink driving limit came into effect on 5 December 2014. The drink driving limit of 80mg of alcohol per 100ml of blood was lowered to 50mg of alcohol per 100 ml of blood, with equivalent changes to the limits for alcohol in breath and urine^[108]. This brings Scotland into line with the majority of other European countries.

143. The Road Safety Framework to 2020^[109] sets out our commitment to work with road safety partners to ensure that there is a steady reduction in injuries and deaths on Scotland’s roads. There is clear evidence, cited in the 2010 North Report on drink and drug driving^[110], that a lower drink drive limit will save lives on our roads. The reduced limit appears to be having an impact on public attitudes towards drink driving acceptability. A 2015 Yougov poll^[111] found that some 82% of Scots believe that drinking any alcohol before driving is unacceptable.

Action 20: we will continue to work with partners to reduce alcohol-related violence and crime, through a combination of enforcing legislation, prevention work and early intervention activity.