THE SHAPE OF THINGS TO COME

As I write we await the outcome of the House of Lords investigation into the workings of the Licensing Act 2003. One of the things they were considering was whether ‘protecting and promoting public health’ should be added as a fifth licensing objective. I don’t know what their Lordships will conclude on this issue, although rumour has it they will not recommend this, but that hasn’t stopped Public Health England (PHE) from publishing ‘Public Health and Licensing Guidance’, subtitled ‘A simple guide for responding to applications as a responsible authority.’ Directors of public health have been included as Responsible Authorities under the Licensing Act since 2013, so many in the ‘public health’ community may consider this guidance long overdue.

So, we have a guidance document consisting of some 27 sides of A4 which explains to local public health practitioners how to object to a licence application based on one or more of the four existing licensing objectives, notwithstanding that ‘public health’ isn’t one of them! As the document explains on page 7:

“Although the licensing objectives do not include a health objective, there is a health and wellbeing angle to each of them. It is also possible for a Director of Public Health to have an independent and supporting role as a responsible authority. The above provide some examples that do not cover the full range of opportunities for public health involvement, but outline some composite examples of actions that have been taken by responsible authorities that directly draw on the connection of health to the existing objectives.”

The reference in the second sentence of the paragraph quoted to “the above” refers to examples regarding how a director of public health might smuggle in a health objection as an objection based on, say, public nuisance:

“…a representation requesting noise related conditions or objecting to an extension of hours for an application using evidence on the health impacts that sleep deficit can have on the local residents.”

Or evidence from:

“last drinks survey data, A&E and ambulance data indicating a high number of alcohol poisoning cases coming from a particular premises, or from within its near vicinity.”

You can see right here the difficulty in relating general evidence to a particular application for a premises that hasn’t yet opened or had its hours extended. You can also see that the implicit assumption of PHE is that local directors of public health should be looking for reasons to object. In fact, the guidance document proposes a traffic light system based on ‘red’ and ‘green’ applications. A ‘red’ application – one that would need to be looked at with a view to making a representation – would include any application for:

·       Off licences

·       Any application for hours after midnight or before 8 am

·       Anything within a cumulative impact policy

·       Night clubs

·       Premises reviews by other responsible authorities

·       High volume or ‘vertical drinking’ establishments.

Whereas a ‘green’ application – one that would be of low concern to public health – might include applications for:

·       Restaurants before midnight

·       Food venue before midnight 

·       Theatre Bars before midnight 

·       Changes to the Designated Premises Supervisor

·       Temporary Event Notices (TENs) as the Director of Public Health does not have the remit to respond to these.

Clearly these benighted nannies don’t want the citizenry up and drinking after midnight – and even then only in posh eateries or theatre bars – but preferably not at all!

When your starting point is that it’s the availability of alcohol that makes people drink it, and that population levels of consumption drive alcohol harm, then it should come as no surprise that the starting point for directors of public health in relation to any application for a new licence is “how can we stop it?” the purpose of the traffic light system is merely to sift out applications where an objection would stand little chance of success.

I hope that the House of Lords and the government will not introduce a health licensing objective – much less a ‘health and wellbeing’ objective – and if you read the PHE guidance document you will see how often that word is insinuated into the text. The system we have works well as it is, and scarce resources need to be directed at those who really are drinking at unhealthy and damaging levels, not at making mischief through gratuitous objections to individual licence applications based on an objection to beverage alcohol as such, rather than any real local concerns.

Paul Chase

The shape of things to come by Paul Chase

As I write we await the outcome of the House of Lords investigation into the workings of the Licensing Act 2003. One of the things it was considering was whether “protecting and promoting public health” should be added as a fifth licensing objective. I don’t know what their Lordships will conclude on this issue, although rumour has it they will not recommend this. But that hasn’t stopped Public Health England (PHE) from publishing “Public Health and Licensing Guidance”, subtitled “A simple guide for responding to applications as a responsible authority”. Directors of public health have been included as responsible authorities under the Licensing Act since 2013, so many in the “public health” community may consider this guidance long overdue.

So, we have a guidance document consisting of some 27 sides of A4 that explains to local public health practitioners how to object to a licence application based on one or more of the four existing licensing objectives, notwithstanding that “public health” isn’t one of them! As the document explains on page seven: “Although the licensing objectives do not include a health objective, there is a health and well-being angle to each of them. It is also possible for a director of public health to have an independent and supporting role as a responsible authority. The above provide some examples that do not cover the full range of opportunities for public health involvement, but outline some composite examples of actions that have been taken by responsible authorities that directly draw on the connection of health to the existing objectives.”

The reference in the second sentence of the paragraph quoted to “the above” refers to examples regarding how a director of public health might smuggle in a health objection as an objection based on, say, public nuisance: “…a representation requesting noise-related conditions or objecting to an extension of hours for an application using evidence on the health impacts that sleep deficit can have on the local residents.” Or evidence from: “...last drinks survey data, A&E and ambulance data indicating a high number of alcohol poisoning cases coming from a particular premises, or from within its near vicinity.”

You can see right here the difficulty in relating general evidence to a particular application for a premises that hasn’t yet opened or had its hours extended. You can also see the implicit assumption of PHE is local directors of public health should be looking for reasons to object. In fact, the guidance document proposes a traffic light system based on “red” and “green” applications. A “red” application – one that would need to be looked at with a view to making a representation – would include any application for off-licences, any application for hours after midnight or before 8am, anything within a cumulative impact policy, nightclubs, premises reviews by other responsible authorities and high volume or “vertical drinking” establishments.

Whereas a “green” application – one that would be of low concern to public health – might include applications for restaurants before midnight, food venues before midnight, theatre bars before midnight, changes to the designated premises supervisor and Temporary Event Notices as the director of public health does not have the remit to respond to these.

Clearly these benighted nannies don’t want the citizenry up and drinking after midnight – and even then only in posh eateries or theatre bars – but preferably not at all! When your starting point is it’s the availability of alcohol that makes people drink it, and that population levels of consumption drive alcohol harm, then it should come as no surprise the starting point for directors of public health in relation to any application for a new licence is “how can we stop it”? The purpose of the traffic light system is merely to sift out applications where an objection would stand little chance of success.

I hope the House of Lords and the government will not introduce a health licensing objective – much less a “health and well-being” objective – and if you read the PHE guidance document you will see how often that word is insinuated into the text. The system we have works well as it is, and scarce resources need to be directed at those who really are drinking at unhealthy and damaging levels, not at making mischief through gratuitous objections to individual licence applications based on an objection to beverage alcohol as such, rather than any real local concerns.

The hydra-headed monster by Paul Chase

I thought I would return to the fray with a new twist on an old theme – minimum unit pricing (MUP). Readers of my articles may recall the legality of a minimum unit price for alcohol is an issue that has been batted back and forth between the Scottish government and the Scotch Whisky Association (SWA) since 2012. The Scottish courts had their say (legal); it was referred to the European Court of Justice (not legal). But the ECJ left the final decision to the Scottish courts, which needed to be convinced there was no other, less trade-restrictive way of achieving the Scottish government’s health objectives in respect of alcohol if they were to conclude it was, after all, “legal” to impose a minimum price on a unit of alcohol.

They promptly did so when the Scottish government provided them with the latest research findings from the boys and girls at Sheffield University, whose modelling forms the basis of all the claims made for this measure. So, game, set and match? Well, not quite. The SWA has appealed the Scottish court’s decision to the Supreme Court in London. They have been rather busy of late considering whether the UK government has to get parliamentary approval before triggering Article 50 of the EU treaty to take us out of the European Union. But the little matter of MUP is likely to be ruled on around June this year.

Meanwhile, the authors of the Sheffield model haven’t been sitting around twiddling their thumbs. Oh no! They’ve been modelling the effect of an MUP of 50p on alcohol-related hospital admissions and deaths in Northern Ireland. A charity called Northern Ireland Chest Heart and Stroke said raising the minimum price paid for booze would save lives, lower hospital admissions and cut the costs of crime by £20m a year. Neil Johnston from the charity said: “Alcohol sold for less than 50p a unit makes up the majority of alcohol purchased by high-risk drinkers. Work by Sheffield University shows that pushing up the price of very cheap alcohol will reduce consumption of it by high-risk drinkers and bring considerable benefits. Introducing a minimum unit price of 50p is estimated to save 63 lives a year and result in almost 2,500 fewer hospital admissions.” Very impressive, but do the figures stack up? It is informative to compare Sheffield University’s predictions for Northern Ireland with its predictions for Scotland:

• How can it be that a 50p MUP saves three fewer lives each year in Scotland than in Northern Ireland, despite the fact Scotland has 3.6 million more people than Northern Ireland? And, in terms of alcohol-related hospital admissions, nearly twice as many of these are saved in Northern Ireland despite the fact Northern Ireland’s population is only a third of Scotland’s!

• It is interesting to note that MUP as a policy has been enthusiastically and uncritically supported by Scotland, Wales and Northern Ireland, whereas in England the UK government’s view has been much more sceptical. The “healthiest” agenda tends to receive much more support by governments that are relatively new, struggling for legitimacy or relevance, and for whom embracing policies that claim to improve the “health of the nation” gives them an opportunity to promote themselves as standing up for the interests of “the people” and against those of big business – in this case Big Alcohol.

It remains to be seen whether the UK Supreme Court will risk being labelled “enemies of the people” by yet again standing up for rationality and finding against MUP. In this “fake fact” world, where an appeal to prejudice is seemingly all that is needed to identify a large constituency of support that will rise up vociferously, it seems to me we need some unelected judges who aren’t afraid to tell us the truth.