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Exploring public health contributions to alcohol licensing in local government: A London-based research study

The London School of Hygiene & Tropical Medicine, Safe Sociable London Partnership and Southwark Public Health are conducting a research study to explore the range of influences on public health practitioners’ contributions to alcohol licensing processes in local authorities across London. As public health has an increasing role to play in shaping local alcohol environments, we are interested in finding out more about how public health practitioners approach alcohol licensing work, to identify how to strengthen public health contributions to licensing processes. The study is funded by the NIHR School for Public Health Research, and the study team includes researchers from London School of Hygiene & Tropical Medicine, Safe Sociable London Partnership, and Southwark Public Health.

We are already working with several local authorities, but want to include as many London local authorities as possible in the study.

We want to explore a wide range of experiences and approaches undertaken by public health practitioners in relation to alcohol licensing work, and to understand how this fits within the broader structures, relationships and context of each local authority. We are also exploring the experiences of practitioners who have been using the Public Health Alcohol Licensing Guidance Tool developed by Safe Sociable London Partnership. Some of you will already have spoken to Joanna Reynolds, from LSHTM, about participating in the study.

Getting involved.

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Editorial: What’s our strategy for IBA?

Identification and Brief Advice (IBA) has incredible potential to prevent and reduce alcohol related harm.  The figure of a 15% decrease in alcohol consumption on average for those who receive an IBA is a compelling and significant impact.  For the individual this can mean reducing alcohol related hospital admissions and risk of alcohol related mortality by a fifth.  For England this could lead to reductions in a wide range of health and social harms.

Despite this, our strategic approach to rolling out IBA in the English population has been lacking.  In the last two national strategies IBA has been noted, but with little strategy for implementation.  The Safe. Sensible. Social alcohol strategy did highlight a research approach, and the development of web-based commissioning tools. In the 2012 strategy, IBA isn’t raised until after social marketing, the sobriety pilot and licensing amongst others – and all it does, is say is that IBA will be part of the NHS health checks and that Local Authorities should consider it for commissioning in primary care settings. We’re yet to have another national alcohol strategy. Local Alcohol strategies tend to be better, but still, there is very little strategic coherence to IBA implementation.

For years IBA has been highlighted as something to be rolled out, the evidence has been clear and further research has been commissioned; examples of good practice have been collected and shared.  However, no real strategic approach to the implementation of IBA has been set out.

Without a clear strategic direction:

  •  The roll out of IBA in primary care – through both Direct and Local Enhanced Services – did not live up to expectation. 
  • Other settings, such as pharmacy, have been the site of IBA initiatives and some research and evaluation work, but we are still unclear of the evidence, practice and approaches that might best work for wider implementation.
  • Since the move of Public Health to Local Authorities, NHS buy-in at commissioning level has initially been limited. The joint commissioning between Public Health and CCGs that we optimistically hoped for a few years ago is still developing.
  • Digital IBA has become increasingly popular.  Although there is definite development and innovation in this space, there is still a fragmented approach across local commissioners – there is little clear guidance and little sharing of good practice despite the evidence base being solid and growing.

If we are to realise the potential of IBA and make best use of the learnings of the past few years, we need a strategic approach to IBA implementation.  This would need to:

  • Make the case: clinically, socially and economically (each being as important for the case as the other).  We need to better make the case for IBA implementation.  Currently we have failed to win over decision makers, commissioners and clinicians sufficiently for the wide-scale, effective delivery of IBA to take place that would show significant impact. 
  • Commissioning: we need to be clear that when commissioning IBA it shouldn’t be service by service or project by project, it should be a comprehensive IBA approach – the HIN IBA Commissioning toolkit (Watson, Knight, Hecht and Currie) provides a detailed and effective guide for commissioning IBA strategically and effectively.
  • Training and workforce development: We need to learn from our smoking cessation partners and develop a minimum standard of training, possibly with accreditation, and a professionalised training and skills acquisition pathway around IBA for more junior staff’s professional development and career progression.
  • Digital integration: We need to work with the existing digital field, in practice, research and innovation; and examine and experiment with how digital and traditional IBA can align, complement and enhance each other for the best ‘merged’ IBA pathways to be available to practitioners and the population.
  • Expanding the knowledge and scope: redeveloping a research and evaluation strategy to genuinely enhance and build our knowledge of what works.  A collaborative strategy that sees our researchers and evaluators work with commissioners and practitioners to fill in the gaps and expand the boundaries of our knowledge rather than reinventing the wheel.

We think that now is the right time to build an alliance of interested parties to start scoping out and developing what an IBA Strategy would look like and what it could achieve.

We would be keen to hear from anyone who is interested in supporting or being involved in this.

Dr Matthew Andrews

Safe Sociable London Partnership

26th January 2017

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Public health focus for 2016/17

2016 has been a busy year for SSLP so far.  We have become a social purpose company – you can see the principles that are built into our founding documents on our home page.  We have moved into new offices,   and we have started work with a range of new partners.

This year we have begun working the Mayor’s Office of Policing and Crime, the World Health Organization and local networks in the South West of England and several London Local Authorities.  All new clients that we are enjoying working with.

We have also held a symposium on the state and future of digital Identification and Brief Advice, and run an expert advisory group on an IBA train-the-trainer toolkit in Copenhagen (see the article here)

Since the beginning of the year we have been developing our focus on a few key areas that we believe are important for reducing public health harms in 2016 and 2017.  These are:

  •  Licensing as a prevention tool:  Public Health involvement in alcohol licensing provides an excellent opportunity to tackle some of the negative impacts that alcohol can have in an area.  The recent study of the impact of intensive licensing approaches by de Vocht et al concluded that there are long term population health benefits of more intensive licensing activity.  There are many ways that Public health can add to these approaches.

 

  • Price measures: Minimum Unit Price is still under consideration in Scotland, but other approaches are being considered and research into its feasibility and impact is still ongoing.  Whilst Scotland, and to an extent, Wales and Northern Ireland, act as pathfinders in MUP, there is scope for some of the key population centres in England to investigate what MUP could mean for population health and how it might be applied.  With Greater Manchester continuing its efforts around MUP there is an opportunity for London to work together to consider what MUP could mean for the capital.

 

  •  Identification and Brief Advice: After a long 7 years of trying to build IBA into a number of systems and settings, and with the end of the Direct Enhanced Service, it is probably surprising the promise that IBA shows for reducing alcohol related harm in 2016/17.  The ability to digitize parts of delivery and the advances made in training and commissioning mean that IBA could be a significant harm prevention tool in 2016/17.

 

  • The return of the strategic assessment: the benefits of supportive, external strategic assessments can be significant for local strategic partnerships.  The CLeaR alcohol self-assessment, peer reviews and rapid reviews can all make a contribution.

 

  • Tobacco control and smoking cessation: having had progress on smoking rates for many years, reductions in funding and restrictions of smoking cessation services may lead to this being an area for focus in 2016/17.

 

We can help with these or any other harm prevention issues you may be facing – please come and talk to us about what we can do to help.

 

Dr Matthew Andrews

September, 2016

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