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Response Of the North Wales Local Public Health Team to the National Assembly for Wales’ Health and Social Care Committee Inquiry into Alcohol and Substance Misuse |
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Authors: Melfyn Thomas, Senior Public Health Practitioner, Public Health Wales; Louise Woodfine, Principal Public Health Practitioner, Public Health Wales.
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Date: 9th January 2015 |
Version: 1a |
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· Internal to Public Health Wales · Welsh Government Health and Social Care Committee |
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Review Date: N/A |
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Purpose and Summary of Document: This document is the North Wales Local Public Health Team submission to the National Assembly for Wales’ Health and Social Care Committee Inquiry into Alcohol and Substance Misuse |
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National Assembly for
Wales / Cynulliad Cenedlaethol Cymru
Health
and Social Care Committee /
Y Pwyllgor Iechyd a Gofal Cymdeithasol
Inquiry into
alcohol and substance misuse /
Ymchwiliad i
gamddefnyddio alcohol a sylweddau
Evidence from Public Health Wales – ASM 19 / Tystiolaeth gan
Iechyd Cyhoeddus Cymru – ASM 19
1 Introduction and summary
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Over the last few decades there has been a change in the culture in Wales as regards deinking alcohol and the use and abuse of illegal substances. Alcohol is much more easily available in Wales now than it has been for many generations; is cheaper than it was at any time in the 20th century; and is more socially acceptable than it has been since the turn of the last century. Illegal substances are also cheaper, more available and much more widely used than they have been in past generations. We are now seeing the physical effects of low-cost, easily available alcohol at clinics across Wales and the financial cost will continue to grow for many years even if the widespread over-use of alcohol in our society were to stop today; social and health related problems linked to illegal substance use in our communities are also more apparent now than they have been for a long time and show no sign of stopping. The challenge from a public health point of view is a huge and growing one and one that needs to be addressed both from a preventative and treatment point of view. The changes in alcohol and substance misuse have gone hand-in-hand with cultural changes within our society which has become more tolerant of their misuse leading to a greater barriers to teach about and treat them. The inquiry asks for a response to the following terms of reference for alcohol and substance misuse in Wales and this paper will follow these headings subsequently:
· the impacts of alcohol and substance misuse on people in Wales, including young people and university students; older people; homeless people; and people in police custody or prisons; · the effectiveness of current Welsh Government policies on tackling alcohol and substance misuse and any further action that may be required; · the capacity and availability of local services across Wales to raise awareness and deal with the impact of the harms associated with alcohol and substance misuse. 2: Alcohol & substance misuse on the North Wales population: “The impacts of alcohol and substance misuse on people in Wales, including young people and university students; older people; homeless people; and people in police custody or prisons” The changing in drinking and substance misuse culture is perhaps more evident and more visibly seen among young drinkers. Because the price and availability of alcohol have changed greatly since the turn of the century young people can now more easily afford to buy alcohol and have far more outlets that sell alcohol than ever before. This has directly impacted on the drinking culture in the UK in that the financial difference between buying alcohol at traditional outlets such as public houses and the growing alcohol retail outlets such as supermarkets and corner shops is great. Supermarkets can afford to sell alcohol at a loss (loss-leaders) and make up their profits on other products while public houses cannot do this and tend to try and make more profits on non-alcoholic drinks. This has led to the development of a culture of pre-loading among the younger generation, where cheaper alcohol bought at supermarkets or other lower-price outlets are drunk before they go out to the more traditional pubs and clubs. The net result of this is to shift the time that young people go out to socialise to later on in the evening and also that they arrive at those places under the influence of alcohol to varying degrees already. This leaves public houses generally more empty earlier in the evenings than they might have been in previous generations and also that alcohol-related problems can be perceived to be associated with pubs and clubs but where the bulk of the alcohol drunk by the perpetrators of anti-social activity has actually been bought at other outlets. The development of a wider home-drinking culture has also been linked with a greater amount of drinking in that traditionally a drinker might have been buying their drinks in a public setting might have some mitigating effect on their consumption. Drinking at home, or drinking alone at home is much harder to gauge how much and how fast they are drinking. The change in drinking culture has also affected the more elderly members of our society and there has been a rise in the number of more elderly drinkers presenting with alcohol related problems. The social element of drinking in a public house might have been minimised with this cultural change, and the price of alcohol at other outlets has seen an increase in more elderly members of the population drinking at home and alone.
3: “the effectiveness of current Welsh Government policies on tackling alcohol and substance misuse and any further action that may be required”
· One of the best evidence interventions into reducing drinking in populations is to increase minimum unit pricing. The proposed introduction of minimum unit pricing as policy in Wales is welcomed as are the policies of reviewing fatal and non-fatal drug poisonings and alcohol related deaths, to ensure that lessons learned and recommendations may be implemented to reduce future deaths.
4: The capacity and availability of local services across Wales to raise awareness and deal with the impact of the harms associated with alcohol and substance misuse. · Local services should seek and be responsive to the needs of their service users. Service users should be regularly and meaningfully consulted as regards the services available and if those services are fulfilling or failing in their duties. There should be a service user element in the evaluation of service providers and in making recommendations for further service development in the future.
· Clear effective and truthful information about substances and the likely consequences of using them or selling them should be made clear to the population in a non-judgmental way.
· Harm minimisation and harm reduction policies in North Wales have had a practical and beneficial effect for both drug users and communities. They should be further invested in and expanded.
· The implementation of the alcohol brief intervention (ABI) training by Public Health Wales has ensured that both NHS and non-NHS staff are suitably skilled to engage with individuals to identify potentially harmful drinking patterns and encourage behavioural change. Over 7000 such staff have now been trained to deliver ABI across Wales, ranging from military personnel to midwives. Welsh Government has been a key driver in the development of this programme.
· Make prevention a clear aim of services and other institutions so that a shift in culture towards a more respectful and mature use of alcohol and substances can be achieved. |