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					                   DRINKING
                  SENSIBLY IN
                  BRADFORD
          THE ALCOHOL
    HARM REDUCTION STRATEGY
     FOR BRADFORD DISTRICT

                   OUR GOAL
   To tackle and minimise the harms caused by
              the misuse of alcohol.




BRADFORD SAFER COMMUNITIES PARTNERSHIP
DECEMBER 2008.

ACKNOWLEDGEMENTS
The principal author of this strategy is Nina Smith, Senior Policy Officer (alcohol and drugs). An earlier
draft was issued for consultation. Later drafts have been seen and improved by members of the
Alcohol Strategy Implementation Group. The final document was approved by the Bradford Safer
Communities Executive.

The treatment section of this strategy has drawn heavily on “Alcohol Health Care Needs Assessment,
Bradford District 2006” ( Dr Simon Padfield for Bradford PCT, unpublished).

All enquiries regarding the strategy should be directed to Nina Smith on 01274 437202,
nina.smith@bradford.gov.uk



Alcohol/Strategies/Bradford as at 17.12.08                                                               1
                                SOME VIEWS ON ALCOHOL

                   “80% of deaths on Friday and Saturday evenings are drink related”
                      (Home Office, “Know your limits” Campaign, October 2006)

                            “It‟s part of teenage culture to drink and get drunk”
                                  (Lydia, 16, Panorama, BBC TV, 19.11.06)

 “As every parent knows, children naturally crave attention – and if negative attention is the only thing
                on offer, they‟ll take it.” (Truthout, Guardian website blogger, 29.1.08)

   “The binge drinking is destroying British society, it‟s devastating the family unit, harming innocent
          bystanders ruining our cities and …making saying „I‟m British‟ an embarrassment”
                              (David, Cardiff, The Times website, 2.1.08)

  “When I was growing up, there was drink in the house only at Christmas and on special occasions,
                    whereas nowadays many people drink regularly, even daily”
            (Ben Bradshaw MP, Health Minister, House of Commons Hansard, 6.12.07)

“All the recovering alcoholics I know say the same thing – they felt different, even as children. They
didn‟t feel safe.” (Tanya Gold, recovering alcoholic, The Guardian, 29.1.08)

The Publican recently advised landlords to “train and incentivise staff to upsell products such as larger
measures of wines and spirits” (The Times 12.4.2008)

“Alcohol is placing an increasing burden right across the NHS, from the GP surgery to the hospital
bed”. (Tim Straughan, Chief Executive, NHS Infomatics Centre)

The number of drink-related admissions to hospital in 2006 was 811,000 (Department of Health, July
2008)

“Price is always going to be an issue. We will certainly at times sell alcohol below cost”. (Rob Chester,
Head of Licensing, ASDA).

 “We have no policy but in response to competition, we will sell below the market price” (Alan Brown,
Tesco) (Both appearing before the Home Affairs Select Committee, 2.6.08 – quoted in Daily Mail
3.6.08)

“We look at what‟s good or bad for consumers, in terms of their pockets rather than their livers.”
(Competition Commission, Observer website, quoted in IAF Briefing Paper “Use of alcohol as a loss
leader”, Bennetts R, 2008)

“In the 1960's one could buy 35 pints of ale on-sales for equivalent of one bottle of spirits off-sales.
Today one buys 3.5 pints on-sales for one bottle off-sales; this represents a fantastic relative 1000%
price swing independent of inflation. c1980, spirit bottles were reduced from 75cl to 70cl to help keep
the price off-sales below £10. 25 years later, despite whopping increases in cereal and energy costs,
one can still buy brands for less than £10. Is there any other product on supermarket shelves selling at
1980's prices. Traditional ale with reusable transport and serving vessels wins the ecological argument
'hands down'. Drinking as supervised by responsible landlords and customer peers easily wins the
under-age, behavioural and off-sales drinking arguments. There are vast social benefits to be
recovered by reverting to the on-sales model where drinkers have to be of age, well mannered, well
behaved and polite etc to be served and to drink in socially responsible timeframes.”
(“Postneoclassic”, Guardian blog, 19.9.08)




Alcohol/Strategies/Bradford as at 17.12.08                                                                 2
          INTRODUCTION BY THE CHAIR OF SAFER
                COMMUNITIES BRADFORD
                                    Councillor Martin Smith
This is not an anti-alcohol strategy. It is a strategy to reduce the harm caused by the misuse
of alcohol. The responsible drinking of alcohol is widely accepted in Britain. Nearly 90% of
adults drink alcoholic drinks, although in Bradford the figure will be lower due to the size of
our Muslim population. The majority of people use alcohol without significant problems.
People get much pleasure from their favourite tipple. Drinking is part of most people‟s social
and family life, and can enhance meal times, special occasions, celebrations and time spent
with friends. Going to the pub for a drink with friends, often with a bar meal, is an established
part of British social life that is enjoyed by a great many people. Hand pumped real ale is
considered by many to be one of the great pleasures of Britain. Alcohol also plays an
important role in the tourism and leisure industries.

Drinking in moderation can confer health benefits, as modest alcohol consumption (1 unit a
day) has a protective effect against coronary heart disease and stroke amongst men over 40,
and post-menopausal women.

But, and it is a big but, there is a serious flip side. Alcohol is a toxic substance, an intoxicant
and a drug of dependence. Alcohol misuse causes harm and misery to many in our society.
8% of men and 5% of women in England are classified as “higher risk” or harmful drinkers;
on a pro-rata basis, that means over 20,000 people in the Bradford district are at higher risk
of alcohol-related harm. It is too easy to become alcohol dependent, as alcoholic drinks are
cheap and widely available throughout the day and, in many outlets, well into the night. The
drink-at-home middle class wine drinker can be at as much risk of health harm as a heavy
drinking pub regular. Alcohol ruins the health of alcohol dependent people, and devastates
their families. It is frequently associated with domestic violence, and fuels the violence,
criminal damage and intimidating behaviour which blight night times in town and city centres.

Alcoholic drinks are cheap in supermarkets, and popular brands are used as loss-leaders,
sometimes being sold below cost price. Strong cheap alcohol literally fuels the extreme
behaviour associated with feral youths who indulge in savage pointless violence resulting in
injury, maiming and murder. It is associated with other youth nuisance, especially but not
exclusively in poorer areas. Drink-driving kills and maims people.

The total cost of alcohol misuse in England is now estimated by the Government at between
£17 and £25million a year – that suggests the annual cost of alcohol use in the Bradford
district is between £160 million and £240 million. This includes health costs, crime and public
disorder costs, workplace costs and costs to families and social networks.

In Bradford, we welcome the increasing government concern about the harms caused by
alcohol misuse, and the growing number of initiatives to tackle the problem. But much more
needs to be done. As the Government recognises in its updated national alcohol strategy,
cultural change is fundamental to achieving a step change in reducing alcohol related harm.
In the meantime, we all have to work both to achieve that change and to deal with the very
serious problems facing us now.

This strategy sets out the scale of the problem and proposes wide ranging measures to
tackle it. It takes account of the recommendations of the Health Improvement Committee




Alcohol/Strategies/Bradford as at 17.12.08                                                        3
(April 2008). It is a strategy for everyone in the Bradford district. We all have our part to
play. We do not need alcohol to cause so much damage to society, moderation is the key.

“DRINKING SENSIBLY IN BRADFORD” -
THE BRADFORD ALCOHOL STRATEGY,
             2008 -2011
EXECUTIVE SUMMARY, AND OUR GOAL, AIMS AND
              APPROACHES
The Bradford District Alcohol Harm Reduction Strategy takes the national strategy
“Safe. Sensible. Social.” as its base, but broadens it to take account of local
concerns, and sets out a number of high-level Aims (Outcome Objectives) and
Approaches (Process Objectives), to set the framework for developing performance
indicators and an implementation plan to work towards achieving Bradford‟s overall
long-term goal or vision, which is a slightly amended version of the Government‟s
goal.

The strategy puts alcohol firmly centre stage as a priority issue for Bradford. Alcohol
is a cross-cutting issue and, whilst this strategy is led by the Community Safety
Partnership supported by the Strategic Health Improvement Partnership, it is
necessary that all the partnerships that make up the Bradford Local Strategic
partnership (LSP) should play their part in implementing it. Tackling alcohol misuse
has been identified as a critical issue in the health theme of “The Big Plan”,
Bradford‟s Sustainable Communities Strategy, and tackling it is central to achieving
several of the critical issues in the Safer and Stronger Communities theme. It is also
relevant to other themes within The Big Plan especially that relating to children and
young people.

Alcohol misuse causes serious problems in the Bradford district. It costs the public
purse, residents and employers around £200m a year. Even more important is the
human cost:
    Bradford district is ranked in the worst quartile for four, and the second worst
       for another four, of eight alcohol related health indicators used as national
       comparators. Bradford is in the top quartile for the ninth, alcohol-specific
       hospital admissions for under-18s.
    The alcohol-specific and alcohol-related death rates for men (2003-5) in
       Bradford are in the bottom quartile, and well above the regional average. For
       women, they are in the second worst quartile, and only just above the regional
       average.
    Bradford is in the worst quartile for three alcohol related crime groups used as
       national comparators i.e. all alcohol related crimes, alcohol related violent
       crimes and alcohol related sexual offences.
    Bradford is the 70th worst local authority area in England (out of 314) for binge
       drinking.
    Bradford has a much lower prevalence of alcohol use amongst children and
       adolescents than the England average, but 4000 school attendees admitted



Alcohol/Strategies/Bradford as at 17.12.08                                                      4
        being drunk at least once in the previous four weeks in 2007, with 1350 of
        these having been drunk on three or more occasions.
       There were 115 positive breath tests in Bradford over Christmas/New year
        2006-7.

National data shows continuing rises in alcohol specific death rates and hospital
admissions, a gradual lowering of the age at which people die from alcohol-related
causes, and behaviour by children and young people which bodes ill for their future
health.

25% of fires are known to be due to alcohol impairment.

Alcohol has become ever more affordable. A bottle of whisky in 1946 cost the
equivalent of £50 at today‟s prices – that‟s nearly £2 per unit of alcohol! A unit of
white cider can now be purchased in supermarkets and some smaller retail outlets
for 13p. A rise in the consumption of alcohol since the 1980s has mirrored the
decline in price.

Whilst the number of children who drink is declining, those that do drink do so from a
younger age and drink significantly more than a generation ago. Since 1992,
consumption amongst 11 to13 year-old boy drinkers increased by 72%; amongst
girls, it increased by 84%, from a lower baseline. Their mean self-reported
consumption in the last week, in 2007, was 8.2 units. In deprived communities, 15%
of 10-19 year olds are drinking at levels that are hazardous or harmful for adults.
There is still considerable off-sales purchasing by under-18s, and a significant
reporting of supply by parents – this seems to be particularly bad in deprived
communities.

Women, whilst drinking less than men, are increasing their consumption, in part due
to increasing strength of wine and partially due to sociological reasons. New methods
of recording units drunk show that between 1998 and 2006, the number of men
drinking more than 4 units on at least one day „last week‟ (40%), and those drinking
more than 8 units (23%) remained similar. Amongst women, the new method of
calculating units shows 33% exceeding 3 units and 15% exceeding 6 units, bringing
the percentage of women exceeding recommended daily limits much nearer to
men‟s. 25-44 year old men and 16-44 year old women are the age groups most likely
to exceed the 8/6 and 4/3 limits.

OUR GOAL
The long–term goal or overall objective of “Drinking Sensibly in Bradford - the alcohol
harm reduction strategy for Bradford district” is:
“to tackle and minimise the harms caused by the misuse of alcohol.”

OUR AIMS
To achieve our goal, we have developed seven aims, formulated thirty-three
approaches, and developed action plans to achieve these.
     A1 To reduce the number of people who drink alcohol above recommended
       limits, thus reducing the adverse health impact of alcohol.




Alcohol/Strategies/Bradford as at 17.12.08                                              5
        A2 To reduce alcohol-related crime, disorder, intimidation, nuisance and anti-
         social behaviour, and ensure that everyone can enjoy all areas of the
         Bradford district without fear of alcohol-related violence and intimidation.
        A3 To reduce the prevalence of harmful drinking by children and young
         people aged under 18.
        A4 To develop a comprehensive range of effective treatment, support,
         rehabilitation and reintegration services for alcohol misusers, with easy
         access and clear care pathways.
        A5 To reduce the harm caused by alcohol misuse within families and
         relationships, including domestic abuse and the “hidden harms” caused to the
         children of alcohol-misusing parents.
        A6 To reduce the number of babies born with a disorder in the Foetal Alcohol
         Spectrum Disorder range, and to decrease the risk of related problems
         experienced by children born with one of these disorders.
        A7 To reduce alcohol-related accidents and fires, thus reducing avoidable
         premature death, disability and less serious injuries.
        A8 To reduce the economic costs of alcohol misuse.
        A9 To ensure that information and services are accessible and welcoming to
         all sections of Bradford‟s diverse population..
        A10 To record and analyse the data necessary to measure our progress.

OUR APPROACHES
UNIVERSAL
    PO1 To include alcohol harm reduction targets in the 2008-11 Local Area
     Agreement; and to achieve those targets.
    PO2 To develop an Action Plan for the implementation of the strategy.
    PO3 To engage all relevant members of Bradford District Partnership (LSP) in
     helping to implement the Bradford Alcohol Harm Reduction Strategy.
A1 REDUCE CONSUMPTION
    PO4 To make the population of Bradford aware of how many units of alcohol
     are contained in their alcoholic drinks of choice, how that relates to hazardous
     and harmful levels of consumption, and of the immediate and potential future
     consequences of binge, harmful and hazardous drinking.
    PO5 To provide adequate provision of brief interventions in NHS and other
     settings across the Bradford district, and ensure that adequate training is
     available to relevant staff and volunteers in all agencies where brief
     interventions could be offered.
    PO6 To develop initiatives at community level, in partnership with local
     organisations, and in consultation with residents and users..
    PO7 To advocate a change in the method of calculating the duty to be
     imposed on alcoholic drinks to a system based on the volume of alcohol; and
     advocate phased increases in the duty on alcoholic drinks to make them as
     expensive in real terms as the equivalent type and strength of drink was prior
     to the beginning of the significant and continuous rise in consumption (circa
     1970). Additionally, to hypothecate increased duty revenues resulting from
     increases in duty rates to pay for improvements in alcohol treatment, brief
     interventions and prevention activity.
    PO8 To advocate changes in competition law, to give the Government and
     local authorities power to ban irresponsible retailing practices; and


Alcohol/Strategies/Bradford as at 17.12.08                                            6
     amendments to the Licensing Act so that licensing authorities can take into
     account public health considerations.
    PO9 To engage with the on- and off-trade (including supermarkets) to
     develop a local code of practice designed to discourage retailing practices that
     promote irresponsible drinking, and to adopt measures to limit access to
     alcohol. If necessary, to use any powers permissible under planning, licensing
     and competition law to impose restrictions on outlets having price promotions
     on alcoholic drinks, using alcohol as a loss leader, or having aisle-end and
     other prominent displays of discounted alcoholic drinks.
    PO 10 To utilise all available measures to ensure that all licensed premises
     provide non-alcoholic and low (under 2% proof) alcoholic drinks at prices
     comparable to purchasing a half pint of normal strength beer.
A2 REDUCE CRIMINAL BEHAVIOUR
    PO11 To use the provisions of the Licensing Act 2003 to ensure that on- and
     off-licensed premises are acting within the law; and to advocate changes to
     the Act to make it a more effective tool for dealing with alcohol related-harm.
    PO12 To work with the retail, alcohol and leisure industries to help them
     eliminate irresponsible practice regarding the sale and consumption of alcohol,
     including the layout and ambience of licensed premises.
    PO13 To generate a debate as to whether the legal age for purchasing and
     consuming alcohol should be raised to 21.
    PO14 To prioritise the reduction of alcohol-related violence, including by
     using intelligence to pro-actively police identifiable hot-spots of alcohol related
     crime, disorder and anti-social behaviour. This will include the development of
     the Cardiff model to reduce alcohol related injuries, and the encouragement
     and support of harm reduction initiatives such as the Street Angels.
    PO 15 To take firm action to tackle anti-social behaviour and threatening
     behaviour by under-age drinkers.
    PO16 To use criminal justice interventions, including Alcohol Treatment
     Requirements (ATRs), to steer alcohol misusing offenders into treatment.
A3 REDUCE UNDER AGE DRINKING
    PO17 To ensure that good quality, relevant, and realistic evidence-based
     education about alcohol and alcohol misuse, which addresses the binge
     drinking culture, is provided in all Bradford schools and youth settings; and
     that screening is available to detect when alcohol misuse is a factor in other
     problems.
    PO 18 To target and work with parents and guardians to help reduce the
     misuse of alcohol by their children.
    PO19 To take pro-active measures to reduce the sale or supply of alcohol to
     or for persons aged under 18.
    PO20 To advocate legislative initiatives to cover mandatory unit labelling,
     health warnings on drink containers, and restrictions on marketing designed to
     eliminate those practices which glamorise alcohol, and make its use seem an
     essential part of social and personal success and happiness. These
     restrictions will apply to advertising and product placement, and include bans
     on promotional activities such as sports sponsorship, association with
     celebrity, promotional pricing campaigns (including Happy Hours, 2 for 1 etc.)
     and the use of alcoholic drinks as loss leaders in both the on- and off-trades.




Alcohol/Strategies/Bradford as at 17.12.08                                            7
     PO21 To advocate a responsible attitude by the mass media to alcohol use,
      with particular reference to media such as pop music shows, ”reality TV” and
      soaps which are aimed at, or reach, large numbers of children and young
      people. In particular, we want to see an end to the glamorisation and positive
      condoning of binge drinking in the media.
A4 TREATMENT
    PO22 To work towards having sufficient treatment provision to meet demand,
      with short waiting times. As a first step, to rapidly develop treatment services
      so that the availability of treatment for dependent drinkers is at least as good
      as the national average.
    PO23 To work with housing providers and funding bodies to provide a full
      range, and adequate provision, of appropriate housing and accommodation for
      male and female dependent drinkers pre, during, and post treatment.
    PO24 To involve users and carers in improving the alcohol treatment locally.
    PO25 To ensure all treatment and wraparound services are of high quality.
    PO26 To lobby Government to provide adequate ring-fenced resources for
      alcohol treatment, following the established model for illegal drugs.
A5 DOMESTIC ABUSE AND HIDDEN HARMS
    PO27 To work with convicted and non-convicted domestic abusers, and those
      at risk of causing domestic abuse, to address the causes of their abusive
      behaviour, and to take a zero-tolerance approach to repeat offenders.
    PO28 To provide interventions to improve the quality of parenting, especially
      those that reduce the risk of harm to children living in households where
      alcohol misuse is prevalent.
A6 REDUCE THE INCIDENCE OF FOETAL ALCOHOL SPECTRUM DISORDER
    PO29 To support the recommendations of the BMA report “Foetal Alcohol
      Spectrum Disorders” (June 2007); to develop a range of local interventions to
      reduce the incidence of the disorders, including increased support for
      pregnant women; and to provide early diagnosis of the disorder so as to help
      children born with it.
    PO30 To support interventions to reduce the level of unplanned pregnancies.
   A7 REDUCE ACCIDENTS AND FIRES
    PO31 To robustly police the current drink-driving law and to advocate a
      reduction in the legal blood alcohol limit for driving to no more than 0.5mg per
      100ml with lower limits for younger and novice drivers, and to introduce
      random breath-testing.
    PO32 To use all available methods to raise awareness of alcohol related
      accidents and fires in and out of the home.
A8 REDUCE ECONOMIC COST
    PO33 To work with employers and employers‟ organisations to introduce fair
      but firm workplace policies regarding alcohol use.
A9 ACCESS TO ALL
    PO34 To use local social marketing campaigns to promote messages and
      reach audiences not covered by the Government‟s own social marketing.
A10 DATA
    PO35 To develop robust data about the prevalence, consumption, and
      adverse impact, of drinking alcohol in Bradford.




Alcohol/Strategies/Bradford as at 17.12.08                                          8
IMPLEMENTATION PLAN
Local Area Agreement (LAA) priorities relating to violent crime (NI 20), young
people‟s substance misuse (NI 115), anti-social behaviour (NI 17), teenage
pregnancy (NI 112) and primary fires (NI 49) mean that reducing alcohol misuse is a
key task in helping to meet Bradford‟s LAA targets.


A seven section implementation plan to deliver the strategy has been produced as a
separate document by the Alcohol Strategy Implementation Group. The group will
performance-manage the delivery of the Implementation Plan, and reports on
progress will be presented to the Safer Communities Executive and the Strategic
Health Partnership at agreed intervals.

The Implementation Plan will be subject to ongoing improvement and annual review
and update.




Alcohol/Strategies/Bradford as at 17.12.08                                            9
           CHAPTER 1: ALCOHOL AND HEALTH
UNITS OF ALCOHOL
Alcohol consumption Is measured in units. A unit is 10millilitres (8 grams) of pure
alcohol, and is the amount of alcohol a healthy adult body can break down in about
an hour. The number of units in a drink can be calculated by multiplying the size of
the drink (in ml) by the ABV (alcohol by volume – the percentage of pure alcohol in a
particular drink), and dividing by 1,000, e.g the number of units in a 250ml glass of
wine with an ABV of 12% is 3% (250mlx12% =3000, divided by 1000, =3%).

Recent research has shown widespread ignorance of the number of units in
particular drinks, especially amongst wine drinkers and older drinkers. (YouGov
survey for Department of Health, April 2008, quoted in DH press release “units – they
all add up-new £10m alcohol campaign launched, 19.5.08). DH is addressing this
with a major advertising campaign in 2008-9.

SENSIBLE DRINKING AND TYPES OF ALCOHOL MISUSE
The Royal College of Physicians, the Royal College of Psychiatrists, the Royal
College of General Practitioners and the British Medical Association have all
recommended that adult men should drink less than 21 units per week and adult
women less than 14 units per week.

The most recent advice is that the weekly limits for adults should be consumed fairly
evenly during the week as binge drinking the weekly recommended amounts in one
to three binge sessions is harmful in itself. The NHS recommends that men should
not regularly exceed 3 - 4 units daily, and women should nor regularly exceed
2-3 units daily (Alcohol Units – a brief guide, DH, 2008.) However it is not advised
that these limits should be reached every day, and one or two alcohol free days
during the week are recommended (apas.org.uk).

Drinking at these levels is referred to as lower risk, rather than safe, both
because drinking at these levels impairs judgement, and because there is some
evidence that regular drinking at these levels over a long period increases the
relative risk of certain alcohol-related diseases, most notably cancer of the oral cavity
(Alcohol Units – a brief guide, DH, 2008, p7).

Drinking in excess of these limits is considered to be „hazardous drinking‟ or „at risk‟
drinking where no long-term health-related consequences have yet occurred.
„Harmful drinking‟ is defined in the ICD 10 classification as a pattern of drinking that
has caused damage to either physical or mental health (e.g. liver disease or
depression) (WHO 1992).

Various terms are used to describe different levels of alcohol consumption. The
following are used in this strategy, unless described otherwise to reflect the usage in
research quoted:
REGULAR DRINKING:


Alcohol/Strategies/Bradford as at 17.12.08                                            10
    Low to moderate drinking (“low risk”) - 1 to 14 (M)/21(F) units a week (2-
     3/3-4 units a day)
   Moderate to heavy drinking (“Hazardous drinking”) (“increasing risk”) -
     14/21 to 35/50 units a week.
   Very heavy drinking (“Harmful drinking”) (“higher risk”) - over 35/50 units
     a week.
   Chronic drinking (will include some people in the above two categories) is
     another term used for sustained drinking which is causing, or likely to lead to,
     harm.
   Dependent drinking or alcohol dependence (also referred to as alcoholism)
     can be diagnosed on the basis of three or more of the following features
     related to alcohol consumption occurring together in the past year (WHO
     1992:
      Strong desire or compulsion to drink.
      Difficulty in controlling consumption, in particular the onset, termination or
         level of use.
      A physiological withdrawal state after drinking has ceased or been reduced
         (e.g. tremor, sweating, palpitations, insomnia), or drinking to avoid
         withdrawal.
      Evidence of tolerance to alcohol, such that increased doses are required to
         achieve the same level of effect.
      Progressive neglect of alternative pastimes because of drinking, and
         increased amounts of time spent drinking or recovering from the effects of
         drinking.
      Persistent drinking despite awareness of harmful consequences.
SESSIONAL DRINKING:
   Binge drinking - commonly used to refer to drinking to get drunk or when
     drunk. Sometimes used to refer to drinking more than five drinks in one
     session (children under 18), or drinking more than six units (women)/ eight
     units (men) in one sitting.

PREGNANT WOMEN AND THOSE TRYING-TO-CONCEIVE.
Pregnant women and women trying to conceive should avoid drinking alcohol: if they
do choose to drink, to protect the baby they should not drink more than 1-2 units of
alcohol once or twice a week, and should not get drunk. (SSS 2007).

DRINKING BY YOUNG PEOPLE UNDER 18 YEARS OF AGE
The Government does not as yet (December 2008) issue guidelines regarding safe
drinking levels for under-18s. It is known that any toxin has a greater impact on an
immature body than a fully developed one, and thus drinking by under-18s is
discouraged, and it is illegal to sell alcohol to this age group. The Government‟s
current position , stated in the “Youth Alcohol Action Plan “ (Cm 7387, June 2008) is
that “whilst not all drinking by young people is of concern, some drinking by young
people could put their health at risk and some is clearly unacceptable.” Clearly those
under 18s who do drink and intend to continue doing so are best advises to drink
below the adult recommended limits for their gender, and the younger they are, the
less they should drink. Evidence from longitudinal research studies in the USA has
demonstrated a correlation between earlier onset of drinking, and the subsequent
development of alcohol dependency.(Grucza R et al, summarised in “Alcohol
dependence often the result of drinking at an early age”


Alcohol/Strategies/Bradford as at 17.12.08                                          11
www.medicalnewstoday.com/articles/109423.php ). However, there is also evidence
that gradually introducing children to alcohol in the home is a protective factor against
binge drinking (Hughes, Bellis et al ”Risky drinking in North West school children and
its consequences: a study of fifteen and sixteen year olds”, Centre for Public Health,
Liverpool John Moores University, March 2008

RISKS POSED BY EXCESS CONSUMPTION OF ALCOHOL ON LONG-TERM
HEALTH
Drinking regularly over the recommended limits increases health risks over the long
term. Even consumption slightly above guideline levels for lower-risk drinking
contributes to significant numbers of deaths.
Men and women who drink over double the recommended limits increase their
chances of contracting the illnesses in the table below by the multiples shown
compared with people who drink below the limits. For example, both men and women
are 13 times more likely to suffer alcoholic liver disease.
Illness Men Women
Alcoholic liver disease 13.0 13.0
Mouth cancer 5.4 5.4
Larynx cancer 4.9 4.9
Oesophagus cancer 4.4 4.4
Liver cancer 3.6 3.6
Stroke 1.8 4.3
Hypertension 4.0 2.0
Irregular heartbeat 2.2 2.2
Coronary heart disease 1.7 1.3
Stomach (colon and rectum) cancer 1.7 1.7
Female breast cancer n/a 1.6


                   14




                   12




                   10




                    8




                    6

                                                                                                                                                                                                                                                 Men
                                                                                                                                                                                                                                                 Women
                    4




                    2




                    0
                                                                                                                                                                                              Stomach, Colon and Rectal
                                                                                                                                                                     Coronary Heart Disease




                                                                                                                                                                                                                          Female Breast Cancer
                                                                                                                                              Irregular Heart Beat
                                                    Mouth Cancer




                                                                                   Oesophagus Cancer




                                                                                                                      Stroke


                                                                                                                               Hypertension
                                                                                                       Liver Cancer
                                                                   Larynx Cancer
                          Alcoholic Liver Disease




                                                                                                                                                                                                      Cancer




People who drink more heavily face even higher risks of these illnesses
In the UK, most of the people who will die because of their drinking are not
alcoholics. Instead, they are drinkers whose habit of regular drinking over a number
of years has contributed to the damage to their health and the shortening of their




Alcohol/Strategies/Bradford as at 17.12.08                                                                                                                                                                                                               12
lives. Many of these people suffer few immediate consequences of their drinking, but
cumulatively it takes its toll.

MIXING ALCOHOL AND ENERGY DRINKS
Recent research in Australia has discovered that mixing alcohol with energy drinks
can double people‟s chances of being hurt or injured after drinking, needing medical
attention, and travelling with a drunk driver (Australian Drug Foundation, 2008,
www.adf.org.au )

HEALTH BENEFITS FROM MODEST DRINKING OF ALCOHOL
Some people drink alcohol as a relexant or de-stresser, and others as a confidence-
booster in social situations; provided sensible drinking levels are observed, these
uses of alcohol can be seen as a health benefit.

Various studies have shown that moderate drinking of red wine can protect against
heart disease. A recent study in Canada by Floras et al, published in the American
Journal of Physiology, Heart and Circulatory Physiology, showed that the health
benefits of red wine are lost after one small glass, as two glasses increased heart
rate and reduced the ability of the arteries to expand. (Non-alcoholic red grape juice
also offers such protection, thanks to resvetatrol, a strong anti-oxidant found in the
skin of grapes.)

There is evidence that drinking more than five alcoholic drinks every week can
reduce the risk of developing rheumatoid arthritis by 40-50% compared to those
drinking less per week. (Kallberg H: Annals of the Rheumatic Diseases, 2008,
reported in the Daily Telegraph, 5.6.08).

PRICE
Alcoholic drinks are available at historically low real prices, and the decline in real
prices since the 1970s correlates with increases in consumption and the increase in
liver disease. In 1947, a bottle of whisky cost the equivalent of £50 today (Ben
Bradshaw MP, Minister of State, Department of Health, House of Commons
Hansard, 6.12.07)




Alcohol/Strategies/Bradford as at 17.12.08                                            13
The graph below shows the price-consumption correlation very clearly:




(source: Bradford Council Health Improvement Committee report)

Since about 1990, there has been a large movement of sale from pubs to
supermarkets, driven by ever more aggressive pricing policies.

Like all businesses, the on-licensed trade is continually looking at new ways of
increasing its profits. In a climate of increasing off-sales of heavily discounted drinks
in supermarkets and of-licences, and a decline in pub sales, that is not surprising.
Many initiatives to increase pub sales have been welcome, such as the increasing
number selling meals and coffees, the offering of guest beers, the hosting of
promotional events such as quizzes and live music, the provision of newspapers and
the increase in comfortable seating. However, other initiatives have been detrimental
to both health and community safety, and are mostly to be found in city and town
centre pubs, many of which qualify of the description of “vertical drinking
establishment” – in other words , venues with limit seating and which attract a lot of
standing customers on weekend evenings. These include promotional price offers (“2
for the price of 1”; “doubles for the price of singles”; and “all you can drink for £10”)..
These offers have declined somewhat in recent years due to increasing criticism that
they encourage binge drinking and threats of legal or legislative action. They have
been partially replaced by low special offer prices on a small range of heavily
advertised brands. However, perhaps the most insidious detrimental marketing
practice has been the disappearance of 125ml wine glasses from many pubs and
restaurants, with a recent survey showing that only 16% consider it their normal size;
the medium size 175ml glass is now called a standard glass by 73% of outlets, whilst
14% of licensed premises now only offer wine in 250ml glasses. (The Publican
magazine, quoted 14.04.08 www.davidclarkwired.blogspot.com ). Given that such a
glass contains more than 3 units of alcohol, which is enough to significantly impair
people‟s driving ability, and is the maximum daily recommended limit for a woman,


Alcohol/Strategies/Bradford as at 17.12.08                                              14
this is highly irresponsible. The 125 ml glass should forthwith resume its rightful place
as the standard pub or restaurant measure.

At the same time, a combination of factors has led to rapid increases in the price of
drinks, especially traditional beers, in traditional pubs. This, together with a number of
social factors, has resulted in many closures of this type of pub, with a consequent
negative impact on community life in many communities. Examples of the social
factors affecting rural pubs include the change in culture towards drink-driving, and
the increase in property prices which has led to pubs in desirable residential locations
being converted to homes; other factors, such as the increasing popularity of home
entertainment and the smoking ban appear to have hit the traditional urban working
class pub the hardest.

In contrast, there has been an increasing volume of sales through supermarkets
whose prices for popular brands are so low that they are sometimes below cost price;
there has been wide availability, especially in discount stores, of very strong cider at
less than £2 for 2 litres (approximately 18 units when 7.5% proof – and there have
been 3 litres for the price of 2 offers –about 27 units for £2); and changes in licensing
law have enabled off-sales of alcoholic drinks over a much wider time band, in some
cases 24 hours.

Another phenomenon which began in the 1990s was the availability of cheap alcohol
imported from France and Belgium, stereotypically by “white van man”. This
exploitation of the rules of the single market with very generous allowances for
personal consumption led to cheap drinks, especially lager, being illegally sold from
the backs of vans, from private houses and in some cases in pubs, usually in the
poorer areas of towns and cities. This probably kick-started the rapid rise of teenage
street drinking and associated anti-social behaviour which has plagued parts of our
district since the 1990s. The availability of very cheap alcohol through legal outlets in
recent years has reduced the extent of illegal importation.

The cheapness of alcoholic drinks has not just been a problem in fuelling binge
drinking and anti-social behaviour, but has also contributed to the increase in
hazardous drinking at home amongst people labelled in the media as “middle class
wine drinkers”, but this group people in all social classes, typically couples, who
share a bottle of decent quality wine purchased for under £5 most or every evening.
Such wine is now typically 13% proof, meaning half a bottle contains approximately
4.5 units – a woman would use up her weekly recommended allowance in three
evenings, a man in four and a half.


Some examples of how cheap or expensive it is to misuse alcohol are shown
below:
THE DAILY WINE DRINKER
Supermarkets promote wine at very low prices e.g. LIDL recently offered six different
types of red wine for £2.79 a bottle; their ABV ranged from a Californian Ruby
Cabernet at 13% to a South African Shiraz Cabernet Sauvignon at no less than
14.5% (approximately 11.5 units a bottle, equivalent to 24 pence a unit). Two people
sharing a bottle a night of even the 13% proof variety would consume 68 units a
week between them, the borderline for higher risk drinking for a woman, at a cost of


Alcohol/Strategies/Bradford as at 17.12.08                                             15
under £10 each. With two dry nights a week, each would still be drinking 24 units a
week, which is 70% above the maximum recommended number of units a week for a
woman i.e. 14 units, and slightly above the maximum recommended level for a man.
A very drinkable bottle of wine can be bought for £4 -£5 in a supermarket, so a
couple can drink hazardously at home for about £15 a week each, or less if cheaper
wine is purchased. If the wine purchased is 13.5% or 14% proof, then the health risk
is increased. Recent research by the Joseph Rowntree Foundation has shown that
many people whose home consumption far exceeded recommended weekly limits
regard their own drinking practices as unremarkable (“Drinking Places: Where people
drink and why” Valentine G et al, JRF, 2008. )This is why the government is to run a
social marketing campaign targeting those who drink harmfully, and characterised in
press reports as “middle-class wine drinkers”.

UNDER-AGE LAGER DRINKERS
One supermarket (LIDL 25.1.08) was selling a four-pack of 500ml cans of lager with
4.1% ABV for £2.29, equivalent to £1.145 per litre, or about 25p per unit of alcohol.
Four cans contain some 8 units of alcohol and thus underage drinkers can intoxicate
themselves very cheaply. White cider and vary strong (7.5 – 9% ABV) lagers are
cheaper still.

THE WHITE CIDER DRINKER
A bottle of 7.5% proof white cider in a discount supermarket costs around £1.99. It
contains about 15 units of alcohol, making the price of a unit of alcohol about 13p.
The weekly adult male harmful threshold of 50 units costs under £8, and the weekly
adult female high risk threshold of 35 units costs only £4.55. White cider is thus a
great favourite of street drinkers, but of even greater concern is how easily and
cheaply a group of teenagers sharing a bottle or two can get drunk, and possibly
poison themselves. Promotional bottles containing 3 litres for the price of two have
been sold – that‟s under 9p per unit of alcohol.

THE REAL ALE DRINKER
Drinking good beer in a pub is in a different price class to supermarket white cider. A
pint of real ale in a pub costs £2 - £3. It typically has an ABV of 3.8% to 4.5%. In
other words, a unit of alcohol costs £1 - £1.20, thus a man would spend around £21 -
£25 a week to drink the maximum recommended 21 units; drinking harmfully (50
units) would cost would cost £50 - £60, and for a woman £35 - £42.


TREATMENT
People seeking treatment for alcohol misuse problems should first see their GP.
Alternatively, drop-in services are available at the Lifeline Piccadilly Project in
Bradford city centre, and a t project 6 in Keighley town centre. A full list of treatment
providers can be seen at :
http://www.substancemisuse.bradford.nhs.uk/Pages/ServiceTypes.aspx
Some providers listed can only help people whose principal substance misuse
problem is related to their use of illegal drugs.




Alcohol/Strategies/Bradford as at 17.12.08                                            16
            CHAPTER 2: GOVERNMENT POLICY
WHAT THE GOVERNMENT IS PLANNING TO DO. “SAFE. SENSIBLE. SOCIAL”
- THE NATIONAL ALCOHOL STRATEGY

The first Alcohol Harm Reduction Strategy for England was published in 2004, and is
divided into four areas:
     Better education and communication
     Improving health and treatment services
     Combating alcohol-related crime and disorder
     Working with the alcohol industry

In June 2007, the Government published “Safe. Sensible. Social. The next steps in
the National Alcohol Strategy” (hereafter referred to as SSS 2007). It builds on the
foundations laid and the lessons learnt since 2004.

Since 2004, although nationally levels of violent crime have fallen, and alcohol
consumption has ceased to rise, public concern about the harm caused by alcohol
has risen. The incidence of liver disease, and deaths caused by excessive drinking,
have both continued to increase. Public opinion surveys have shown that most
people think that the root of the problem lies in the British drinking culture and that
many people are too willing to tolerate drunkenness and anti-social behaviour as an
accepted way of life.

The Government states that the purpose of SSS is to deliver three things:
        “First, to ensure that the laws and licensing powers we have introduced to tackle
        alcohol-fuelled crime and disorder, protect young people and bear down on
        irresponsibly managed premises are being used widely and effectively.

          Secondly, to sharpen our focus on the minority of drinkers who cause or
          experience the most harm to themselves, their communities and their families.
          These are:
          • young people under 18 who drink alcohol, many of whom we now know are
            drinking more than their counterparts did a decade ago; and
          • 18–24-year-old binge drinkers, a minority of whom are responsible for the
            majority of alcohol-related crime and disorder in the night-time economy;
          • harmful drinkers, many of whom don‟t realise that their drinking patterns
            damage their physical and mental health and may be causing substantial
            harm to others.

          Finally, we all need to work together to shape an environment that actively
          promotes sensible drinking, through investment in better information and
          communications, and by drawing on the skills and commitment of all those
          already working together to reduce the harm alcohol can cause, including the
          police, local authorities, prison and probation staff, the NHS, voluntary
          organisations, the alcohol industry, the wider business community, the media
          and, of course, local communities themselves. Together, we need a clear and
          focused programme of action that will meet our shared, long-term goal:



Alcohol/Strategies/Bradford as at 17.12.08                                                  17
        To minimise the health harms, violence and antisocial behaviour associated
        with alcohol, while ensuring that people are able to enjoy alcohol safely and
        responsibly.
         We will use regular national and local data on alcohol-related
        crime and ill health to track progress against our goals and to identify where
        more effort is needed in the future.

        Next steps, a call to action:
        • Sharpened criminal justice for drunken behaviour – The criminal justice
          system will be used to bear down on those committing crime and antisocial
          behaviour when drunk. Points of intervention will be introduced following
          arrest, through conditional caution and through disposal. Offenders will be
          given the facts about unsafe drinking and its link to criminal behaviour. They
          will be offered advice, support and treatment where appropriate. And we will
          explore ways to make them pay for these interventions.

        • A review of NHS alcohol spending – A root-and branch stocktake of the
          burden of alcohol-related harm on NHS resources will be carried out to
          inform smarter spending decisions, driving local investment in prevention
          and treatment while delivering better health and saving the NHS money.

        • More help for people who want to drink less – Many people who reduce their
          drinking to within sensible limits don‟t need or want professional help, but
          there are many people who would like more support. We will develop and
          promote sources of help for people who want to drink less, including
          telephone helplines, interactive websites and support groups.

        • Toughened enforcement of underage sales – Successive enforcement
          campaigns have made it harder for under-18s to buy alcohol. Since 2004, the
          national test-purchase failure rate has fallen from around 50% to around
          20%. Now, local authorities and the police have more powers to prosecute
          and even close premises that persistently sell alcohol to children.

        • Trusted guidance for parents and young people – Many young people drink
          alcohol that has been bought for them by adults at home or in public places –
          with or without the approval or knowledge of their parents. To help young
          people and their parents make informed decisions about drinking, the
          Government will provide authoritative, accessible guidance about what is and
          what is not safe and sensible in the light of the latest available evidence from
          the UK and abroad.

        • Public information campaigns to promote a new sensible drinking culture – A
          new generation of publicity campaigns will mark a paradigm shift in the
          ambition and impact of public information about alcohol. The „Know Your
          Limits‟ campaign will continue to develop and expand, acting as a call to
          action to promote sensible drinking and highlighting the physical and criminal
          harm related to alcohol misuse.

        • Public consultation on alcohol pricing and promotion – Does alcohol pricing
          and promotion cause people to drink more? An independent review of the
          evidence, followed by a consultation beginning next year, will enable us to
         explore the relationship between promotional activity and harmful
         consumption, particularly among young people.

        • Local alcohol strategies – Local communities are best placed to tackle local


Alcohol/Strategies/Bradford as at 17.12.08                                                   18
          problems, including alcohol-related disorder. By April 2008, all Crime and
          Disorder Reduction Partnerships (CDRPs) – comprising the police, local
          authorities, police authorities, fire and rescue authorities and primary care
          trusts in England, and civil society organisations – will be required by law to
          have a strategy to tackle crime, disorder and substance misuse (including
          alcohol-related disorder and misuse) in their area. “



YOUTH ALCOHOL ACTION PLAN
The Government‟s “Youth Alcohol Action Plan”, subtitled “A commitment from The
Children‟s Plan” was published in June 2008 by three Departments of State – the
Department for Children, Schools and Families, the Home Office, and the
Department of Health (Cm 7387). The plan reviews the evidence about young
people‟s drinking, and states that the government will focus on five priorities:
   Stepping up enforcement activity to address young people drinking in public
   Taking action with industry on young people and alcohol
   Developing a new national consensus on young peple and drinking
   Establishing a new partnership with parents on teenage drinking
   Supporting young people to make sensible decisions about alcohol

The Plan contains, at Annex A, a summary of actions being undertaken by
Government.


LICENSING ACT 2003

The Licensing Act 2003 came into force on 24th November 2005. It has four
fundamental objectives:
 The prevention of crime & disorder.
 Public safety.
 The prevention of public nuisance.
 The protection of children from harm.

Its measures include:-
 Responsibility for licensing moved from magistrates to LAs, which are required
    every three years to publish a statement of policy outlining how they will promote
    the licensing objectives.
   Renewal of licensing structures to allow 24-hour sale of alcohol. However, only
    2% of the UK‟s licensed premises have 24 hour licences, and 98% of these
    (approx 2880 premises) are hotels, supermarkets and convenience stores
    (DCMS, quoted by Baroness Coussins, House of Lords Hansard, 6.12.07.)
    Bradford has a below par number of 24 hour licenses (12 as at 31.1.08); of
    these, 8 are for supermarkets, 3 for filling stations, and one for a mail order
    company.
   Police & Courts have the power to make temporary closure orders in respect of
    premises where there is, or is likely imminently to be, disorder on or in the vicinity
    of those premises, or where a public nuisance is being caused by noise.




Alcohol/Strategies/Bradford as at 17.12.08                                                  19
   Applicants for premises‟ licences are expected to have regard to the Authority‟s
    Statement of Licensing Policy and produce an operating plan, describing the
    steps they intend to take to promote the four licensing objectives.
   Revised guidance to local authorities was issued under section 182 of the Act on
    28.6.07. Bradford‟s revised Statement of Licensing Policy for 2008-2011 was
    adopted by the Council on 11.12.07. Amongst its provisions are:
       o The prevention of crime and disorder
       o Public safety
       o The prevention of public nuisance
       o The protection of children from harm
       o Licensing hours
       o A partnership and multi-disciplinary approach.

There is a detailed section concerning prime entertainment areas, which applies
particularly to clubs. The provisions embrace:
        o Age restriction (no under 18s)
        o Drugs prevention (premises and manager to be covered by Drugwatch
            scheme)
        o First aid provision
        o Safety measures
        o Air conditioning and ventilation
        o Prevention of overheating
        o Availability of drinking water
        o Security cameras
        o Staff training
        o Transportation issues

It is the council‟s view that it is necessary to restrict the number of licenses in any
part of the district on grounds of cumulative impact or saturation, but the council does
not adopt a quota system. Consideration will be based on the individual
characteristics of premises and to the likely impact on the local community.

Nationally, there is disagreement as to whether the Licensing Act has had an
adverse impact. Research in 2008 (“Licensing Act 2003 and the effects of alcohol”,
TNS UK for LGA, June 2008) amongst 51 local authorities (LAs), 49 NHS primary
care trusts (PCTs) and 20 police authorities (PAs) revealed different perceptions of
the Act‟s impact. 29% of PCT respondents perceive an increase in alcohol related
incidents, compared to 10% of PAs and 4% of LAs, whilst 86% of PCTs felt that it
had increased pressure on resources (43% said that it had increased pressure on
A&E, 21% considered that it had spread problems over a wider time frame, and 21%
that it had increased pressure on ambulances). 94% of LAs felt that their resources
were now more stretched and would like it implemented on a full cost recovery basis.
59% of Police Authorities reported that incidents are happening later, and 10% said
that the Act had stretched resources.




Alcohol/Strategies/Bradford as at 17.12.08                                           20
             CHAPTER 3: WORKING TOGETHER

PARTNERSHIP WORKING
In Bradford, alcohol very clearly comes within the remit of the action partnerships
within the LSP (Bradford District Partnership) structure. Tackling alcohol related
issues is led by the Safer Communities Partnership, but alcohol is a cross-cutting
issue and the other three strategic partnerships within the Bradford District
Partnership also have an interest in alcohol issues.

The Strategic Health Partnership has designated alcohol misuse as one of its priority
areas, and funding has been made available to train a wide range of NHS and other
staff in brief interventions.

BSCP (Bradford Safer Communities Partnership) has led the development of this
strategy because of its concern about the links between alcohol and violent crime
and alcohol and road accidents. BSCP has funded social marketing campaigns to
tackle binge-drinking, and a young person‟s alcohol worker, and part funds the
Piccadilly Project. The Joint Commission Group (JCG) of the BSCP oversees PCT
and partnership funding.



LOCAL AREA AGREEMENT 2008-2011
The Bradford Local Area Agreement (BDLAA) is the key agreement between the
Local Strategic Partnership and central government for the delivery of performance
improvement across the district. The BDLAA contains 35 national indicators which
Bradford LSP and Government Office have agreed are the key indicators for
improvement in Bradford. These include the following indicators which are central or
very relevant to this alcohol strategy:
    NI 20 Assault with injury crime rate (proxy for alcohol related violent
       offences)
    NI 17 Perceptions of anti-social behaviour.
    NI 115 Substance misuse by young people.
    NI 48 Children (under 16) killed or seriously injured in road traffic accidents
    NI 49 Number of primary fires, and related fatal and non-fatal casualties.
    NI 112 Under-18 conception rate.

However, there are a further 163 national indicators, and all will be monitored by the
council as part of the new Comprehensive Area Assessment, which will replace the
Comprehensive Performance Assessment. These include the following which are
central to this alcohol strategy:
    NI 39 Alcohol-harm related hospital admission rates (This is the first ever
       national commitment to monitor how the NHS is tackling harm caused by
       alcohol)


Alcohol/Strategies/Bradford as at 17.12.08                                            21
       NI 41 Perception of drinking or rowdy behaviour as a problem.
       NI 32 Repeat incidents of domestic violence
       NI 47 People killed or seriously injured in road traffic accidents
       NIs 21, 22, 24, 25 relating to anti-social behaviour.

Formulae and targets for pertinent LAA indicators and the two alcohol-specific
National Indicators include the following:
    NI 20 Number of recorded “assaults with less serious injury”/total population x
      1000. Bradford target: Reduction from 7.96 per 100k in 2007-8 to 7.75 in
      2008-9, 7.53 in 2009-10 and 7.32 in 2010-11.
    NI 48 Percentage change in the number of children under 16 killed or
      seriously injured during the calendar year compared to the previous year, but
      based on a three-year rolling average. Bradford target: 45 casualties in 2008-
      9, dropping to 32 in 2010 -11. (Alcohol seems to play a part in very few of
      these cases; the exceptions being young teenagers under the influence who
      steal a car and crash it).
    NI 115 Designed to measure progress in the proportion of young people
      frequently misusing substances. Bradford target: no target has yet been set
      because of methodological problems in establishing a baseline, as robust data
      is not available.
    NI 39 Number of alcohol related admissions per 100,000 population, derived
      from an agreed methodology.
    The perceptions indicators (NI17 and NI 41) will be measured as part of the
      new Place Survey which all local authorities are required to do at least every
      two years from 2008, but can be done wholly or partially every year.

Alcohol Concern has identified a further 29 targets which link to alcohol misuse
(Factsheet, Local Area Agreements, December 2007, Alcohol Concern).This is in
one of three ways.
     achievement of the target may impact on the level of alcohol misuse and
        alcohol related harm (e.g. NI 110, young people‟s participation in positive
        activities)
    a reduction in alcohol misuse may help achieve the target (e.g. NI 152,
       number of working age people on out-of-work benefits)
    providing support to existing or recovering alcohol misusers to help towards a
       person‟s recovery (e.g. NI 142, number of vulnerable people who are
       supported to maintain independent living).


LINKS TO OTHER KEY STRATEGIES
  Alcohol misuse cuts across national, regional and local strategies. Addressing
  alcohol misuse will not only be dependent on this strategy but also the delivery of
  other strategies and plans. Addressing alcohol misuse will help to achieve targets in
  these strategies and plans. As the coordinating body under the Safer Communities
  Executive, it will be important for the Alcohol Strategy Implementation Group to be
  kept aware of developments which impact on the delivery of the Alcohol harm
  Reduction Strategy for Bradford district.




Alcohol/Strategies/Bradford as at 17.12.08                                          22
                                 Safe, Sensible & Social. The next steps in the National Alcohol Strategy

         Choosing Health White             Dual Diagnosis Good               Every Child Matters             Crime Strategy
                Paper                        Practice Guide

                                                                            Young People 10 year         Respect Action Plan

                                                                                   strategy
                                                                                                            Probation Alcohol
                                                                                                                Strategy

                                                                                                            Prisoners Alcohol
                                                                                                                 Strategy
                                                Bradford‟s Community Strategy

                                                         Local Area Agreement

                                                         Local Alcohol Strategy


        Education and                      Treatment and                  Young Persons and            Crime and Disorder
      Prevention Theme                      Care Theme                      Family Theme                    Theme


    Valuing Older People Plan            Joint Commissioning             Young Person Substance       Crime & Disorder Reduction
                                                Strategy                      Misuse Plan                      Strategy

     Health Improvement Plan
                                            Carers Strategy              Children & Young Person      Domestic Abuse Strategy
                                                                                   Plan
      Sexual Health Strategy
                                         Mental Health Strategy                                     Reducing Re-offending Plan
                                                                            Parenting Strategy
                                           Supporting People                                                 Respect Plan
                                                 Plan                       Hidden Harm Plan
                                                                                                            Licensing Policy
                                           PCT local delivery
                                                 plans
                                                                                                      Tackling Alcohol-Related
                                                                                                         Crime Action Plan




Health Improvement Committee‟s recommendations
HEALTH IMPROVEMENT COMMITTEE REPORT:
“ALCOHOL AS A HEALTH ISSUE”, OCTOBER 2008.

Bradford Council‟s Health Improvement Committee examined “Alcohol as a health
issue “in 2007-8, adopted its recommendations on 10 April 2008, and published them
on 3 October 2008. Most of the committee‟s recommendations were already
contained within the strategy; those that were not have subsequently been
incorporated. The recommendations are:

Their report stated that the Committee believes that the negative/destructive impact
of alcohol on health and family life is an issue that requires attention and action from
a range of organisations and as such it welcomes the districts' forthcoming alcohol
harm reduction strategy, and will monitor the implementation and effectiveness of the
Strategy.

The Committee made the following recommendations:
IMPROVED EDUCATION IN SCHOOLS



Alcohol/Strategies/Bradford as at 17.12.08                                                                           23
We commend the work of the Life Caravan in educating children on alcohol in the wider
context of health education and recommend that it should be available free of charge to all
primary schools.

IMPROVED INFORMATION FOR POLICY MAKERS
There was not enough evidence to come to any conclusions about a number of issues and
the Committee recommends it consider in its work planning considerations for 08/09 the
following:
(a) alcohol use and harm by and older people
(b) alcohol use and harm in the Asian communities.
the question of what evidence there is in relation to the often stated view that “the majority of
people are drinking sensibly”.

IMPROVED INFORMATION FOR HEALTH PROFESSIONALS
The committee recommends the creation of a Bradford & District Alcohol Information
Service (web and telephone based) which would serve as a hub for the collection and
dissemination of information on the harmful effects of alcohol, the availability of suitable
treatment, and the funding for such treatment.

We recognise the value of the information about alcohol treatment and support in the District
provided at www.nhs/uk/alcohol, and encourage all relevant organisations to publicise this
link.

The Committee recommends that the Council and its partners work to ensure that clear
information is provided to the public on the potential harmful effects of alcohol, with particular
emphasis on the following:
     Specific health risks for women
     What units / harmful levels/hazardous levels actually mean in relation to day to day
       drinking
     Information on the growing incidence of alcohol related liver disease
     Targeted information for “at risk groups” such as young people and middle aged
       drinkers.
     Encouraging people to seek help at an early stage.


EARLY INTERVENTION
The Committee commends the development of further involvement of dentists and doctors in
screening for alcohol related diseases; the training in “brief interventions” that is being made
available for health professional and others; and in particular requests that all doctors and
dentists be involved and trained in the near future.

TREATMENT
The committee commends the work being undertaken by all the organisations and agencies
in relation to support and treatment and given that there is clearly a lack of capacity and
availability in some areas of alcohol support and treatment, the Committee requests:
(a) that relevant commissioners work with existing providers of treatment and support to
ensure adequate core funding and
(b) further information from the relevant commissioners about the gaps in provision and what
needs to be done to ensure that appropriate and adequate provision is available.

STREET ANGELS
The Committee commends the work of Street Angels in addressing some of the immediate
harms caused by binge drinking and recommends increased partnership involvement and
support.



Alcohol/Strategies/Bradford as at 17.12.08                                                     24
BRADFORD COUNCIL EMPLOYEE ALCOHOL POLICY
The Committee welcomes the Council‟s forthcoming Employee Alcohol Policy and requests
that it be presented to the Corporate Improvement Committee before it is completed and
submitted to the Executive.

SUPERMARKETS
The Committee commends the clear alcohol unit labelling on bottles where it already exists
and recommends:
(a) that other major retailers and wine producers adopt similar clear labelling and (b) that
the Government encourages such an approach.

PUBS AND CLUBS
The Committee requests all licensed premises in Bradford district to provide zero and low
alcohol drinks and reasonably priced soft drinks.
The Committee recommends that the Council and the tPCT work with relevant retailers and
licensed premises to promote sensible drinking

LICENSING
The committee recommends that more should be carried out to prevent young people under
18 from obtaining alcohol, with a particular focus on licensing enforcement.

PRICING
The Committee recommends that the Government:
(a) tax alcohol relative to its strength and
(b) amend the 2003 Licensing Act to include considerations of public health.




Alcohol/Strategies/Bradford as at 17.12.08                                                 25
                CHAPTER 4:
   THE SCALE OF ALCOHOL USE, MISUSE AND
        RELATED HARM – A SUMMARY

THE NATIONAL PICTURE




   Figure 1. Summary of alcohol measures illustrated in the various sections of the
   Association of Public Health Observatories report “Alcohol” (APHO 2007). Figures
   here are annual totals for England attributable to alcohol (unless stated).




Alcohol/Strategies/Bradford as at 17.12.08                                      26
COST OF ALCOHOL-RELATED HARM: ENGLAND
(Government Strategy Unit, interim Analytical Report, 2003)




The current annual cost to the NHS has since been revised upwards to £2.7 billion,
following a refining of the methodology, and after allowing for inflation.
(“The cost of alcohol harm to the NHS in England”. July 2008. Health improvement
Analytical Team. DH)




Alcohol/Strategies/Bradford as at 17.12.08                                       27
COST OF ALCOHOL-RELATED HARM: YORKSHIRE AND THE HUMBER
(based on 2003 Government Strategy Unit figures)


      Alcohol-related harm                   Yorkshire & the Humber          Bradford pro rata
                                                                                (approx.)
                                                      £m                           £m

NHS cost of alcohol-related                          270*                           25*
harm (2008 figures*)

Drink driving                                         50                             5

Criminal justice system                               180                           18

Cost of services as a                                 350                           33
consequence of alcohol-related
crime

Cost of anticipation of alcohol-                      150                           14
related crime

Cost of alcohol-related lost                        170-210                        16-20
working days

Cost to economy of alcohol-                         230-250                        22-24
related deaths

Alcohol-related absenteeism                         120-180                        11-17

Street drinkers                                       N/A                           N/A

Children affected by parental                         N/A                           N/A
alcohol problems

Source: “Our Region Our Health” – Y & H Regional Director of Public Health 2004. Based on Prime
Minister‟s Strategy Unit Alcohol Harm Reduction Project Interim Analytical Report. 2003. These figures
are 10% pro rata of the England figure. Bradford data are pro rata approximations, calculated by Nina
Smith. All these calculations exclude street drinkers; children affected by parental alcohol problems;
and the human cost of alcohol related crime. Costs will have increased since the base data was
calculated, and recent national data has improved the methodology. In particular, NHS costs for
England are now estimated at £2.7bn p.a.*, suggesting a cost to the NHS in the Bradford district of
about £25m p.a.*.




Alcohol/Strategies/Bradford as at 17.12.08                                                         28
                               The statistical scale of alcohol-related harm


                        Harm                                            Number of people
                                                         Yorkshire &                Bradford
                                                         the Humber                (pro rata)
Alcohol-related deaths due to acute incidents                  400-410                     38-40
Alcohol-related deaths due to chronic diseases              1,100-1,800                  105-170
Drink-driving deaths                                              53                          5
Arrests for drunk & disorderly                                  8,000                       760
Alcohol-related sexual assaults                                 1,900                       180
Alcohol-related domestic abuse                                  36,000                     3,400
Lost working days due to reduced employment                  1.5-2million                140-190k

Lost working days due to absenteeism                          1.1-1.7m                 100-160k
Number of street drinkers                                    500-2,000                  45-190
Child affected by parental alcohol problems               78,000-130,000             7,400-12,400

Source: “Our Region Our Health” – Y & H Regional Director of Public Health 2004.

Based on Prime Minister‟s Strategy Unit Alcohol Harm Reduction Project Interim Analytical Report.
2003.

Bradford data are pro rata approximations, calculated by Nina Smith, and have not been updated.




Alcohol/Strategies/Bradford as at 17.12.08                                                          29
                   CHAPTER 5:
     ALCOHOL USE, MISUSE, AND RELATED HARM
               AMONGST ADULTS
LIFESTYLE – NATIONAL
     A YouGov survey carried out to inform the Department of Health‟s Know
      Your Limits campaign found that half of 35-44 year olds and 44% of 45-54
      year olds rely on alcohol to unwind after a stressful day (Campbell D, The
      Observer, 18.5.08)
     A survey of 16-35 year olds in nine European cities, including Liverpool,
      revealed that a third of male respondents, and a quarter of females, drank to
      increase their chances of having sex (Bellis M et al 2008, quoted BBC News,
      9.5.08,)
     Research amongst 18-35 year olds in the West Midlands and the South West
      found that advertising campaigns by drinks manufacturers highlighting the
      fun nature of alcohol, had much more influence on young people than social
      marketing messages (Bengry-Howell A, University of Bath, quoted in the
      Observer 11.5.08)


LIFESTYLE - REGIONAL AND LOCAL
 In 2003, there were 8% off-licensed premises per 100,000 population in West
   Yorkshire (England 8.7) and 23.1 on-licensed premises (England 21.2). {Source:
   DCMS}
 In 2004, 43.1% of residents in Yorkshire and the Humber Region identified “going
   to the pub” as a hobby or interest, compared to 38.9% in 2001 (England
   33.2%/37.1%). {Source: Axciom National Lifestyle Survey}
 A survey in the former City PCT area in 2005 showed the most popular drinks
   were normal strength beer/lager/cider, and wine (33% each), followed by spirits
   (22%) and low-alcohol drinks (15%). Strong beers and RTDs (“Ready to Drinks”)
   were favoured by 4% each (DPH Report 2006).
 Y & H Region is second highest in England for the percentage of adults visiting a
   pub nine or more times in the evening in the last month, 2004/5-2005/6 (8.3%), a
   marginal increase over 2002/3, during which period the number of visits declined
   in all other regions. However, the percentage visiting nightclubs or discos in Y &
   H declined from 2.7% to 2.4%, with our region having the third greater number of
   visits. (APHO 2007, p. 87)




ALCOHOL PREVALENCE AND CONSUMPTION – ADULTS 2006.
Questions about alcohol use were asked in the General Household Survey (GHS),
carried out in 2006, published in 2008. Unless otherwise stated, information is for
England. (ref: Smoking and drinking among adults, 2006. Goddard E, ONS 2008).
THE NATIONAL PICTURE




Alcohol/Strategies/Bradford as at 17.12.08                                            30
       More men (71%) than women (56%) drank „last week‟. Both figures represent
        a small but significant decline since 1998.
       Amongst men, the over 45s were the group most likely to drink „last week‟;
        amongst women, it was the 45-64 age group
       62% of men and 76% of women drank on two days or less „last week‟, whilst
        12% of men and 7% of women drank every day.
       Amongst 16-24 years olds, 78% of men and 85% of women drank on two days
        or less, and only 4% of men and 1% of women drank every day
       There was a big decline between 1998 and 2006 in the number of 16-24 year
        old men (13 to 8%) and women (8 to 3%) drinking on five days or more each
        week.
       There was a significant decline between 1998 and 2006 in the number of men
        drinking more than 4 units on at least one day „last week‟ (39 to 33%) and
        more than 8 units (22 to 18%) using the former method of calculating units, but
        the new method of calculation shows that these drinking levels in 2006 were
        40% and 23%.
       Amongst women, the numbers exceeding 3/6 units a day remained stable
        using the old methodology, but the new method of calculating units shows that
        women‟s consumption had been seriously underestimated. 33% of women
        had drunk more than 3 units of alcohol on at least one day a week, and 15%
        had exceeded 6 units.
       25-44 year old men and 16-44 year old women are the age groups most likely
        to exceed the 8/6 and 4/3 limits.
       The over 65s are the age group most likely to drink daily (20% of men and
        15% of women), but they are easily the least likely to exceed recommended
        daily levels.
       Managerial and professional people are the occupational groups most likely to
        have had a drink „last week‟, and also to drink on 5 or more days. People in
        routine and manual occupations are the least likely to. These class differences
        also apply to the percentage of men and women exceeding the hazardous and
        harmful limits - differences that were not apparent using the old method of
        calculating units consumed. 24% of managerial and professional men, and
        17% of such women, are drinking at a hazardous level on at least one day a
        week, compared to 21% of men and 16% of women in routine manual
        occupations.
       The percentage of both men and women who drank last week increases with
        income, presumably reflecting differences in affordability. However, the three
        income categories above a household income of £600 per week were equally
        likely to drink at harmful levels, and approaching twice as likely as those in the
        two lowest income bands.
       Drinking is more frequent amongst the employed than the unemployed.
       Men and women of Pakistani and Bangladeshi origin are the ethnic group
        least likely to drink, and the majority of Indian, other Asian, and African women
        are also teetotal. The ethnic groups most likely to drink are white men and
        women, Caribbean and Chinese men and some groups of mixed race men
        and women. (ref: GHS 2005)
       Hazardous and harmful drinkers are most likely to be white or mixed race.
        40% of white British men drink hazardously and 23% harmfully amongst
        women, the figures are 23% and 10%. (ref: GHS 2005)



Alcohol/Strategies/Bradford as at 17.12.08                                             31
       Amongst men, small employers/own account workers have the highest
        consumption, but amongst women it is large employers and those in higher
        managerial posts. (GHS 2005).


YORKSHIRE AND HUMBER REGION
   Average weekly consumption for women is higher (11.2 units) in the Y&H
    region than in any other region (England 9.2 units); for men, Y&H is equal
    second highest at 21.4 units, compared to the England average of 18.9 units
   Yorkshire and the Humber Region is the region with the highest percentage of
    men who drink hazardously on at least one day a week (48%), and the second
    highest percentage who drink harmfully (29%). Amongst women, Y&H has the
    highest percentage drinking harmfully one day a week (23%) and shares the
    worst position for hazardous drinkers (40%).
   Using the previous methodology, Y&H‟s position amongst the nine English
    regions deteriorated significantly between 1998 and 2003. Amongst men, this
    reflects stabilisation, as the national average has improved; amongst women,
    there have been very significant increases, whilst the national picture has
    remained stable. The following table illustrates the change.

                     % drinking more than 4/3     % drinking more than 8/6
                     units a day                  units a day
                     1998          2005           1998          2005
England –            39            34             22            18
Men 16+
Y & H – Men          41                      42   25              25
16+
England –            21                      20   8               8
Women 16+
Y&H–                 19                      27   7               13
Women 16+



DRINKING: ADULTS‟ BEHAVIOUR AND KNOWLEDGE IN GREAT BRITAIN,
2006 (ONS 2008)

In 2006, the Office for National Statistics (ONS) carried out an omnibus survey of
2,474 adults aged 16 and over residing in Great Britain. The research looked at
knowledge and behaviour related to drinking alcoholic drinks. Some key findings
follow:
     The average man drinks more (18.6 units a week) than the average woman
        (9.9 units); this pattern is consistent for the 25-44 and 45-64 age groups. Over
        65s drink less, but the 16-24s drink significantly more – an average of 24.1
        units a week for men, and 13.0 for women.
     Normal strength beer, lager and cider are the source of the most units of
        alcohol a week for men (41%), and this is true for all age groups. The strong
        beer, lager and cider group is the second most popular source of units of
        alcohol for men aged 16-24 (31%), but consumption then declines rapidly.



Alcohol/Strategies/Bradford as at 17.12.08                                            32
        (Author‟s comment: This correlates with the binge drinking behaviour of the
        under 25s)
       Wine is by far the most popular drink amongst women, providing 57% of
        weekly units, followed by spirits (17%) However, amongst the 16-24 age
        group, spirits (26%) provide almost as many units as wine (32%), with strong
        beer, lager and cider providing a higher percentage of weekly units (9%) than
        for other age groups.
       Alcopops provide 18% of the unit alcohol consumpton of women aged 16-24,
        and 7% of equivalent men, but are otherwise of little importance to adults,
        clearly showing their appeal to young drinkers.
       These figures are compiled using the new method of measuring unit
        consumption introduced in 2007 to take account of the trend towards
        increasing the alcohol content of beer, lager, cider and wine, and the trend
        towards larger wine glasses. They show that the previous method of
        calculation underestimated women‟s unit consumption by twice as much as
        men‟s (46% compared to 22%), reflecting women‟s preference for wine.
       This new methodology also shows that a higher percentage of people are
        drinking at hazardous and harmful levels than previously thought; 27% of
        men (21% on the previous method), and 22% of women (compared to 14%).
        Of these, 7% of men and 6% of women are drinking harmfully (over 50/35
        units). Again, this demonstrates that the previous methodology was
        seriously underestimating women‟s alcohol consumption.
       The age group with the highest number of harmful level drinkers (over 8/6
        units on at least one day in the past week) was the 16-24 group (32% of men
        and 40% of women). Additionally, 17% of men and 9% of women aged 16-24
        drank hazardously at between 5/4 and 7/5 units on at least one day in the past
        week. More than one –third of both the 25-44 and 45-64 age groups were also
        drinking at these potentially harmful or hazardous levels on at least one day a
        week. There was steady increase between1997 and 2007 in the percentage of
        drinkers (now 69%) who had heard of daily benchmarks, with heavy drinkers
        being more knowledgeable about how many units there were in individual
        measures of particular types of drink. Spirit drinkers were more knowledgeable
        than beer and wine drinkers, with the figure for wine drinkers being
        complicated by confusion over glass sizes.
       Only 15% of drinkers kept a check on the number of units they had drunk. This
        ignorance about units has serious immediate (e.g. drink-driving) and longer-
        term (e.g. alcohol related disease) implications.
       Only 34% of men and 38% of women actually knew their daily benchmark was
        up to 4/3 units; ironically, those most knowledgeable about benchmarks were
        the most likelt to exceed them.
       15% of male drinkers and 9% of women drinkers had discussed drinking with
        a medical/health person in the past year, most often with a GP. The number
        increases with age, and with consumption. Although 19% of men who drink in
        excess of 21 units a week, and 8% of women who drink in excess of 14 units
        had had such discussions, most hazardous and harmful drinkers had not
        sought help, thus demonstrating the need for the wide availability of brief
        interventions.
       Supermarkets were the most common purchase point for alcohol in 2007,
        followed closely by bars and restaurants; off-licences have less than half the
        number of customer nominals. Women were significantly less likely than men


Alcohol/Strategies/Bradford as at 17.12.08                                          33
        to buy in a bar or in an off-licence, except that women aged 16-24 were as
        likely to buy in a bar as men (46% in last week).
       On their heaviest drinking day in the last week, the commonest venue for both
        men and women was at home, except amongst the 16-24 age group, half of
        whom were most likely to drink in a pub or bar. Harmful level drinkers (8/6
        units + per week) were the most likely to drink in a pub or bar, followed by
        drinking at home. The 16-24s were most likely to drink with 2-5 other people,
        and the 45+ age group with one other person. Solo drinking increased with
        age, (probably reflecting widowhood or divorce). Those who drank within
        recommended limits were most likely to drink with one other person (44%),
        whilst those drinking at harmful levels were more likely to drink with two or
        more people (77%). Men drinking at hazardous levels were most likely to drink
        in a group, but women drinking at these levels were evenly split between one
        companion and a group. Solo drinking was associated with moderate
        consumption.

    BRADFORD
     According to the North West Public Health Observatory, Bradford is the 70 th
      worst local authority area (out of 314) in England for binge drinking (8+ units
      for men/6+ for women, in one session). However, as around a quarter of the
      population under 25 are from Pakistani or Bangladeshi heritage backgrounds
      (and almost entirely Muslim), the level of binge drinking amongst other groups
      (mainly whites) is likely to be significantly higher than this statistic suggests.




Alcohol/Strategies/Bradford as at 17.12.08                                           34
                   CHAPTER 6:
      ALCOHOL USE, MISUSE AND RELATED HARM
       AMONGST CHILDREN AND YOUNG PEOPLE

   4,900 children under the age of 18 were admitted to NHS hospitals in 2006-7 with
    a primary diagnosis specifically related to alcohol; these included drunkenness,
    dependence, cirrhosis and acute alcohol poisoning. This represents 9% of all
    such NHS admissions. (“Statistics on Alcohol: England, 2008”, NHS Infomatics
    Centre)
   A survey of 9-11 year old primary school pupils (Life Education Children‟s
    National Survey, May 2008) showed that 54% of this young age group are aware
    that alcohol is harmful.
   Detailed research on secondary school pupils, and additional research on young
    people from deprived backgrounds illustrates, the scale of the drinking epidemic
    amongst a significant minority of under 18 year olds.
   A survey of alcohol use in 35 European countries (ESPAD Report 2003, cited in
    AHPO 2007 p144) shows that 23% of UK 15-16 year old boys and 15% of girls
    drank alcohol on more than 40 occasions in the previous year. In both cases, the
    UK was in the top (worse) quartile.
   It is estimated that the number of children affected by parental alcohol misuse
    is between 780,000-1.3 million nationally (Strategy Unit 2003) i.e. circa 11%. This
    would translate as some 7,500-12,500 in Bradford, but the fact that some one-
    third of under-16s are from Muslim families suggests the actual figure is more
    likely to be in the 5000-8000 range.
    In the November/December 2005 AMEC (Alcohol Misuse Enforcement
    Campaign), the number of tested outlets selling alcohol to under-18s was 17% of
    supermarkets, 20% for all of all off-licence premises and 29% for on-licence
    premises. These figures show a considerable decline from the comparable 2004
    campaign, when 32% of both off-premises and on-premises failed. Summer
    campaign failure rates have been higher: 45% of on-licence premises sold to
    minors in 2004 and 51% in 2005, with the corresponding figures for off-licence
    premises being 31% and 36% (H.O. Police Standards Unit, 2006).
   The number of under-18s admitted to hospital via A&E with alcohol-related
    conditions in 2006-7 was 8245, an increase of 30% over the 6,288 in 2000-1


Why do young people drink?
Research in S.E. England (Coleman and Carter, 2004) by individual interview with 64
young people aged 14-17 (96% from the two highest levels of multiple deprivation)
found the following influences:
       o Social facilitation - overcoming shyness and „pulling‟
       o Individual benefits - escapism/forget problems; “buzz” (everyone
          happy/having fun); something to do (overcoming boredom)
       o Social influences - peer pressure and guidance; respect and image (cool);
          under social influences - “kind of normal thing to do”


BRADFORD DISTRICT


Alcohol/Strategies/Bradford as at 17.12.08                                           35
   Bradford district has a much lower prevalence of alcohol use amongst children
    and adolescents than the England average, reflecting the large number of local
    young people who are Muslims. In 2007, 64% of 10 -15 year olds in Bradford had
    never had an alcoholic drink, compared to 42% in England. (TellUs2 survey,
    Ofsted, 2007)
   Of the 28% (approximately 13,000 children) admitting to have drunk alcohol in
    Bradford, some 2750 (6% of the age group) had been drunk on one or two
    occasions in the previous 4 weeks, and some 1350 (3% of the age group)
    admitted to having been drunk on 3 or more occasions during the period.
    This figure of 4100 is almost a third of those admitting to drinking alcohol, yet is
    likely to be an underestimate, as the survey only covered those attending school
    when the fieldwork was carried out. The comparable figure for England is 12% of
    the age group drunk on one or two occasions, and a further 7% drunk on three or
    more occasions in the previous four weeks. (TellUs2 survey, Ofsted, 2007)
   In 2008, 55.6% of schools in England have achieved the revised upgraded
    National Healthy Schools Programme standard, with 94.7% of schools
    participating. Following the implementation of a new programme of support and
    audit, Bradford figures have improved from 22% in 2005 to 60% in 2008 of
    schools having achieved the new NHSO standard, with 97% of school registered
    as working towards this. These figures reflect Bradford‟s rapid progress from a
    red “traffic light rated” authority to its current green status.
   In 2007-8, 188 young people under 18 were treated for substance misuse
    problems by specialist services in the Bradford district. Of these, 53 (28%) were
    treated for alcohol as their primary substance of misuse; 30 (16%) as their
    secondary substance; and 2 (1%) as their third substance of misuse.

YORKSHIRE AND HUMBER REGION
 In 2004/5, the Y & H rate of fixed-period drug or alcohol-related exclusions from
  schools per 100k pupils of 150 was slightly worse than the England average of
  146, but the rate of such permanent exclusions was the lowest (5.0, compared to
  an England average of 6.2). (APHO 2007, p83.)
 In 2002-6 in Yorkshire & Humber an average of 21.6% of Year 10 pupils and
  5.3% of Year 8 pupils drank seven or more units of alcohol in the previous seven
  days; the Year 10 figure is significantly more than the England figure of 19.0%.
  (ACPO 2007, p112, adapted from HRBQ, Schools Health Education Unit). In
  Bradford, it is probable that the overall figure may be less owing to the proportion
  of Muslim children in our schools, although the figure for non-Muslim children can
  be expected to be at least in line with the regional average, and possibly higher.
 Data from the North West of England (there is no similar data for Yorkshire &
  Humber) showed little difference between levels of deprivation in school locations
  in frequent drinking or binge-drinking amongst 15-16-year olds, but there was
  significantly more drinking in public places between schools in the 40% most
  deprived areas, and those in the 20% least deprived. AHPO p114).
 In 2006-07, 178 children under 14 living in the Yorkshire and Humber region were
  admitted to hospital either suffering from alcohol poisoning or being the victim of a
  drink related illness or accident (Information Centre for Health and Social Care,
  quoted by Rose D, The Times, 29.12.07)




Alcohol/Strategies/Bradford as at 17.12.08                                           36
DRINKING AMONGST YOUNG PEOPLE IN ENGLAND IN 2007.
The information in this section is taken from “Drug use, smoking and drinking
amongst young people in England in 2007 ( Fuller E (ed), The Health and Social
Care Information Centre, 2008) (www.ic.nhs.uk/websites/publications etc ). It should
be noted that this survey excludes children not in school when the fieldwork was
carried out, and are therefore highly likely to understate prevalence.

The proportion of school pupils who drank alcohol in the last week hit a high point in
2001 and has since declined. In 2007, 41% of 15 year olds so drank, as did 28% of
14 year olds, 17% of 13 year olds, and 7% of 12 year olds. These are no significant
differences by sex. (table 4.5)

The proportion of 11-15 year old pupils who have never had a drink increased from
38% in 1988 to a 47% in 2007. (table 4.4). 6% of all 11-15 year olds said they usually
drank alcohol at least twice a week (no age breakdown available) (table 4.7). The
equivalent survey in 2006, which was much more comprehensive, showed that
Saturday was the most popular drinking day, followed by Friday and Saturday. 8-
10% drank on one or more of Mondays to Thursdays. (Fuller E (ed), Smoking,
drinking and drug use amongst young people in England in 2006, Information Centre
for NCSR and NFER, 2007, table 3.11).


The level of alcohol consumption by children who drink is a real cause for concern.
The mean alcohol consumption of 14 and 15 year old pupils rose steeply between
1990 and 2000, and then went into a plateau; 2007 results using the earlier
methodology suggest a decline in the amount drunk compared to the previous few
years. One year‟s figure can never be taken to be either fully accurate or to show a
new trend, but the data gives cause for optimism that consumption levels may have
peaked. However, the new methodology (see below) reveals that the consumption
level is higher than was previously thought. There was a very worrying increase in
consumption during 2000-2006 of 83% amongst 11-13 year old girl past week
drinkers, and 43% amongst equivalent boys, but there is welcome news in that the
2007 data (old methodology) suggests a significant drop in actual consumption.
However, the corollary is that the 2000-2006 consumption figures are almost
certainly underestimates, as the survey‟s way of calculating a unit of alcohol has
remained constant since 1990, despite the increases since then in the ABV of many
beers, lagers, cider and wine.

Mean alcohol consumption (units, using previous methodology) by those who
had a drink in the last week, by age and gender. (table 4.8)
                 1992             2000             2006       2007
11-13 Boys       3.6              8.3              11.9       6.2
11-13 Girls      3.1              4.6              8.4        5.7
14 Yrs Boys      5.3              9.5              10.1       10.2
14 Yrs Girls     3.8              10.1             11.7       9.1
15 Yrs Boys      9.6              14.5             13.9       10.9
15 Yrs Girls     6.0              11.2             10.9       10.1




Alcohol/Strategies/Bradford as at 17.12.08                                           37
In 2007, a revised method for calculating the number of units consumed was
introduced, taking account of the fact that the alcoholic strength of most wines, and
many beers and ciders has increased since the previous methodology was
introduced; this has resulted in an upward adjustment in the number of units
consumed. This does not mean that there was an increase in consumption in2007,
rather that consumption figures are now more accurate. Using this new methodology,
the report shows that of pupils attending school, those who drank in the past week
consumed the following amounts

Alcohol consumption (units, using revised methodology) in the last week, by
11-15 year olds who drank in the past week (2007).
                 % who drank      Mean          % increase
                 in last week     alcohol       in
                                  consumption percentage
                                  (units)       who drank
                                                last week,
                                                compared to
                                                the next
                                                youngest
                                                age group
11-13 Boys       9%               8.3           n/a
11-13 Girls      8%               8.1           n/a
14 Yrs Boys      26%              13.7          +225%
14 Yrs Girls     30%              12.8          +15%
15 Yrs Boys      42%              15.0          +40%
15 Yrs Girls     40%              14.4          +33%

It should be noted that the percentage of 11-13 year olds drinking in the last week
masks a very large increase in the first teenage year, especially for boys. 12% of 13
year old boys drank in the last week compared to 3% of 12 year olds; for girls, the
figures are 9% and 5%, showing a more even rise in the age of onset. Unfortunately,
consumption figures are only available for the combined age group 11-13.

It must be remembered that these are average figures, which is especially alarming
because if the average consumption of 14 and15 year old female past week drinkers
is equal to or just below the recommended weekly limit for an adult woman, then a
sizeable number of these girls must be drinking in excess of this limit. Amongst boys,
some will clearly be drinking in excess of the medium risk weekly threshold for adult
males of 21 units. Closer analysis of the data shows:
     1 in 20 12 year old girls is drinking at least once a week
     I in 8 13 year old boys is drinking at least once a week
     1 in 11 13 year old girls is drinking at least once a week.
     1 in 5.5 14 year old boys is drinking at least once a week
     1 in 4.6 14 year old girls is drinking at least once a week.
     1 in 3 15 year old boys is drinking at least once a week
     1 in 3.3 15 year old girls is drinking at least once a week.

Some of these young people will be drinking only very modest amounts in controlled
situations with their parents, and there is some evidence that this may be a protective



Alcohol/Strategies/Bradford as at 17.12.08                                          38
factor. Of concern is the fact that in the past week, 31% (no gender difference) drank
more than 14 units. By age groups, these break down as:

Alcohol consumption (units, using new methodology) by those who had a
drink in the last week, by age and gender. (Table 4.8)
% of last week       Age and gender % of age group     % of age group
drinkers who                          (drinkers & non- who drank in the
drank 14+ units                       drinkers)        last week
(the recommended                      drinking 14+
weekly safe drinking                  units in last
limit for an adult
woman, and two-
                                      week
thirds that for an
adult male.)
16%                       Boys 11-13 yo      1.4%             9%
17%                       Girls 11-13 yo     1.4%             8%
31%                       Boys 14 yo         8.1%             26%
31%                       Girls 14 yo        9.3%             30%
38%                       Boys 15 yo         16.0%            42%
38%                       Girls 15 yo        15.2%            40%


In 2006, last week drinkers consumed a wide variety of types of drink, with each
drinker choosing on average 2.6 different types of drink. A majority of boys and girls
had consumed beer/lager/cider, spirits, and alcopops in the last week; these were
also the drinks of with the highest unit consumption. (Fuller, 2007, tables 3.15 & 3.16)

Sources of alcohol
   In 2006, children‟s prime source of alcohol was from parents or friends. Of
      those drinking more than 14 units a week, 89% were given it by friends and
      48% by parents: a further 42% had taken alcohol from home. There is clearly
      a large amount of adult collusion in under-age drinking. (Fuller, 2007, table
      3.21)
   Amongst current drinkers who buy alcohol, the most common “usual source”
      was from a friend or relative (17% of 11 year olds rising to 21% of 14 year
      olds). (Table 3.23).
   The commonest retail sources were off licences (18%), followed by shops or
      supermarkets (13%), pubs or bars (7%), and club or disco (4%); “somewhere
      else” accounted for 12%. 48% never buy alcohol (Table 3.23).
   Significant numbers of children buy alcohol from both retail and on-licence
      premises. Amongst the pupils who buy alcohol, 29% of 11 year old
      purchasers rising to 70% of 15 year olds purchased or obtained alcohol from
      off-licences, other shops, supermarkets or garage forecourts. The heavier the
      drinker, the more likely they were to use these outlets. (Tables 3.24. 3.25)
   66% of 11-15 year olds (ranging from 61% of 11-13 year olds to 71% of 18
      year olds) who had attempted to buy alcohol from a shop or pub/club in the
      last four weeks had succeeded (Table 3.26).
   There was a significant decline in the number of current drinkers who drank in
      a pub/club between 1996, and 2006, but this has been counter-balanced by a
      rise in those drinking in streets, parks, or somewhere else outside. 37% of 15
      year old drinkers currently drink in these locations. The heavier drinkers are


Alcohol/Strategies/Bradford as at 17.12.08                                           39
        the most likely to drink outside - 63% of those drinking fourteen or more units
        a week in 2006. (Table 3.29).
       12% of 14 year olds and 22% of 15 year olds had an alcoholic drink in a pub,
        bar or club in the last 4 weeks. (Table 3.31)
       19% of 11-15 year olds pupils (ranging from 5% of 11-12 year olds to 42% of
        15 year olds) had been drunk in the last 4 weeks. 14% of 11-12 year olds and
        45% of 15 year olds had deliberately tried to get drunk. (table 3.38)
       11% of 11-15 year old boys who drank alcohol in the pub during the previous
        four weeks had consequently got into a fight; 22% of such girls had had an
        argument. 1% of both sexes had been taken to hospital. All these
        consequences increase with frequency of drunkenness (Table 3.39, 3.40.)
        15% of pupils think it is “ok to get drunk once a week (Table 3.41). Family
        attitudes bear little relationship to pupils‟ propensity to get drunk (Table 3.49).




DRINKING, BINGE DRINKING AND ASSOCIATED PROBLEM
BEHAVIOUR AMONGST 10-19 YEAR OLDS LIVING IN DEPRIVED
COMMUNITIES
Positive Futures is a national sports, arts and activity-based social inclusion
programme managed by Crime Concern, and funded by the Home Office in
partnership with the Football Association. It aims to engage young people living in
deprived communities in the thirty areas of England most affected by drug-related
crime, including Bradford. In 2007, they commissioned a survey of young people
participating in their projects, and there were 1250 responses. (Talbot S and Crabbe
T, “Binge drinking: young people‟s attitudes and behaviour”. Crime Concern 2008 ).
The findings are important because they give an important insight into the lives of
young people from the backgrounds most associated with crime and anti-social
behaviour, low educational attainment, teenage pregnancy, chronic worklessness
and other social problems.

Key findings appear below:
       o 15% reported drinking at levels which are hazardous or harmful for
          adults. 3% were drinking 61-80 units a week; 4% were drinking 41 -60
          units a week; and 8% between 21 and 40 units a week.
       o 39% drank up to 20 units of alcohol a week.
       o A later question revealed very high levels of drinking in one session, but
          the report is ambiguous about whether these were continuous sessions
          and thus the results may not be reliable – but they suggest that some of
          these young people are drinking at levels which pose an immediate threat
          to their lives.
       o A further 22% did not know how much they drank, 19% did not respond,
          and there was widespread ignorance of the unit value of alcoholic drinks,
          so the above percentages must be seen as absolute minimums.
       o 8% began drinking when they were ten or younger, 7% at eleven, and 12%
          at twelve – that is 27% started drinking before their thirteenth birthday.
       o !5% began drinking at thirteen, and 23% at fourteen or fifteen.
       o 42% know family and/or friends with alcohol related problems (and a
          further 26% did not respond)


Alcohol/Strategies/Bradford as at 17.12.08                                              40
The most common reasons given for drinking were:
     o Their friends did it and it looked like fun (40%)
     o A desire to experiment and see what it was like (19%)
     o Following the examples of family members and relatives (17%)
     o Boredom (10%)

In terms of attitudes:
       o 69% said they enjoyed drinking
       o 29% liked getting drunk for the sake of it.
       o 29% said socialising with friends and having fun.

Of especial significance is the fact that 50% of these deprived young people
reported that their parents either condoned their children‟s drinking, were
ambivalent or did not care, whilst a further 11% were unaware of their children‟s
drinking. 22% did not respond. 25% of respondents drank mostly at home, and 22%
obtained alcohol from home with parental approval.

Respondents said they drank in the following locations:
     o 32% in the street or a local park
     o 25% at home with family members
     o 22% in pubs, night clubs or bars, despite being underage.
     o 12% elsewhere, usually their local area or housing estate.
     o 9% did not respond

17% reported drinking alone.

Usual drink of choice was as follows:
      o 35% “beer” (no more detail given , but it is safe to assume that this will
          include strong beers and lagers)
      o 29% spirits
      o 22% cider (no more detail given, but some of this will be strong white cider)
      o 21% wine
      o 20% alcopops
      o 19% other forms of alcohol

Respondents reported alcoholic drinks sourced as follows:
     o 52% from corner shop, off licence or supermarket, in some cases by
        getting adults to buy it for them.
     o 22% at home from parents or other family members
     o “a small number” stole from their parents
     o 9% from pubs, clubs or bars
     o 17% did not respond

Respondents reported a range of misbehaviour and trouble as a result of drinking,
with many respondents clearly reporting several transgressions:
      o 50% involved in violence, fighting or aggression
      o 45% involved in anti-social behaviour or vandalism
      o 36% involved in drunken arguments
      o 24% had trouble with the police


Alcohol/Strategies/Bradford as at 17.12.08                                          41
        o 19% were violent and aggressive
        o 18% took drugs
        o 18% missed school/college
        o 17% were sexually irresponsible (12% female, 5% male – but there may be
          gender differences in what is perceived as irresponsible).
        o 8% were taken to hospital
        o 7% were involved in drink driving

Respondents were asked what they thought would most reduce youth alcohol-related
crime and disorder. Answers included:
      o More things to do including sports facilities (46%)
      o Health information on sensible drinking (38%)
      o Stopping underage alcohol sales (33%)
      o Control and closure of pubs and clubs (29%)
      o Clamping down on drunken behaviour (23%)
      o Labelling products with health messages (23%)
      o Making alcoholic drinks more expensive (20%)

55% said Positive Futures had directly helped them to reduce their drinking, and 10%
said their level has stabilised; 34% did not know. Respondents identified three main
ways in which Positive Futures had helped them:
       o Education about drinking
       o Positive role models
       o Positive activities


RISKY DRINKING IN SCHOOLCHILDREN AND ITS CONSEQUENCES
An important study in 2007 of 9833 fifteen and sixteen year old schoolchildren in
secondary schools in NW England has shed further light on the contemporary
drinking behaviour of this age group. (Hughes S, Bellis M et al, “Risky drinking in
North West school children and its consequences: a study of fifteen and sixteen year
olds”, Centre for Public Health, Liverpool John Moores University, March 2008,
http://www.nwph.net/nwpho/publications/Forms/DispForm.aspx?ID=177

There is no reason think that the behaviour of their non-Muslim peers in Bradford will
be significantly different. . The survey excluded those not in school. The survey
found that:
     84% consumed alcohol
     Drinking was more common in the three wealthiest quintiles (88% of second
       quintile down to 80% of the poorest)
     Females were more likely to drink than males (88% v 80%)
     Differences between 15 and 16 year olds were small
     52% of drinkers (43% of the age group) drank 10 or more units a week. 16%
       (14%) drank more than 20 units, and 7% (6%) more than 40 units.
The survey looked at predictors of these young people being binge drinkers (here
defined as five or more units on one occasion once a week or more), frequent
drinkers (twice a week or more), and drinking in public places (pubs, clubs, street,
park or shopping areas):
     36% of those who drank were binge drinkers, 28% frequent drinkers, and 55%
       drank in public places.


Alcohol/Strategies/Bradford as at 17.12.08                                         42
       Major predictors of binge drinking were buying their own alcohol, getting adults
        to go into shops to buy it for them, increasing level of money available, and
        stealing alcohol from parents. Males were more likely to binge drink than
        females, and 16 year olds compared to 15 year olds.
       Protective factors against binge drinking were having a hobby or being
        involved in sport, and parents providing alcohol. Results for frequent drinkers
        were generally similar, but here was no significant age difference, and no
        correlation with parents providing alcohol.
       Results for drinking in public places showed much greater variation, with
        buying own alcohol or getting adults going into shops to buy it being enormous
        predictors. Having a hobby or playing sport, and parents providing alcohol
        were protective factors, as was being male. This last variable is likely to be
        due to the greater ability of girls in this age group to pass as being over 18.


Binge drinkers, heavy drinkers and frequent drinkers were all more likely to smoke
cigarettes.

Getting drunk was associated with negative outcomes. Being violent or getting into a
fight when drunk was strongly correlated with frequency of binge drinking (someone
binge drinking on three or more days a week was nearly six times as likely to do so,
compared to a peer who binge-drinks less than once a month or never. There was
also a very strong correlation with consumption, and smaller ones with frequent
drinking and deprivation. Interestingly, there was no significant difference between
boys and girls. Not surprisingly, girls were much more likely to regret having sex after
getting drunk, and it was the most frequent binge drinkers and the heaviest drinkers
who were most likely to have such regrets.




Alcohol/Strategies/Bradford as at 17.12.08                                           43
                      CHAPTER 7:
          SOME FACTS ABOUT ALCOHOL RELATED
                      PROBLEMS

7.1 ALCOHOL-RELATED PROBLEMS - CRIME
NATIONAL
 One in five violent crimes occurs in or around pubs and clubs, and 80% of
  assaults in nightlife areas are related to alcohol (Povey & Allen, 2003). 29% of
  “vicious woundings” took place in and around pubs and clubs in 2006-7.
 There were 1,087,000 violent incidents in 2006/7 in which the victim believed that
  their attacker was under the influence of alcohol. This accounts for 46% of all
  violent incidents including 39% of domestic violence cases, 47% of acquaintance
  violence cases, and 58% of stranger violence cases. (British Crime Survey 2006)
 The Government‟s Strategy Unit (2003) cited heavy drinking by victims as a risk.
 In 1999-2001, one in five arrestees in England and Wales tested positive for
  alcohol (Home Office NEW-ADAM Monitoring system).
 The extent of the link between alcohol and crime was demonstrated by a survey
  of 405 prisoners (58%) in HMP Winchester (Hampshire DAAT 2006). It is
  reasonable to assume that this is probably representative of imprisoned offenders
  in England:
      o 22% were moderate-to-heavy drinkers (UK 16%)
      o 40% were hazardous or dependent drinkers (UK 4%)
      o the average pre-imprisonment consumption by those prisoners who said
          they did not have a drinking problem was 43 units a week, with 43%
          drinking above the recommended limit of 21 units a week and 20%
          consuming over 50 units a week. 8 of these prisoners were drinking over
          120 units a week
      o The average pre-imprisonment consumption by those prisoners who said
          they do have an alcohol problem was 157 units per week! (range circa 20-
          420 units per week)
      o 46% of all prisoners identified alcohol as being linked to their offending,
          with violent crime accounting for 46% of this total, i.e. 22% of all prisoners
          in HMP Winchester considered that their violent crime offence was related
          to their alcohol consumption
      o 51% of respondents who said they had a drinking problem were in prison
          for violent crime
      o 23% of the prisoners who identified alcohol as being linked to their
          offending were in prison for acquisitive crime, and around 11% for drugs-
          related offences
      o 68% of those imprisoned for violent crime and 42% of those
          convicted of acquisitive crimes (including 12% of those convicted of
          robberies) believe their offences were related to alcohol use.
      o When asked how often they had carried out violent crimes under the
          influence of alcohol, 23% replied always and 27% often; only 8% said
          never. In contrast, 33% of burglars and 18% of thieves said they never
          committed their crimes under the influence of alcohol
BRADFORD


Alcohol/Strategies/Bradford as at 17.12.08                                           44
   Bradford is in the highest (worst) quartile for all alcohol-related recorded crime (
    based on attributable fractions for alcohol for each crime category) but in the 51-
    75% (third worst) quartile for alcohol-related violent crimes and alcohol-related
    sexual offences. The figures, together with national ranking (England) and the
    regional average statistics were:
        Alcohol-related recorded crimes 11.32 per 1000 pop (rank 274 out of 354;Y&H 11.25)
        Alcohol-related violent crimes 7.36 per 1000 population (rank 252; Y&H 7.68)
        Alcohol-related sexual offences 0.15 pet 1000 population (rank 260; Y&H 0.14) (2007
        Local Alcohol Profiles for England (NWPHO (NWPHO 2007
        http://www.nwph.net/alcohol/lape/LAProfile.aspx?reg=d )
   These figures show improvement. The total of alcohol related recorded crimes
    declined from nearly 15 per 1000 in 2003-4. Alcohol related violent offences for all
    three years declined slightly from a range between 8 and 9 per 1000 population.
    Alcohol-related sexual offences increased significantly in 2005-6 to a three-year
    high of around 0.16 per 1,000, before this 2006-7 fall. (NWPHO, 2006 and 2007 -
    this data is based on the Government Strategy Unit‟s formula for alcohol
    attributable fractions for each crime, which was developed from survey data on
    arrestees who tested positive for alcohol.)
   Around 160 domestic violence incidents were reported to West Yorkshire Police
    in the Bradford District in an average week during 2005-6. Alcohol was a factor in
    43% of these incidents.
   The 2006/7 British Crime survey figures pro rata for Bradford translate into some
    8700 alcohol related violent incidents.
   The number of drivers arrested after positive breath tests in West Yorkshire over
    the Christmas/New Year period 2006-7 increased by 100 from 2005-6 to 420. 115
    of these arrests were in the Bradford district. Home Office data shows that
    nationally, 88% of drink-driving violations are by men. (Daily Mail 21.04.08)
   Provisional results from the Bradford 2006 General Household Satisfaction
    Survey show that about a quarter of respondents regarded people being drunk or
    rowdy in the immediate area in which they live as a very or fairly big problem.
   42% of offenders supervised by the Probation Service in Bradford have alcohol
    linked to their offending behaviour (which exceeds the 35% who have a drug link
    to their offending behaviour) (report from Clare Wallis, WP Probation Service,
    January 2008).

YORKSHIRE AND HUMBER REGION
 In West Yorkshire, 19 out of 25 offender deaths of offenders under NOMS
  supervision (in prison or in the community) involved substance misuse (alcohol
  and/or drugs) as a factor, with 11of these cases being dual-diagnosis (drugs&/or
  alcohol, together with mental health problems). (Wallis, op cit)
 20% of Penalty Notices for Disorder (PNDs) issued by WY Police in 2004 to 16
  and 17-year olds, and 24% of those to adults, were for alcohol-related disorders.
  These figures are easily the lowest in Y & H (average 35%/42%), and under a
  third of the percentage in South Yorkshire (63%/77%). Public perceptions of
  alcohol being a major cause of crime are increasing. In Y&H, 41% of adults held
  this view in 2004-2006, compared to 31% in 2002-4; both figures are significantly
  lower than the England average. However, very few people consider alcohol to be
  the main cause of crime.




Alcohol/Strategies/Bradford as at 17.12.08                                              45
7.2 ALCOHOL-RELATED PROBLEMS - FIRES
NATIONAL
   Alcohol involved in 33% of fire deaths in UK
   25% of fires caused by alcohol impairment
   26% individual responses to fires affected by alcohol impairment
   Most fires occur evenings and weekends
   Most at-risk group are males aged 30-59
    (Reference: Macklam V (GOYH FRS Secondee), presentation to YH Regional Alcohol Group, 12.07.07)
    .



7.3 ALCOHOL-RELATED HEALTH ISSUES – MORTALITY,
MORBIDITY AND TREATMENT

NATIONAL
The misuse of alcohol is associated with a variety of health problems. These include
chronic liver disease and cirrhosis; cancers of the oesophagus, larynx and oral
cavity; stroke and hypertension; breast cancer; low birth weight, foetal alcohol
syndrome; and Korsakoff‟s Syndrome (“wet brain”), a degenerative brain disorder. In
addition, alcohol-related accidents significantly impact on A&E services, GP services,
spinal injuries units, oral and maxilo-facial surgical services, and neurological units.
There are significant correlations between alcohol misuse and mental health
problems. The scale of the problem can de discerned from the facts below:
 26% of the population aged 16-64 are drinking hazardously or harmfully) (38% of
   men, 16% of women).
 Around 6% of men and 2% of women have an alcohol dependency.
 There is only one treatment place for every 18 alcohol dependent individuals in
   England and Wales (range 1:12 to 1:102)
 Alcohol-dependent women are 1.7 times more likely than men to access
   treatment (ANARP).
 GPs tend to under-identify younger patients with disorders related to their alcohol
   use (ANARP).
 The average GP sees 22 patients with alcohol-use disorders each month. 71%
   were felt to need specialist treatment but many were not referred either because
   of waiting lists or because the patient preferred not to be referred (ANARP).
 Research suggests that GPs limit “demand” for specialist services by low levels of
   routine enquiry about alcohol use, and by finding alternatives to specialist
   treatment, such as in-house interventions and referral to self-help groups
   (ANARP).
 There is a high level of satisfaction with specialist services once access has been
   achieved, but the national average waiting time for assessment was 4-6 weeks.
   Bradford does better than this, with waiting times of 2 weeks for the Piccadilly
   Project and under 3 weeks for ACDAT.
 30% of alcohol-related hospital (ICD 10) admissions in 2000/1 to 2002/3 were for
   mental and behavioural disorders due to alcohol misuse
 35% of all A&E attendance and ambulance costs may be alcohol-related
   (Strategy Unit, 2003).



Alcohol/Strategies/Bradford as at 17.12.08                                                            46
   70% of A&E attendances between midnight and 5am were alcohol-related
    (Strategy Unit, 2003).
   The number of patients seeing a consultant for an alcohol related disease
    increased from about 145,000 (440 per day) in 1999-2000 to 284,000 (or 779 per
    day) in 2006-7, a 95% increase; the rate of A&E admissions for alcohol related
    conditions in the same period increased from 82,000 to 152,000, an increase of
    83%. (Merrick J,”1,000.That‟s how many victims of alcohol are treated in hospital
    every single day” Daily Mail, 11.1.08 - figures from DH and probably in a Written
    PQ answer from Dawn Primarolo MP 12.1.08)
   At “peak times”, 43% of A&E users were identified as problematic drinkers; 41%
    of attendees were positive for alcohol consumption, and 14% were intoxicated
    (Strategy Unit, 2003).
   Significantly more common reasons for attendance at A&E by alcohol-positive
    individuals include violent assault; incidents involving weapons; road traffic
    accidents; psychiatric emergencies; and deliberate self-harm episodes (Strategy
    Unit, 2003).
   In 2006/7, 152,216 adults were admitted to hospital via A&E with alcohol related
    conditions. 8245 of these were under 18. (Andrew Lansley MP, Shadow Health
    Spokesman, Conservative Party website, 16.1.08.). The numbers admitted in
    2004/5 included 21,700 people with alcohol poisoning, up from 13,600 in 1994/5
    (The Guardian 27.10.06).
   Figues issued in January 2008 gave a figure of 207,800 alcohol-related
    admissions to NHS hospitals in England in 2006-7, a rise 122% over the 93,500
    admissions in 1995-6. Of these, 57,100 had a primary diagnosis specific to
    alcohol such as alcoholic liver disease, a rise of 52%. 4,900 patients were under
    18. (Statistics on alcohol: England 2008. NHS Infomatics Centre)
   However, national data of the number of alcohol-related admissions using
    sophisticated new methodology were released by DH in July 2008; this showed
    811,000 hospital admissions in England in 2006, a rise of 71% compared to
    473,500 in 2002. The 2006 figure represents 6% of all hospital admissions.
    (www.alcoholpolicy.net/2008/07/alcohol-related.html ) (N.B. these are
    admission episodes, including multiple admissions in the year, and there fore the
    number of individuals admitted is smaller than this). This figure is expected to
    reach one million episodes in 2008-9 (Bellis M, National Alcohol Conference,
    Nottingham, 5.11.08).
   112.300 prescriptions were dispensed in primary care to treat alcohol
    dependency in 2006-7, an increase of 20% in four years (ibid, NHS Infomatics
    Centre)
   Alcohol causes 50% of cases of liver disease in the UK (British Liver Trust, 2007).
    Two million people in the UK are thought to have chronic liver disease (Kaneta
    Bebar, Alcohol hazards, website, 29.01.08 ). Cases of cirrhosis of the liver have
    doubled between 1999 and 2006 (David Taylor MP, House of Commons
    Hansard, 6.12.07). Alcohol related fatalities account for most liver deaths, and
    have doubled in 15 years from 4144 in 1991 to 8758 in 2006 (Bebar, opcit).
   A recent experiment on the Channel 4 „Despatches‟ programme (18.06.07)
    suggests that the incidence of liver disease is higher than had been feared. One
    liver specialist referred to the results as “an epidemic which is going to face us in
    15/20 years‟ which the health service will find impossible to deal with”.
   In Scotland, people in their thirties and early forties are being diagnosed with
    Korsokoff‟s Syndrome, an irreversible form of diabetes related to heavy drinking;


Alcohol/Strategies/Bradford as at 17.12.08                                            47
    their age is at least ten years younger than twenty years ago. (The Scotsman,
    08.02.07).
   Cardiff University researchers have found that the blood alcohol level of more
    than one third of male and one sixth of female drinkers on weekend nights out in
    Cardiff, one of the UK‟s safest cities, was above the internationally recognised “at
    risk” level. The highest intoxication levels in men were amongst those in their late
    20s, whilst for women, intoxication levels increased with age. Younger people,
    the unemployed and students all had below-average alcohol levels. (Western Mail
    03.08.07).
   Substance use is a factor in 8% of maternal deaths, leading to recommendations
    to screen for alcohol and other drugs screening in pregnancy (Sixth Report of the
    Confidential Enquiry into Maternal and Child Death, 2000-2002).
   Foetal Alcohol Spectrum Disorder (FASD), also known as Foetal Alcohol
    Syndrome (FAS), is the name given to a group of adverse characteristics reported
    in the babies of women with a clearly identified drinking problem. The
    Government‟s Strategy Unit (2003) estimated the prevalence as between 0.4 and
    2.0 live births, but the Canadian House of Commons Standing Committee (2006)
    estimates suggest that 9 births per 1000 will suffer from FASD. They estimate that
    foetal alcohol disabilities cost some $CDN 1.5 million additional direct costs over
    an affected individual‟s lifetime, excluding the value of lost potential to the
    individual, family, or caregivers.
   Every £1 spent on treating people with alcohol problems with either social
    behaviour and network therapy or motivational enhancement therapy would save
    £5 in spending on NHS and other public services, including the criminal justice
    system. (UKATT: see BMJ (2005), 331, 544)
   The latest Five Year Report of the National Confidential Enquiry into Suicide and
    Homicide by People with Mental Illness identified 1659 suicides by those with a
    dual-diagnosis of severe mental illness together with drug or alcohol dependency
    or misuse. The victims were mainly young, single, unemployed males, who lived
    alone.



BRADFORD
Data from the Local Alcohol Profiles for England (NWPHO 2007,
http://www.nwph.net/alcohol/lape/LAProfile.aspx?reg=d ) shows Bradford‟s
performance on a number of critical health indicators, the regional picture, and where
Bradford is ranked against all other local authority areas in England. It will be seen
that Bradford is in the worst quartile on six indicators; in the next worst quartile for
four more, but in the top quartile for hospital admissions for under-18s, a
performance which must be due to the large minority of Muslims in the teenage
population. Bradford fares worse than the regional average on most indicators,
although the estimate for binge drinking shows Bradford slightly better than the
regional average; this may again reflect the above average number of Muslims
amongst teenagers and young adults.




Alcohol/Strategies/Bradford as at 17.12.08                                           48
BRADFORD LOCAL ALCOHOL PROFILE (NWPHO 2007)
(Rank is from a total of 354 local authorities in England, where 1 is best ranked, and 354
worst ranked; any ranking below 265 is in the worst quartile)


ALCOHOL RELATED MORTALITY                                                    England         Regional
                                                              Bradford         Rank          Average
1. Alcohol-specific mortality – males                            16.11           289            12.93

2. Alcohol-specific mortality – females                            5.56            218             5.35

3. Alcohol-attributable mortality – males                         58.90            315          51.35

4. Alcohol-attributable mortality – females                       24.94            235          23.87

1 + 3 = Alcohol related mortality – males                         75.01                         64.28

2 + 4 = Alcohol related mortality – females                       30.50                         29.22


(All rates per 100,000 population, annual average -2003-2005)

ALCOHOL RELATED HOSPITAL ADMISSIONS

5. Alcohol-specific – males                                     388.11             265         335.02

6. Alcohol-specific – females                                   159.29             203         159.39

7. Alcohol-attributable – males                                1042.15             280         937.71

8. Alcohol-attributable – females                               565.20             268         522.11

5 + 7 = All alcohol related – males                            1432.26                        1272.73

6 + 8 = All alcohol related – females                           724.49                         681.50

9. Alcohol specific – under 18s – male and female                 32.77             71          63.32


(All rates per 100,000 population 2005-2006)

HAZARDOUS HARMFUL AND BINGE DRINKING –
AGE 16 AND OVER

10. Hazardous drinking (synthetic estimate %)                     22.35            286          22.34

11. Harmful drinking (synthetic estimate %)                        7.05            342             5.99

10 + 11 = Hazardous and harmful (synthetic estimate %)            29.40                         28.33

12. Binge Drinking (synthetic estimate %)                         20.07            262          22.00




Alcohol/Strategies/Bradford as at 17.12.08                                                    49
   The ratio between types of admissions is shown in earlier data. Bradford had 162
    per 100,000 alcohol-related hospital admissions for mental and behavioural
    disorders in 2000/1-2002/3 (Y & H range 97-366), and 30 per 100,000 for toxic
    effects (Y & H range 3-53). The former Bradford City PCT area had easily the
    highest combined number of admissions at 253 per 100,000 (2000/1-2002/3).
   There were 1454 finished admissions episodes in 2006-7 in the Bradford district
    for patients admitted via A&E where the primary or secondary diagnosis was
    alcohol related (Bradford Hospitals Teaching NHS Foundation Trust 1070;
    Airedale NHS Trust 384, Bradford District Care Trust 58), an increase of 11%
    over the 1290 episodes in 2004-5. This compares very favourably to a regional
    increase of 18%, and a national increase of 26%. (DH, written answer to PQ,
    Conservative Party press release, 31.03.08).
   The reformulated national hospital admissions data for 2006, issued in July 2008
    showing 811,000 admissions in England, suggests a true figure for all alcohol-
    related admissions in the Bradford district in 2006 of some 7,500-8,000 episodes.




YORKSHIRE AND HUMBER REGION
 In Yorkshire and Humber (Y & H), in 2001-5, 1.03% of male and 0.44% of female
  deaths were from alcohol-specific causes, and 5.21% of male and 3.75% of
  female deaths were from alcohol-attributable causes (APHO 2007, pp. 27-8).
  These figures are slightly better than the England averages.
 I in 20 (5.2%) of the population aged 16-64 in Yorkshire and the Humber were
  dependent alcohol users in 2004 (England 3.6%). Three quarters of these people
  were men (ANARP).
 Y & H has the second worse ratio of treatment places to alcohol-dependent
  individuals (1:46) {source: ANARP 2005}. It should be noted that the true figure
  may be better than this due to incomplete data, but will still be high. Bradford‟s
  ratio is not available, although work currently being undertaken by the tPCT
  suggests that Bradford may have a better ratio of places than the national
  average.
 Mortality from chronic liver disease in West Yorkshire has risen from below the
  England average in 1993 (SMR 44) to higher than the England average in 2003
  (SMR 108) - a 145% increase (England 80%). It is now the highest former SHA
  region in Yorkshire (previously the lowest). Rates per 100,000 in 2001-3 include:
  males 15-34 = 14, females 10.7; males 35-64 = 26.4, females 12.3. Data for
  2004 (NWPHO) shows a circa 60% increase in female mortality; this now
  exceeds that for males which has declined by circa 7%.
 In 2005/6, there were 335 hospital admissions for alcohol-specific conditions
  per 100,000 males in Y & H, and 159 for women; these figures are slightly lower
  than the England average, whereas they were above it five years previously.
  However, the figures represent a 31% increase in male admissions in the region,
  and a 34% increase for females. (APHO 2007, p.45).
 For alcohol-attributable conditions, Y & H has remained worse that the
  England average for both men and women, although both gaps have narrowed.


Alcohol/Strategies/Bradford as at 17.12.08                                         50
    There were 938 admissions per 100,000 population for men and 440 for women,
    representing five-year increases of 17% for males and 19% for females. (APHO
    2007, p.45).
   There was a 4.6 inequality ratio for males and a 2.9 ratio for females for hospital
    admissions for alcohol-specific conditions in the 2001/2-2005/6 period between
    residents of the 20% most deprived wards, and those in the 20% least deprived.
    (APHO 2007, p.45).
   For alcohol-attributable conditions, the ratios were 2.5 for men and 2.0 for
    women, both just below the England average. (APHO 2007, p.47). The ratio
    between the lowest and highest geo-demographic groups was 3.6 (male) and 2.7
    (female) (calculated from APHO 2007, p.48).
   Males dying from alcohol-attributable conditions in 2003-5 lost an average of
    20.6 years of life; females lost an average 15.4 years. These figures are slightly
    better than the England average. (APHO 2007, p. 26.)
   In Y & H, alcohol-specific mortality in the population aged under 75 in 2001-5
    showed an inequality ratio of 7.0 for men and 3.3 for women between the least
    deprived and most deprived quintiles. Y & H has the second worse ratio in
    England for men, and the fifth worse for women. The ratio between quintiles is
    much greater between the second most deprived and least deprived quintiles
    than between the other quintiles. (APHO 2007, p.35.)
   The inequality ratio in Yorkshire & Humber for the under-75s in 2001-5 for
    alcohol-attributable mortality was 3.1 for men and 2.2 for women. The male
    figure is slightly worse than the national average, the female figure slightly better.
    (APHO 2007, p.37.)
   In Y & H (as in England), there was great inequality within the under-75 year-olds
    geo-demographic group with the lowest rate of alcohol-specific mortality (the
    “Country Orchards” – well-educated, high-income agricultural workers, likely to be
    self-employed) and the “Urban Challenged” group; the ratio in 2001-5 was
    approximately 7:1 for women and 10:1 for men. For alcohol-attributable
    mortality, the ratios are approximately 4.4:1 for men under 75, and 3.3:1 for
    women. “Blossoming Families” have the lowest such mortality amongst men,
    “Mature Oaks” amongst women. (APHO 2007, p. 36)
   115 per 1000 working age adults in Y&H claiming Incapacity Benefit or Severe
    Disablement Allowance had alcohol as the main medical reason (slightly below
    the England average) (APHO 2007 p67) (1.5% of claimants in Y&H).




Alcohol/Strategies/Bradford as at 17.12.08                                             51
                  CHAPTER 8:
    DRINKING HABITS – YORKSHIRE AND HUMBER
                     REGION
   5.2% of the population of Yorkshire and the Humber region aged 16-64 are
    dependent on alcohol (ANARP, 2006). This equates to some 15,000 people in the
    Bradford district.
   In 2000-2, 27.8% of the population of West Yorkshire aged 16-64 were drinking
    above the “sensible drinking” weekly limits (Y & H 27.1; England c. 24.5). This
    equates to some 84,000 people in the Bradford district.
   In 2000-2, the average consumption of alcohol per person in West Yorkshire was
    the regional average of 14.1 units per week (England c.12.5) (ANARP, 2006). The
    real average is likely to be higher than this due to weaknesses in the data
    collection system. (Bellis M, National Alcohol Conference, Nottingham, 5.11.08)
   In 2003, 20% of persons over 16 in Yorkshire and the Humber drank more than
    double the sensible drinking limit on at least one day (equal highest in England
    with the North West).
   Y & H is the worst region for binge drinking (Dept of Health definition) (range 11.3
    to 28.7% of over-16 population) {CHSE 2000-2002}. The main number of units
    consumed on the heaviest drinking day in the past week by self-reported
    moderate drinkers was 7.9 (men) and 5.1 (women), both figures being the worse
    of any English region (AHPO 2007 p104). The average for Bradford is 17.2% (if
    the former City PCT area is excluded, it is 19.1%).
   In 2003, alcohol was consumed on average 2.7 days a week by men and 1.8
    days by women aged 16+ in Yorkshire and the Humber (in line with England
    average). {Source: Health Survey of England}.
   In 2003, the mean number of units consumed on the heaviest drinking day in
    Yorkshire and the Humber by persons aged 16+ was 8.2 (men) and 4.0 (women)
    - both above the national average (HSE).
   A further quarter of the population aged 16-64 in Yorkshire and the Humber
    (25.8%) are hazardous or harmful alcohol users (England 22.6%) {Source:
    ANARP}. This is in addition to the 5.2% dependent on alcohol.

BRADFORD
 Research in the former City PCT area (2005) shows that on average women have
  only a slightly exaggerated view of safe daily drinking limits, whereas men feel
  they can safely drink six units a day and women 3.8 units. Interestingly, the 25-34
  age group was the best informed, and the 18-24 and 65+ age groups the worst
  informed.
 39% of drinkers in the former City PCT area thought their current level of drinking
  could be harmful to their health, with 2% thinking it very harmful. This was
  highest in the 35-44 age-group (6% were very concerned about their drinking);
  24% of drinkers in this age group had been advised to cut down or stop by a
  doctor or nurse.
 In the former City PCT area, 32% of white residents have an alcoholic drink at
  least twice a week, ranging from 18% aged 18-24 to 4.4% aged 35-44.
 36% of drinkers in the former City PCT area normally drank outside the house,
  31% at home, and 33% both. Younger drinkers are mostly likely to drink away
  from home.


Alcohol/Strategies/Bradford as at 17.12.08                                           52
  CHAPTER 9: ALCOHOL, THE ECONOMY AND
            THE ENVIRONMENT
ALCOHOL AND THE ECONOMY

National
     The Government‟s Strategy Unit (SU) cited 2001 figures that the total value
       of the UK alcoholic drinks market exceeds £30bn, and it will inevitably have
       increased significantly since then – probably to between £35bn and £40bn
       on a pro-rata basis, most of which will be generated by national and trans-
       national companies. The value of the market in Bradford is not known; pro-
       rata, it could be worth as much as £300m, but in reality will be smaller due to
       the structure of the industry locally; there is only a relatively small brewing
       sector (the only sizeable brewery is Timothy Taylor‟s in Keighley), and the
       city centre alcohol economy is very much smaller than other cities like Leeds
       and Manchester.
     The SU estimated that the drinks industry generates approximately one
       million jobs (full and part-time) across the whole of the value chain. (Strategy
       Unit 2003). It is not possible to pro-rata the figure for Bradford because the
       drinks industry is not evenly spread throughout the country.
     The revenue raised by duty and VAT on alcoholic drinks in 2006/7 was
       £14.120 billion (source: British beer and Pub Association, personal
       correspondence with Lee le Clerq). The night-time economy has been
       responsible for finding new uses for redundant listed and other buildings of
       architectural merit.
     77% of employers believe that alcohol misuse is the number one threat to
       employee well-being, and that it encourages sickness absence. Only 9% of
       employees shared employers‟ concerns. Almost one-third of employees in a
       Norwich Union survey (32%) admitted to having been to work with a
       hangover, and 15% even owned up to having been drunk at work. One in 10
       employees admits to this happening at least once a month and one in 20
       says it happens once a week. Some occupations are worse culprits than
       others in regards to drinking and the workplace. The research showed that a
       fifth of people working in construction and 15% of those working in wholesale
       and agriculture go to work hung over once a week. Of those who have had a
       hangover or been drunk at work, 85% confirmed that it affects their
       performance or mood, proving that the concerns of British employers are not
       unfounded. Employees said that alcohol affected their performance at work
       on a number of levels:
           o 36% of employees find it hard to concentrate
           o 35% of employees find they are less productive
           o 42% feel tired to the point of being very sleepy
           o A quarter do the minimum amount of work and go home as soon as
               possible
           o Nearly one in 10 make lots of mistakes which they need to rectify.
               (“UK employees admit that regular drinking affects their jobs”. Article
               date: 2008-05-07. www.norwich-union.co.uk )




Alcohol/Strategies/Bradford as at 17.12.08                                           53
Yorkshire and the Humber Region
     The volume of alcohol sold in licensed venues in the Yorkshire TV region in
       2004 was 75 litres per person, the fourth highest of nine regions. However,
       consumer on-licence expenditure at £328 per head was the sixth highest (out
       of nine regions), and slightly below the England and Wales average. (APHO
       2007, p121-3, from AC Neilsen)
     Yorkshire & the Humber Region has the highest expenditure per person on
       alcohol when eating out in England (£4.29 pw in 2003-6).
     Yorkshire & the Humber Region has the fourth highest expenditure per
       person on alcohol for household consumption (£2.56 pw in 2003-6), which is
       below the England average). 11.8% of total household expenditure on food
       and drink was spent on alcoholic drinks, marginally above the national
       average.
      (all above, APHO. p. 124-6, from Expenditure & Food Services, National
      Statistics.)
     In Yorkshire & Humberside in 2005, there were 51,700 people employed in
       bars (2.3% of total employees, of whom 37% were full-time. 43% of female
       employees were part-time, compared to 20% of men.
      (APHO 2007, p.129, from Annual Business Enquiry 2005, National Statistics)
     West Yorkshire had 23.1 on-licensed premises and 8.2 off-licensed premises
       per 10,000 population in 2003/4. (APHO 2007, p130 from DCMS) Bradford‟s
       figures are lower at about 15 on-licensed and 6.4 off-licensed premises per
       10.000 population.

Bradford
 It is not possible to calculate the full gross value of alcohol to the economy of the
Bradford district, but the following information is available on the number of people
employed in the industry (source NOMIS/ONS – 2006 data)
         o 580 pubs and night clubs, employing 3530 people.
         o 645 off-sales outlets including off-licenses, convenience stores and
            supermarkets
         o 187 members‟ clubs
         o 155 people employed in off-sales premises (excluding supermarkets and
            probably excluding convenience stores).
         o 157 people employed by Timothy Taylor and Co Ltd of Knowle Spring
            Brewery, Keighley, the only sizeable brewery in the district (ref: OneSource
            report, 1.2.08 )
The percentage of the employees in the district who are employed in the Standard
Industrial Classification (SIC) codes specific to alcohol is inline with the GB average
(1.059%), which is marginally below the average for Yorkshire and the Humber
Region (1.108%). The percentage employed in bars (0.716%), however, is below the
GB (0.906%) and Y&H (0.981%) averages, the reasons probably being that
Bradford‟s night time economy is smaller than other cities of its size, and that the
sizeable Muslim population means that there are less community pubs than would
otherwise be the case.

Turnover and profit figures are mostly impossible to come by, as the employers
concerned are either private companies or are branches of multiple chains. However,
information is available about Timothy Taylor‟s (ref; OneSource, as above). For the


Alcohol/Strategies/Bradford as at 17.12.08                                           54
fiscal year ending 30.9.06, their annual sales were £16.844m, and their net income
was £1.980m. Their revenue growth during that year was 5.7%.


ALCOHOL AND CLIMATE CHANGE
Alcoholic drinks make a significant contribution to the UK‟s greenhouse gas
emissions. It has been estimated that the UK‟s consumption of beer, wine and
spirits (but not other types of alcoholic drink) accounts for approximately 1.5% of the
UK‟s total greenhouse gas emissions. 38% of this is related to the consumption
stage, 26% to transport, 13% to packaging and 22% to agriculture and production
(this last figure is for beer and spirits only). Because of the data omissions, the actual
contribution will be somewhat higher than 1.5%. The contribution has been
increasing due to the changing patterns and volumes of alcohol consumption, in
particular the shift from mostly draught beer to wine, bottled and canned lagers and
flavoured spirit mixers (alcopops). (Garnett T, “The alcohol we drink and its
contribution to the UK‟s greenhouse gas emissions. A discussion paper. University of
surrey, Centre for Environmental Strategy, 2007).




Alcohol/Strategies/Bradford as at 17.12.08                                             55
        CHAPTER 10: EQUALITY AND DIVERSITY
HEALTH INEQUALITIES

The Chief Medical Officer for England acknowledges that alcohol related problems
are greater in our more deprived communities. He has stated that we need to
redouble our efforts to reach these communities and raise their awareness about a
range of lifestyle issues including alcohol. (interview with Sir Liam Donaldson,
Commissioning News, March/April 2008)

There are great inequalities in health outcomes related to alcohol. OPCS data shows
that the months of life lost per geo-demographic classification in England in 2003-5
were over 4 times greater in the group classified as “Urban Challenged”
(unemployed, low income, older smokers) than the “Mature Oaks” (wealthy, older
people living in large detached houses in rural areas). (APHO 2007, P. 33.)


FLOOR TARGETS
Bradford has significant problems of deprivation, with 44% of the population living in
wards which are amongst the 20% most deprived in England. Consequently, the
Bradford District qualified for Neighbourhood Renewal funding (NRF) as one of the
most deprived local communities in England. NRF ended on 31 march 2008, to be
replaced by the Working Neighbourhoods Fund (WNF).

PSA Floor Targets were set by the DCLG Neighbourhood Renewal Unit (NRU) for
the 91 local authority areas in receipt of Neighbourhood Renewal Funding prior to
April 2008 (the 91 poorest districts). Although none of these targets refer specifically
to alcohol, alcohol is a contributing factor in performance towards the health and
crime targets. Bradford‟s performance on floor targets compared to all NRF local
authorities, and to England as a whole, is shown below.

Floor targets are designed to demonstrate how the 91 NRF authorities are improving
compared to each other, and to all authorities in England. The figures in the table
below show progress between 1996-8 and 2003-5 (ref: “PSA Floor Targets, Local
Authority Profiles, Bradford, August 2007.” DCLG)”.
http://www.fti.neighbourhood.gov.uk/document.asp?id=237

       Male life expectancy has improved both absolutely, and relative to the NRF 91
        average, but the gap with the whole country remains the same. The gap
        between male and female life expectancy has narrowed more in Bradford
        (from 5.7 to 4.2 years) than the NRF average, and is equal to the decline in all
        England. Female life expectancy has improved, but by less than the NRF and
        England figures. Bradford‟s teenage conception rate has improved
        significantly, now being closer to the all England figure than the NRF 91
        average. However, this is likely to disguise significant differences in
        conception rates between Muslims and non-Muslims, with higher rates
        occurring amongst non-Muslim girls.




Alcohol/Strategies/Bradford as at 17.12.08                                            56
          There has been a dramatic fall in the circulatory disease mortality rate across
           England, with Bradford‟s improvement outperforming the NRF 91 and all
           England, with a 36% fall in the death rate during the seven-year period
          Burglary rates have fallen very significantly across England, but Bradford‟s
           performance remains significantly higher than the NRF and England averages.
           Bradford‟s robbery rate is remarkably low, declining heavily during a period
           when NRF 91 and national rates plateaued. Bradford‟s rate was half the
           England average and less than a third of the NRF average
          Vehicle crime in Bradford remains worse than the NRF average, but the
           absolute figure has declined by a third.
          Violent crime, much of which is alcohol related, has been lower than the NRF
           average in Bradford district throughout the seven year NRF period, although
           during the period, Bradford‟s rate has worsened by a greater percentage
           (+114%) than both the NRF (+62%) and England (+75%) averages. Bradford
           now has a worse rate for violent crime than the England average, but remains
           better than the average for districts in receipt of NRF.
          Progress over time is shown in the table below:


                                                            1996-8                         2003-5

               Health
                                              Bradford NRF91         England Bradford NRF91 England

Male life expectancy at birth (years)         73.1          73.4     74.8    75.4          75.5       76.9

Female “        “      “   “      “           78.7          78.9     79.8    79.5          80.2       81.1


Conception rate for under-18s, per            53.6          58.7     46.0    46.8          53.2       41.6
1000 females, 15.17

Circulatory Disease Mortality Rate            165.5         172.6    135.4   105.9         117.6      90.5
per 100k population (*
Spearhead/NRF crossover, not NRF
91)

                Crime                                1999   /00                     2006   /07

Burglary rate per 1000 households             33.0          30.6     20.8    21.2          18.7       13.4

Robbery rate per 1000 population              1.5           3.2      1.7     1.4           3.4        1.9

Vehicle crime rate per 1000                   27.7          26.9     20.0    17.4          17.0       13.0
population

 Violence against the person per 1000 population
                                      9.3                   15.2     10.9    19.9          24.6     19.3

                                                        2003/04
 Overall crime rate per 1000 pop              96.4         105.5     69.3    75.8          88.3     61.1




 Alcohol/Strategies/Bradford as at 17.12.08                                                          57
THE RURAL DIMENSION

18% of Bradford District‟s population live in rural areas (this includes large villages
such as Addinham, Haworth, Denholme and Wilsden, and the market town of Ilkley).
Rural pubs are less likely to stay open all day, and their limited number means that
drinkers are likely to spend the whole evening in the same pub, reducing the potential
for disorder on the streets.

The isolation and uncertainty of some rural trades such as farming and gamekeeping
is a contributory factor to rural stress and, therefore, increases the potential for
hazardous and harmful drinking.

Access to support services can be limited, and can be hampered by poor transport;
access to those support services found in villages (e.g. pharmacies and primary
care) can be conspicuous and thus off-putting. There may be a need to increase the
locations in which treatment and support services are provided.



DRINKING AMONGST MINORITY ETHNIC GROUPS

The mostly widely accepted interpretation of Islam forbids the consumption of
alcoholic drinks, and most Muslims obey this.

Research in 2005 for the former Bradford City tPCT showed that 97/98% of Pakistani
and Bangladeshi heritage respondents state that they never consume a drink
containing alcohol. (Bradford City tPCT “Health in the City” Annual Report of the
Director of Public Health 2006). Broadly similar results have been found amongst a
similar population in London.

A small number of Muslims do drink and more work is needed as to whether any
specialist services are required either for them, or for people from other ethnic
minority groups who develop problem-drinking. Other surveys have shown regular
drinking by Sikhs and, to a lesser extent, Hindus. Nearly 60% of Afro-Caribbean
residents in the former City PCT area drink alcohol, with around 37% drinking at least
four times a week.

However, anecdotal evidence from within the Muslim community suggests that
drinking alcohol is not as rare as these figures suggest. The two groups most likely to
drink are older men who have been in Bradford since the 1960s and 1970s, and
young people who are rejecting some of the norms of the Muslim community. This
latter point has also been highlighted by Project 6 in Keighley, who are encountering
15-19 year olds (especially males) drinking alcohol, some of them being poly-drug
users (two or more of alcohol/cannabis/cocaine/pills). They often attempt to hide their
alcohol use, and are more likely to admit to drug use before revealing their „haraam‟
drug use (info from Mike Cadger, Project 6)

 Recent research in Stoke-on –Trent (“Drinking Places. Where people drink and
why.” Valentine G et al, Joseph Rowntree Foundation, 2008) identified significant
levels of drinking amongst young Muslim males, who start drinking in their mid to late


Alcohol/Strategies/Bradford as at 17.12.08                                          58
teens, but in many cases give up in their twenties when they get married and take on
responsibilities. The teenagers who started drinking said that it gave them confidence
- particularly with women- and was an escape from the stresses of everyday family
life. They often drank to get drunk, and favoured spirits bought from off-licences
which was drunk in informal places such as parks, bus shelters and cars. Drinking by
young men is described as an “absent presence” in the community because it is
known that it occurs, but it is rarely acknowledged within families, except between
siblings. Young women were most unlikely to drink, unless they leave home, for
example to go to university; drinking by girls and young women is much more
strongly prohibited and policed by parents and the community than is drinking by
young men.

For this reason it is highly necessary that we are able to engage in aculturally
appropriate and sensitive manner with these Muslim drinkers, who are in need of
help. The Stoke research found that married men who drank frequently had feelings
of shame and guilt; and that alcohol was associated with a lack of respect, a lack of
control and was seen as degrading.

In response to the Stoke research, the Director of the Project 6 drug and alcohol
agency has made the following observations from their work in Keighley.
       1. The picture of youthful alcohol use is very familiar.
       2. The deliberate attempt to hide it, also rings true.
       3 Our detached workers are now regularly reporting a tendency for young
       men to more readily admit to cannabis use, before revealing the 'haraam'
       alcohol use.
       4 There is also growing evidence of (weekend) poly drug use (alcohol,
       cannabis, cocaine and pills).
       5 We've no direct evidence of shifting patterns following marriage (because of
       course we don't see so many married men on the streets).
       6 There is some (emerging) evidence of youthful female substance use.
       7 Street venues and cars are widely utilised as meeting/socialising places.”


Another issue to consider is that the unfavourable impact of drunken behaviour by
other people on Muslim residents, who favour modesty, should be recognised; this
may contribute to community relations problems, and to the development of extremist
views amongst a small minority of young Muslims.

More work is needed as to whether any specialist services are required either for
Muslims, or for people from other ethnic minority groups who develop problem-
drinking. Other surveys have shown regular drinking by Sikhs and, to a lesser
extent, Hindus. Nearly 60% of Afro-Caribbean residents in the former City PCT area
drink alcohol, with around 37% drinking at least four times a week.,

We also need to address alcohol abuse amongst Eastern European migrant workers.
Although there is very little available in terms of evidence-based research, anecdotal
evidence suggests that there is heavy drinking amongst this population, and that
some individuals from these communities are involved in violent crimes. The whole
issue around access to services and targeted publicity specific to this group needs
attention.


Alcohol/Strategies/Bradford as at 17.12.08                                          59
OLDER PEOPLE AND ALCOHOL

Although older people (aged 65+) have not been identified as a key priority group
with regard to alcohol misuse, there are specific issues relating to this age group.

This is an under-researched group, but it is known that alcohol use affects seniors in
different ways from younger people.
     The benefits of low to moderate drinking, e.g. the protective effect with regard
       to cardiovascular disease, apply especially to this age group.
     There are reports that low to moderate alcohol consumption may be
       associated with better cognition, psychological wellbeing and improved quality
       of life in elderly populations, but these may be related to social interaction
       around alcohol use rather than the alcohol use itself.
     As people become older, they become less tolerant to alcohol due to
            o A fall in ratio of body fat to water – less water for the alcohol to be
                diluted in
            o Decreased hepatic blood flow – liver will receive more damage
            o Inefficiency of liver enzymes – alcohol will not be broken down as
                efficiently
            o Alerted responsiveness of the brain – alcohol will have a faster effect
                on the brain
     This reduced tolerance means that elderly drivers are three times as likely to
       be involved in an accident after consuming even a small amount of alcohol,
       than they are with a zero level of alcohol.
     Alcohol depresses the brain function to a greater extent in older people,
       impairing coordination and memory, which can lead to falls and greater
       confusion.

Older drinkers have been classified into three types:
    Early –onset drinkers or survivors are people who have a continuing problem
      with alcohol misuse which developed in earlier life
    Late-onset drinkers or reactors who begin problem drinking later in life, often
      in response to traumatic life events
    Intermittent drinkers drink occasionally, and may sometimes drink to access.

(all the above information is taken from the institute of Alcohol Studies Fact Sheet
“Alcohol and the elderly”, dated 3 April 2007.)


LGBT PEOPLE AND ALCOHOL
There is little good research about the drinking habits of LGBT (lesbian, gay men,
bisexual and transgender) people, but there is some evidence that young LGBT
people drink heavily and have more alcohol problems than the general population,
and that this may also apply to LGBT adults. (1. “Gay, lesbian, bisexual and
transgender health. Alcoholism among GLBT people. “ Public health, Seattle and
King County. www.metrokc.gov/health/glbt/glbtalcohol ) (2. Hughes t L and Eliason



Alcohol/Strategies/Bradford as at 17.12.08                                             60
M , “Substance use and abuse in lesbian, gay, bisexual and transgender
populations.”. The Journal of Primary Prevention v22, #3, 2002. pp263-298)

A health needs assessment was carried out amongst 104 LGB people in the
Bradford district in 2007. There were methodological issues which mean that the
results need to be treated with caution, but allowing for this, 43% of respondents
exceeded recommended drinking levels at least sometimes, and 34% binge drink at
least sometimes. No respondents were very concerned about their consumption, but
two were very concerned about their binge drinking.(Williams S, Bradford and District
LGB Health Needs Assessment, The Equity Partnership, October 2007,
www.equitypartnership.org.uk )




Alcohol/Strategies/Bradford as at 17.12.08                                         61
      CHAPTER 11: CURRENT AND FUTURE
 INTERVENTIONS TO HELP US ACHIEVE OUR AIMS
ACTIONS BY OUTCOME OBJECTIVES – INTERVENTIONS TO HELP US
ACHIEVE OUR AIMS
This chapter reviews recent and current activities in the Bradford district, and
proposes key actions which will help to deliver the aims (outcome objectives) of the
local strategy..


A1 TO REDUCE THE NUMBER OF PEOPLE WHO DRINK ALCOHOL
ABOVE RECOMMENDED LIMITS, THUS REDUCING THE ADVERSE
HEALTH IMPACT OF ALCOHOL.
The prime methods that we can use locally to achieve this aim are to make brief
interventions widely available, to lobby government directly and indirectly for
legislative changes, and to develop social marketing initiatives.

Brief interventions are a cost effective way of impacting upon the alcohol
consumption of those who are drinking hazardously or harmfully, but have not
become dependent. The Department of Health publication “Alcohol Misuse
Interventions: Guidance on Developing a Local Programme of Improvement”
(Department of Health, 2005) outlines their advantages.
 A recent exemplar analysis of an average A&E department has modelled the
    potential impact of brief interventions for hazardous and harmful drinkers on the
    percentages of attendances at A&E seen within the four-hour target, and
    suggests that the use of screening and brief interventions could impact on alcohol
    consumption to the extent that it could reduce patients‟ average journey time
    through A&E by between 6% and 16%. In a busy A&E department this would be a
    significant improvement.
 Patients who received a brief intervention following visits to a London accident
    and emergency unit made on average 0.5 fewer repeat visits in the following 12
    months compared to those in a control group.
 The direct cost of a brief intervention delivered to hazardous or harmful drinkers
    was calculated to be only £20 in 1993.
 A recent WHO study estimated that the cost-effectiveness of brief interventions
    for hazardous and harmful drinking is approximately £1,300 per year of ill-health
    or premature death averted. This is slightly better than the cost-effectiveness of
    smoking cessation interventions, which is around £1,200.
 A recent trial found that brief intervention trials can reduce weekly drinking by
    between 13% and 34%, resulting in 2.9 to 8.7 fewer mean drinks per week with a
    significant effect on recommended or safe alcohol use. For every 8 hazardous or
    harmful drinkers who receive brief interventions, one reduced their drinking to
    low-risk levels. This compares favourably with smoking cessation where 20
    people need to be treated (or 10 if nicotine replacement therapy is included), for
    one to change their behaviour.
Commissioners must develop partnership arrangements with acute hospital providers
to ensure that patients accessing secondary care services are offered brief
interventions for screened and assessed alcohol misuse. Secondary care is a key



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setting for the potential screening of individuals for alcohol misuse. Given the
confirmation by considerable evidence of the burden placed on acute hospitals, there
are considerable benefits to be gained, by both the hospital and patient, from
screening patients at a Tier 1 setting (i.e. A&E Departments, Ante-Natal
Departments).
 St. Mary‟s Hospital, London has shown that interventions for screened
    hazardous/harmful drinking resulted in an average of 0.5 fewer visits to A&E in
    the following 12 months.
 Evidence suggests that hazardous and harmful drinkers receiving brief
    interventions were twice as likely to moderate their drinking 6 to 12 months after
    an intervention when compared to drinkers receiving no intervention.
 If consistently implemented, GP-based interventions would reduce levels of
    drinking from hazardous or harmful to low risk levels for 250,000 men and 67,500
    women each year. (This translates as approximately 2000 men and 520 women
    in Bradford, and would offer significant savings to the NHS locally.


RECENT AND CURRENT ACTION IN BRADFORD
 Anti binge-drinking social marketing campaigns in December/January 2005-6,
  and in January/ February 2007.
 Provided funding for the Lifeline Piccadilly Project (secondary care and street
  agency), funded until March 2008 by the PCT, SSCF/NRF and Communities for
  Health. All funding has been mainstreamed by the PCT from April 2008.
 Brief interventions are provided on an ad hoc basis in various settings, and in a
  structured way in the Primary Care Pilot Project based at Allerton Health Centre.
  The Allerton Pilot will be gradually rolled out to other primary care practices
  across the district from 2008.
 An additional £42,000 has been made available by the PCT and the former
  Strategic Health Implementation Partnership (SHIP) to train up to 1300 staff
  across Bradford to deliver brief interventions in a variety of settings. These will
  include NHS staff in primary care, A&E, general and surgical wards, out-patient
  clinics, mental health services, health visitors, midwives and dentistry; and
  colleagues in other settings including the Police, Probation Service, DWP, Adult
  Service, Children‟s Services, housing providers, the Youth Service, education
  and voluntary sector agencies. The training programme ran from March to
  September 2008, and is currently being evaluated.
 The SHIP funding will also enable 20 professionals to be trained to deliver brief
  interventions training to new colleagues, thus sustaining the training programme.
 W.Y. Probation Services is delivering accredited binge-drinking programmes to
  clients in the District.
 Bradford Council‟s Health Improvement Committee recommended (April 2008)
  that all relevant organisations publicise the information website
  www.nhs.uk/alcohol , and further recommended the creation by mid 2009 of a
  local information centre “which would serve as a hub for the collection and
  dissemination of information non the harmful effects of alcohol, the availability of
  suitable treatments, and the funding for such treatments.” (“Alcohol as a health
  issue”, Health Improvement Committee, City of Bradford Metropolitan District
  Council, October 2008.)




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FUTURE ACTION IN BRADFORD

       Brief interventions will be mainstreamed across key agencies following
        completion of training.
       Additional social marketing campaigns planned subject to funding
       Commission dedicated alcohol workers in the acute hospital setting to deliver
        brief interventions, treatment, support and liaison with other providers in
        accordance with RCP guidance; this should include recognition of the differing
        needs of ethnic minority communities, particularly the Muslim community
       Commission services within A&E to deliver brief interventions for harmful and
        hazardous drinkers through the use of a dedicated alcohol worker.
       Information about the national information website www.nhs.uk/alcohol to be
        included on the Safer Communities Bradford website, other relevant local
        websites, and on appropriate locally produced publicity and marketing material
        about alcohol.
       Create a Bradford and District Alcohol Information Service, web and telephone
        based, to collect and disseminate to the public information on the harmful
        effects of alcohol and on how to access treatment.


A2 TO REDUCE ALCOHOL-RELATED CRIME, DISORDER,
INTIMIDATION, NUISANCE AND ANTI-SOCIAL BEHAVIOUR, AND
ENSURE THAT EVERYONE CAN ENJOY ALL AREAS OF THE
BRADFORD DISTRICT WITHOUT FEAR OF ALCOHOL-RELATED
VIOLENCE AND INTIMIDATION

There are strong correlations between alcohol and certain types of crime. The Facts
section of this strategy illustrates some of these connections. As well as rape,
violence (including domestic violence and racist and homophobic attacks), acquisitive
crime and driving offences, other crimes associated with alcohol include property
damage, fire-setting, aggression and harassment and sexual crimes (in which the
victim as well as the perpetrator may have been under the influence of alcohol).

Alcohol-related crime and nuisance place an enormous burden on public services,
such as the Police, Ambulance Service, A&E, street cleaning and public transport,
and the staff of all these services are at an increased risk of violent assault and
abusive behaviour. As well as the night-time economy, the pinch-points also occur
around professional football matches; live football being shown on TVs in pubs or on
big outdoor screens; and some popular music events.

As well as the violence and disorder associated with pubs and clubs, considerable
public nuisance is caused by teenagers (and a few pre-teens) drinking alcohol in
public places. This typically results in rowdy and sometimes intimidating and violent
behaviour, littering and vomiting, and is dangerous to the health of these young
people who are still growing and whose internal organs have not reached maturity.



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Another source of disorder is street drinkers, who are socially isolated dependent
drinkers, mostly living in poor accommodation or homeless.

The Council‟s Licensing Authority actively encourages the further development of
Prime Entertainment Districts i.e “those parts of the district that have developed over
time to be the prime areas for entertainment venues, cinemas, restaurants etc” It
recognises their role in adding to the vibrancy of the district and believes that they
are supportive of Bradford Council‟s cultural, tourism and evening economy
strategies. The areas which the Licensing Authority considers to be Prime
Entertainment Areas are:
     Bradford City Centre
     Little Germany
     West End of Bradford
     Bradford Leisure Exchange
     Central Shipley
     An area of central Keighley
     An area of central Bingley

Other areas with significant entertainment “offers” include Saltaire, Baildon, Wibsey
and Ilkley.

The binge-drinking culture - drinking with the intention of getting drunk - means that a
range of problems is now an intrinsic feature of evening and night-time city and town
centres. Noise, rowdy behaviour, littering, vomiting, urinating in the streets, criminal
damage, disorder and violence exclude many people from participating in the night-
time economy.

It is essential that the night-time economy (used to mean activities from 6pm
onwards) is attractive to people of all ages who wish to enjoy it. It must be recognised
that whilst much of the night time economy is oriented to young adults, there are
significant other attractions of great importance to the cultural life of the district whose
popularity is dependent on patrons being able to access and egress them without
being subject to anti-social, intimidatory or violent behaviour from those under the
influence of drugs or alcohol; these venues include St George‟s Hall, the Alhambra
Theatre, the cinemas (including those in the National Media Museum), bowling
alleys, leisure centres, restaurants and those pubs catering for an older clientele.
Bradford and Keighley centres are short of the type of good quality restaurants and
cafes found in other large town and city centres. Whilst the youth oriented venues
have made a significant contribution to the regeneration of Bradford city centre, the
unattractiveness of the city centre to older people on Thursday to Sunday evenings
must be a significant factor impeding Bradford‟s ambitions to grow its non youth
oriented evening economy.




INITIATIVES BY SUPERMARKET AND OFF-LICENCE CHAINS
As this strategy was being concluded, evidence of the beginning of a more
responsible attitude by some major retailers emerged.


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ASDA announced new controls for 2008, including:
   phasing out the sale of sweet fruit-flavoured shot-sized "shooters", which
     have 15% alcohol content. They have been highlighted by campaigners as
     particularly attractive to underage drinkers. They include Shuda sour and
     sweet drinks, and Sidekick Splitz and Shooters.
   introduce a Challenge 25 ID system
   considering private prosecutions against under-18s in cases where police
     choose not to prosecute. A spokesman said: "In appropriate cases, we will
     urge and expect the police to take action themselves where offences are
     committed. However, we are giving offenders a clear message that we have
     the right to prosecute them ourselves even if the police decide not to
     prosecute. We hope this will act as a deterrent."
   doubling the number of test purchases at its 352 UK stores
   from April, the chain's 100 town-centre 24-hour stores will stop selling alcohol
     between midnight and 6am to stop people buying alcohol late at night when
     they leave bars and clubs.
   £1m invested via Business in the Community into targeted youth projects
     aimed at reducing underage alcohol misuse
  (ASDA presentation to Bradford Council Health Improvement sub-committee,
  26.2.08)

In May 2008, Tesco instructed its cashiers not to sell alcohol to adults who were
shopping with young people, if they suspect that the adult is buying the drink for an
under-age youth. (Daily Telegraph, 15.5.08)

In Westminster, Tesco, Waitrose, Budgens, Londis and Threshers have agreed to
stop selling three cheap, very strong drinks – Carlsberg Special Brew, Tennent‟s
Extra and Diamond White cider in an attempt to dter street drinkers. (Independent on
Sunday 24.2.08)

However, both Asda and Tesco were criticized by the Home Affairs Committee for
selling alcohol below cost price (Daily Mail, 3.6.08).


WHAT BRADFORD IS DOING
   Implemented the Best Bar None Scheme, a WYP initiative to encourage
    responsible pub management, although take-up has been slow.
   Established the Bradford District Licensing Forum which brings together
    Council‟s Licensing Authority, Council‟s Safer Communities alcohol policy
    lead, West Yorkshire Police, West Yorkshire Fire and Rescue Service, West
    Yorkshire Trading Standards, and the licensed trade.
   Set up a Licensing Review Group, members of which are the Council‟s
    Licensing Authority, Councils Environmental Health, WYP, WYFS, and WYTS.
    The group focuses on compliance with and enforcement of the Licensing Act
    2003.
   Police ran an AMEC (Alcohol Misuse Enforcement Campaign) campaign in
    2004, 2005 (twice) and 2006 (summer). This has now been mainstreamed into
    Operation Gridiron, which covers Bradford city centre and the west end.



Alcohol/Strategies/Bradford as at 17.12.08                                              66
       Police issued 399 Penalty Notices for Disorder (PNDs) for alcohol related
        offences between April and December 2007; of these, 358 were for drunk and
        disorderly in a public place, and 30 for the sale of alcohol to an under 18.
       Implemented controlled drinking zones in Bradford City Centre, and the town
        centres of Keighley, Bingley, Shipley and Ilkley, using the powers in the
        Criminal Justice & Police Act 2001.
       In its first two years, the provisions of the Licensing Act re opening hours have
        assisted with the reduction in violent crime in Bradford city centre, due to
        flexible closing hours and a reduction in tensions at takeaways and in taxi
        queues. The 2am rush has ended. Another contributor to the reduction in city
        centre violence and disorder has been the increase in opening hours in local
        areas, which has resulted in less people visiting the city centre to drink.
       The Probation Service is implementing the NPS‟s draft alcohol strategy which
        puts the emphasis on advice and guidance for hazardous drinkers, in line with
        Government approaches on early interventions.
       Funded a wet house/day shelter for alcohol-dependent and other homeless
        people, run by Horton Housing Association in Edmund Street. Additional
        funding for a rear garden has been agreed by the Environment Partnership
       A working group is currently (Summer 2007) developing a systematic
        approach to reducing alcohol-related injuries using the Cardiff model of
        intervening at hotspots identified through A&E data.
       Bradford Youth Service provides young people with access to information
        relating to alcohol and other substance misuse, and relevant support services.
       Alcohol and drugs awareness is addressed through informal interventions with
        young people in youth projects, youth cafes and youth centres across the
        District.
       The Youth Offending Team (YOT) screens all clients for alcohol and drug
        misuse, with follow-up if there is cause for concerns. Clients referred for
        treatment are seen within ten days, in accordance with national
        Standards/EFQA guidelines.
       The Youth Support service delivers alcohol and drug awareness sessions to
        YOT clients on a weekly basis.
       YOT offers 1-to-1 and group work sessions on substance misuse, including
        alcohol.
       YOT can request that a Drug Treatment (and Testing) Requirement (DT{T}R)
        be attached to a Supervision Order, or Action Plan Order.
       The 2005-6 social marketing campaign saw anti binge-drinking posters in
        Bradford City Centre and inside buses and licensed premises, together with
        the use of a big screen in the West End; the social marketing campaign
        complemented the AMEC campaign.
       The 2007 social marketing campaign “Drinking: Know Your Limits” used bus
        sides and posters and leaflets inside pubs and clubs; it was designed to
        complement the Government‟s “Alcohol: Know Your Limits” campaign.
       The Street Angels, a church based voluntary organisation, have since 2007
        been working to reduce alcohol related harm in centre and west end by
        providing a support and assistance to people under the influence of alcohol.
       Launched in October 2008, a social marketing campaign aimed at deterring
        adults from purchasing alcohol for under-18s.




Alcohol/Strategies/Bradford as at 17.12.08                                            67
FUTURE ACTIONS
 The Confiscation of Alcohol (Young Persons) Act 1997 should be vigorously
  implemented; it allows the Police to confiscate alcohol from under-age drinkers in
  any public place.
 Youth Service to consider increasing outreach work with under-age people
  drinking in public places.
 Enhanced enforcement by Trading Standards on off-licences (including
  supermarkets) who sell alcoholic drinks to or for young people under 18 years.
 Introduce polycarbonate glasses, and ban drinking from glass bottles, in all
  licenced premises which have, or are in, areas which have a history of alcohol
  related violence.
 Police to robustly implement the new powers in the Violent Crime Reduction Act,
  allowing the 48-hour closure of premises persistently selling to under-age
  drinkers.
 Develop a Safer Travel at Night Scheme, including the provision of night-time
  public transport on key routes at weekends and taxi marshall schemes in key
  locations.
 Increased treatment interventions with street drinkers.
 Enhanced measures aimed at eliminating sales in pubs and clubs to and for
  minors, and to and for adults who are intoxicated.
 Continue with social marketing campaigns to combat binge-drinking, provided that
  there is a need not met by national campaigns.
 Implement the Respect Action Plan which includes intensive working with
  problem families responsible for serious anti-social behaviour.
 Close working with British Transport Police regarding alcohol-related crime,
  disorder and nuisance on trains, railway stations and other railway property.
 Courts to be encouraged to impose Alcohol Treatment Requirements (ATRs),
  whereby an offender is required to attend treatment or reduce or eliminate
  dependency on alcohol (ATRs are one of the Community Orders introduced
  under the Crime & Disorder Act 2003).
 Implement robustly (a) the provision in the Violent Crime Reduction Bill which will
  allow the issuing of 48-hour Drinking Banning Orders to individuals, and (b) the
  new police powers to expedite reviews of premises seen as associated with
  serious crime and disorder, with associated LA powers to impose additional
  licensing conditions, pending the results of the review.
 Advocate the setting up of a West Yorkshire network of chairs, vice-chairs, and
  key officers of Licensing Committees, to enable sharing and learning from others‟
  experience, and the promotion of best practice.
 The Police to increase the roll out of the Best Bar None initiative, and otherwise
  identify and take action against premises that serve alcohol to people who are
  drunk.
 The Licensing Authority should consider a pub or club‟s reputation for drunken
  clients when approving, renewing or reviewing licences.
 Introduce polycarbonate glasses, and ban drinking from glass bottles, in all
  licensed premises which have, or are in, areas which have a history of alcohol
  related violence; lids to be available to prevent spiking. This is to be achieved by


Alcohol/Strategies/Bradford as at 17.12.08                                         68
    a mixture of persuasion and by the Licensing Authority laying down conditions for
    new and renewal applications when representations are received that alcohol
    related violence is a risk.
   All licenced premises to be recommended to offer 125ml glasses of wine.
   Consideration to be given to the introduction of a Bradford Standard for on-
    licensed premises (which would be broader than the Best Bar None scheme),
    ideally in collaboration with the alcohol and entertainment industries. The
    Standard would aim to change the drinking environment and reduce the risks
    associated with binge drinking through:
         o BEST BAR NONE FEATURES
            o Good management
            o Training for bar staff
                (both of these to focus particularly on not serving the intoxicated, and
                on giving good service to other customers)
            o Enforcement limits on numbers of customers admitted
            o Better toilet design and toilet supervisors
            o Reducing risks of fire (especially regarding clubs) and ensuring fire
                exits are clear
            o Zero tolerance policy towards illegal drug use
            o Booking service for taxis and minicabs (private hire)
            o Awards for the best premises and co-ordinated marketing opportunities
                for all Bradford Standard premises
         ADDITIONAL FEATURES
            o Designing out features which encourage binge drinking and
                aggression, e.g. replacing „vertical drinking establishments‟ with seated
                venues
            o No overheating of premises
            o Plentiful and easily-accessible provision of free water
            o Diversification, especially into food (late night food offer has the
                additional advantage of reducing demand for take-aways)
            o Ending all cheap drinks promotions (although the remit of the
                Competition Commission makes this problematic)
            o Agreed maximum noise levels
   Implementation, should future circumstances demand it, of the provision in the in
    the Violent Crime Reduction Act which designates Alcohol Control Zones (ACZs),
    thus allowing pub and club-owners to be charged for policing as a lever to
    encourage bar and club owners to sign up to the Standard.
   Proposals for economic regeneration which include night-time economy elements
    should include a robust cost benefit analysis to the community of such indicators,
    and should specify that all proposed licensed premises meet the proposed
    Bradford Standard.
   The potential for alcohol related crime, disorder, and nuisance to be considered
    by the Council‟s Planning Department at both the strategic planning (Local
    Development Plan) and development control (planning applications) levels.
   Police to use “Direction to Leave” powers contained in the Police Reform Act to
    counteract alcohol-related anti-social behaviour in specific areas.


A3. TO REDUCE THE PREVALENCE OF HARMFUL DRINKING BY
CHILDREN AND YOUNG PEOPLE UNDER 18

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Whilst fewer adolescents drink in Bradford than the national average, this is no cause
for complacency. Bradford‟s lower prevalence reflects the large numbers of Muslim
young people in Bradford, and it can be assumed that other ethnic groups have an
attitude to alcohol similar to their peers elsewhere in England. The extent of under-
age drinking by young people under 18, and especially by secondary school children
aged 11-15, is thus a major cause for concern. Data in another section of this
document details the scale of the problem. Whilst drinking alcohol has always been
seen as a rite of passage for teenagers, the concern today is that children are
starting their alcohol careers younger, and that those who drink are drinking more.
The social impact of this is neighbourhood and town centre nuisance and anti-social
behaviour, together with violent crime. The educational impact is of school and
college work suffering due to alcohol-related unfitness. The immediate health impact
is alcohol poisoning and accidental injuries. The longer-term health impact for
young, heavy and binge-drinkers is the early onset of sometimes fatal alcohol-related
diseases from the mid-20s onwards.

As well as the damage caused by under-age drinking, there is some evidence that
binge drinking amongst some 11-15 year olds is an early step down their road to
misusing cannabis/skunk and other drugs.(Research amongst prisoners at HMYOI
Polmadie, reported in “The Herald”, 2.3.07).

There is concern over the tactics of the alcoholic drinks manufacturers with regard to
young people. An industry insider has admitted that the market is booming for high
strength, pre-mixed spirits that get young people drunk faster. The executive said
that cheap, sugary drinks packaged in bright colours are the best way to start
drinking early in adulthood. (“Stuart J. Mascat tells of young drinkers being targeted,
The Age, Melbourne, 6.8.07”). It is clear such products have a similar and probably
greater appeal to under-age drinkers.

There is concern over the effectiveness of school-based drug education
programmes, and systematic reviews of available published research, mainly from
the USA, show that the success of these programmes is limiting the uptake of
tobacco, alcohol or other drugs has been slight or non-existent, and that they may
actually be counter-productive (ACMD, “Pathways to Problems”, 2006). This sets an
enormous challenge in enhancing primary prevention.

WHAT BRADFORD IS DOING
 In 2005, 38% of schools in Yorkshire and the Humber had achieved level 3 of the
  Healthy Schools Standard, and 40% were working towards it (England 38%/34%).
  Bradford figures were much lower at 22% and 23% - the worst in the region (DH,
  2005).
  By 2008, the national average of schools having achieved the revised upgraded
  NHSP standard is 55.6% with 94.7% of schools participating. In Bradford, there
  have been major improvements. Following the implementation of a new
  programme of support and audit, Bradford figures have improved to 60% of
  schools having achieved the new NHSO standard, with 97% of school registered
  as working towards it. Both figures are significantly higher than the national
  statistics and are reflective of the authority‟s rapid progress from a red RAG rated
  authority to its current green status.


Alcohol/Strategies/Bradford as at 17.12.08                                           70
Schools- Substance misuse is a key feature of PSHE delivery in school settings with
particular reference to alcohol. Just as relationships are a key element of sex
education the same association has been implemented for delivery of alcohol
education.
    Primary Schools
   The primary PSHE spiral curriculum spans the year groups from reception to year
   6 with additional focus and preparation from transition year 7. Whilst delivered as
   a timetabled subject there are also cross curricular links to support and affirm
   healthy behaviour messages within literacy, numeracy and the science
   curriculum. The main focus is on prevention and health promotion and the
   curriculum has clear educational outcomes within DCSF guidelines mapped by
   the ECM key judgement framework. This ensures an externally audited and
   moderated baseline delivery, consistency of contact of teaching staff / support
   staff, less likelihood of challenging subject area. An additional benefit of this
   district wide model is the continuity of learning which can be achieved for more
   transient sections of the community. Even if a primary pupil experiences several
   changes of primary school within the district the continuity of PSHE should be
   maintained.

    The Life Education Programme supports the primary PSHE strategy and provides
    more in depth alcohol and relationships education to primary pupils, teaching
    staff, parents and carers.

    Life Education is a national charity and Education Bradford hosts the specialist
    educators and commissions the extended provision which includes parenting
    support work in targeted areas of known with high incidence of substance misuse
    through two routes- primary assembly project for parents of all participating pupils
    and targeted 6 week parenting programmes where needs analysis has shown
    alcohol to be a key problem area.

     Secondary Schools
    A revised secondary PSHE curriculum was introduced in October 2007 following
    a full review of the PSHE network coordinators consultation and pupil consultation
    re generic PSHE delivery methods. Unlike primary settings the pressure on the
    secondary timetable is intense particularly from year 10 when pupils select study
    options and are on varied pathways, many of which may be vocational and pupils
    are offsite for the majority of their education. This in addition to the move from
    class based teaching to subject led teaching which requires more staff to be
    skilled in delivery, with excellent PSHE subject coordination a vital support
    element. To support this, Education Bradford provides basic and advanced
    substance misuse training with drug & alcohol kits given free to all schools on
    completion. In addition, unlimited free one to one consultant support is offered to
    facilitate the move beyond policy development to implementation and curriculum
    delivery. This support includes signposting to multi-agency interventions to add to
    curriculum delivery that is quality assured.

    Pupil consultation gave clear messages as to how they wanted PSHE to be
    delivered. Key areas identified were: more interactive methods of delivery,
    opportunity to work in groups and individually, and the “subject needs to feel
    worthwhile”. In response schools are now using a new interactive media lesson


Alcohol/Strategies/Bradford as at 17.12.08                                            71
    builder system to cover all aspects of PSHE delivery including specific alcohol
    modules to promote discussion and interactive learning. Work can be carried out
    in classes, year groups or at individual pupil level and enables tracking of
    individual pupil progress to enable tailored targeted intervention.

    Peer education- Education Bradford hosts the training, delivery and support of the
    Bradford Schools Drug Prevention Initiative (BSDPI). The steering group is a multi
    agency body. Introduced for secondary pupils, the programme has been
    extended to primary pupils from 2005.

    Primary and secondary PSHE networks have been introduced to bring together
    those leading in this area across the district. The aim is to provide a
    communication system to update re Government directives / changes to
    legislation and enables sharing of best practice.

    Continued Professional Development (CPD) mentorship- Education Bradford
    supports this national externally assessed post graduate module now in wave 5.
    This includes the opportunity to recruit to the programme teachers who specialise
    in drug education with a focus on alcohol misuse.

   Youth Service
    The service provides access for young people to health related information,
    support and specialist services at a variety of informal settings, including The
    Information Shop for Young People, Youth Cafes, youth centres and projects.

    Detached youth workers increase young people‟s access to information and
    services through contact made outside these settings e.g. on the street, in parks
    and in places where they choose to be.

    The Service provides opportunities for young people to have fun and get involved
    in positive experiences, at times when they are more likely to indulge in under-
    age drinking e.g. evenings, weekends and holiday periods.

    Youth workers provide a range of curriculum activities to increase young people‟s
    emotional, physical and mental well-being.

    Youth workers provide opportunities which raise young people‟s awareness of the
    consequences and risks of alcohol and substance misuse and enable them to
    make more informed choices.

    Youth workers work in partnership with other agencies to provide integrated, non-
    stigmatised services for vulnerable and individual young people including those
    who are at risk of offending or not in education, training or employment.

   Bradford was a High Focus Area (HFA) for young people‟s substance misuse
    services during 2004-7
   Bradford has a Young People‟s Drug and Alcohol Service (BYPDAS) made up of
    three services functioning as a virtual team:
        o Bradford Council Youth Support Services Alcohol and Drugs Team



Alcohol/Strategies/Bradford as at 17.12.08                                             72
       o Bradford District Care Trust (NHS) Children‟s and Adolescents‟s Mental
          Health Services Substance Misuse Team (CAMHS SMT)
       o Bridge Young People and Families‟s Service (voluntary sector provider).
       The team has a referral protocol and a centralised referral line. Referrals can
       be self-referrals, or from third parties including parents, schools, GPs etc.
 BYPDAS meet weekly with the Youth Offending Team (YOT) to allocate cases.
 The Youth Support Service works with disadvantaged young people who have
   any substance misuse problems, including alcohol. It has four teams:
       o Drug Prevention Team delivers alcohol and drug awareness in various
          youth venues, including schools, children‟s homes, pupil referral units and
          the YOT.
       o Outreach Team, who provide counselling, psychosocial and harm
          reduction interventions.
       o Arrest Referral Team, who make contact with arrestees aged under 19,
          and provide short term tier 2 interventions; their role is being expanded to
          include being a first contact and onward referral point for other vulnerable
          groups, and to do some work with parents and carers.
       o Specialist Family Assessment Team
 Bridge have a Young People‟s Alcohol Worker, who works with young people with
   alcohol problems. She helps them find ways of reducing their intake by focussing
   on developing coping strategies, working on what motivates them, and setting
   goals for the future.
 A new common assessment tool is in use across settings.
 Anti binge-drinking social marketing campaigns (Christmas/New Year 2005-2006,
   and January/February 2007) reached under-18s, although nominally aimed at the
   18-25 age group.
 From 2007, the Young Persons‟ Substance Misuse Commissioner has produced
   an annual needs assessment to an NTA template.
 The YP Substance Misuse Commissioning group agrees an annual treatment
   plan, which is submitted to the NTA
 Key House, Keighley (a hostel for young people aged 16-24) has an alcohol
   worker funded by Comic Relief. Key House has a throughput of about 100 clients
   a year. The worker provides information and education on alcohol issues to all
new residents, and refers into structured treatment at Project 6, where
  appropriate; she also enables user involvement in centre activities.
 In October 2008, a social marketing campaign aimed at deterring adults from
   purchasing alcohol for under-18s was launched.



TARGETS FOR 2008-9
The following targets are contained in the Young People‟s Needs Assessment and
Plan for 2008-9, agreed with the National Treatment Agency:
        All young people of secondary school age attending a Pupil Referral Unit
          (PRU) to be screened for substance misuse, and receive drug and alcohol
          awareness information.
        Engage with 40 pupils excluded from school, and attending a PRU,
          through the delivery of drug education and awareness work, and ongoing
          referral if required.



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            Identify the number of young people excluded from school who are
             accessing tier 3 treatment services.
            Identify the number of young people accessing tier 3 services who define
             themselves as non-attenders at school.
            All young people aged 11 and over who are looked-after (within the district)
             to be screened for substance misuse.
            Engage with 20 looked-after children (11 years+) through the delivery of
             drug education and awareness work, and ongoing referral if required.
            Identify the number of young people accessing tier 3 services who are
             defined as looked-after.
            Engage with 86 young people whose parents are substance users through
             the SUPAKids Project.
            All young offenders engaging with the YOT are to be screened for
             substance misuse.
            Engage with 175 young offenders through the delivery of drug education
             and awareness work, with ongoing referral if required.
            Identify the number of young people accessing tier 3 services who are or
             have been a YOT clients
            300 young arrestees to be contacted by arrest referral workers in custody
             suites.
            Engage with 1000 secondary school pupils through the delivery of targeted
             drug education and awareness work, with ongoing referral if required.


Future Actions

   To implement new interventions to meet needs highlighted in the needs
    assessment;
       o Target awareness and prevention work to those wards with the highest
          number of adverse indicators for alcohol and drug misuse i.e. Bradford
          Moor, Bowling, Little Horton and Toller.
       o Further target all vulnerable young people, thus ensuring that they have
          access to substance misuse screening, and to alcohol information and
          awareness interventions.
       o Strengthen and formalise existing pathways to ensure that all vulnerable
          young people have a fast track referral route to referral services should
          they need it.
       o Establish closer links between Connexions and BYPDAS, as the majority
          of adolescents in specialist treatment are aged 15-18.
       o Introduce an updated website for BYPDAS which will have an on-line
          screening tool and information for young people, parents, carers, and
          professionals, enabling them to make a referral.
       o Establish referral pathways between BYPDAS and the two Accident and
          Emergency Departments, to establish referral pathways for young people
          presenting with an alcohol related condition.

   Continue to expand the role of the PSHE coordinators as mentors for other school
    based staff who may offer education and /or support re alcohol issues. This will




Alcohol/Strategies/Bradford as at 17.12.08                                            74
    encompass further modules within the continued professional development plan
    for coordinators.
   Recruit 20 new teachers to wave 6 of the CPD programme. (This will be aligned
    to schools / areas where current CPD levels are low and or there are significant
    known issues with alcohol misuse).
   Education Bradford to provide further training for school staff and multi agency
    staff re interactive secondary system and develop the central lesson base.
   Education Bradford to continue the substance misuse training programme for
    academic year 2008/09.
   Advocate legislative and fiscal changes which will make alcoholic drinks less
    glamorous/exciting/sexy, less accessible and less available to under-18s.
   Increase the level of activity aimed at eliminating the illegal sale of alcohol to
    minors, including:
                 Ensuring licensees and their staff are fully aware of their
                   responsibilities under the law
                 Encourage the use of high quality ID for all who look under 25
                   seeking to purchase alcohol
                 Develop initiatives to make adults fully aware of the law regarding
                   purchasing alcohol for under 18s
                 Increase levels of enforcement, using all legal methods.
   Police to take a zero-tolerance approach to under-18s drinking in public places
    and, if the law is changed, to under 18s in possession of alcohol in public.
   Education Bradford to influence and support all schools to achieve the Healthy
    Schools Standard (Level 3), and in doing so to provide alcohol education from
    Key Stage Three onwards that:
                 Provides information and teaching on skills and attitudes to young
                   people on the health and social aspects of drinking alcohol
                 Is age-appropriate, taking into account the different needs and
                   interests of different age groups
                 Is delivered every year to pupils in secondary schools, and those in
                   the final year of primary school
                 Is delivered in innovative ways, including through peer education,
                   and through representatives from voluntary agencies such as
                   Alcoholics Anonymous (AA).
                 Stresses the dangers of binge drinking and combined alcohol and
                   drug (especially cannabis) use.
   School governors to seek to influence and improve alcohol education in their
    schools and include in their „Annual Report to Parents‟ a summary of activity in
    relation to alcohol education.
   Advocate the introduction of a dedicated national alcohol helpline for young
    people.
   To deliver training to all staff working with children and young people to raise their
    consciousness of the risks associated with alcohol use.
   Request the Bradford and Keighley Youth Parliament to debate these issues, to
    endorse this strategy, and to develop their own involvement in tackling adolescent
    alcohol misuse.
   Consider emulating the Calderdale Alcohol Impacts Course, which is designed to
    offer 14-17 year olds arrested or detained for alcohol related offences a positive
    alternative to receiving criminal sanctions


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   Investigate making the LIFE drug education caravan available free of charge to all
    local primary schools.
   Seek to further develop the use of positive role models (e.g. responsible sports
    stars) to promote sensible drinking amongst young people.
   The Youth Service will increase young people‟s engagement in exciting and
    appealing music, arts and sports events, that are safe and alcohol free.
   Youth Workers will involve young people in developing models of peer led
    interventions.
   The Youth Service will develop and implement a Substance Misuse Policy with
    good practice guidelines to increase staff awareness and confidence in
    addressing young people‟s alcohol and drugs misuse. The policy will reflect the
    priorities of the „Drinking Sensibly in Bradford‟ strategy.


A4 TO DEVELOP A COMPREHENSIVE RANGE OF EFFECTIVE
TREATMENT, SUPPORT, REHABILITATION AND REINTEGRATION
SERVICES FOR ALCOHOL MISUSERS, WITH EASY ACCESS AND
CLEAR CARE PATHWAYS.

Recent studies suggest that as well as its health and social benefits, alcohol
treatment has both short and long-term savings.
  Analysis from the UKATT study suggests that for every £1 spent on treatment,
     the public sector saves £5.
 In a Scottish study alcohol treatment reduced long-term health care costs by
    between £820 and £1,600 per patient (2002/3 prices).
 The provision of alcohol treatment to 10% of the dependent drinking population
    within the United Kingdom would reduce public sector resource costs by between
    £109m and £156m. (“Alcohol Misuse Interventions: Guidance on Developing a
    Local Programme of Improvement” (Department of Health, 2005
 The NHS spends £217million a year on specialist alcohol treatment (Dawn
    Primorolo MP, Public Health Minister, quoted in The Guardian, 23.5.08)
 The Health and Social Care Act 2008 contains a new duty on PCTs to secure
    continuous improvement in the quality of healthcare provided or commissioned by
    them.

In 2006, the National Treatment Agency for Substance Misuse (NTA) published the
Models of Care in Alcohol Misuse (MoCAM). The overall strategic aim for alcohol
treatment is to achieve a fully resourced MoCAM service for the Bradford district.
MoCAM separates functions for care and treatment into four tiers, and these provide
the framework for commissioning alcohol treatment services. These are:

Tier 1: Provision of screening, information, brief advice, referral and shared
care in mainstream services, through;-
    Targeted screening
    Information and advice to hazardous drinkers
    Referral
    “Shared care” with agencies providing tiers 2-4 services




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Tier 2: Provision of open access support to reduce alcohol-related harm;
assessment and referral services, by those with defined competency in alcohol
(trained mainstream services or alcohol specialists) through:-
      Alcohol specific assessment
      Shared care with those providing higher tier services
      Mutual aid, e.g. AA

Tier 3: Provision of community-based alcohol-assessed, care-planned, co-
ordinated treatment. Provided by specialist alcohol agencies, through:-
    Comprehensive assessment
    Care planning and co-ordination
    A range of psycho-social therapies and support within a care plan. (Two
       current treatment approaches (Motivational Enhancement Therapy and Social
       Behaviour and Network Therapy) yield savings to the public sector of five
       times their cost (UKATT).)
    A range of interventions for assisted withdrawal (detoxification), and
       pharmacotherapies
    Shared care and training for Tier 1 and 2 providers

Tier 4: Provision of residential and inpatient care-planned, alcohol treatment.
Provided by specialist alcohol agencies, through:-
    Comprehensive assessment
    Care planning and co-ordination
    A range of psycho-social therapies and support within a care plan
    A range of interventions for assisted withdrawal (detoxification), and
       pharmacotherapies
    Shared care and training for tier 1 and 2 providers.

To these must be added the importance of appropriate housing in the treatment and
recovery journey. Housing provision also needs to include “wet houses” for those
homeless alcohol dependent people who cannot or will not be treated, and require a
safe place for the final part of their lives. Access to ETE (Education, Training and
Employment provision is also necessary for recovering formerly dependent drinkers,
who are insufficiently skilled or ready for the labour market.




WHAT BRADFORD IS DOING
A Planning Officer was appointed in March 2008 to the PCT substance misuse
commissioning team with responsibility for commissioning alcohol treatment services
and leading on the development of user and carer involvement.

The following services are currently available in Bradford district:
Tier 1
Details of Tier 1 services are given in the section about Aim A1 as these are
essentially designed to reduce people‟s alcohol consumption before serious harms
are caused, as well as to identify people who need referral to treatment services.




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Tier 2
    Alcoholics Anonymous (AA) has autonomous branches across the Bradford
       district. These run mutual support sessions according to a series of twelve
       common principles, which form the basis of AA‟s 12-step recovery
       programme.
    The Horton Housing Association Community Alcohol Support Team (CAST)
       offers a range of support in the community for alcohol misusers, including debt
       counselling, budgeting, welfare rights, liaison, health and hygiene.
    Caleb Café operates a drop-in facility.

Tier2/Tier 3
    The Lifeline Piccadilly Project is a long-established open access project
       offering information, advice, assessment, care planning, brief interventions,
       group work access to a physical health nurse, and complementary therapies.
       Bradford and Airedale PCT is providing core funding from April 2008
       (previously, some funding came from time limited sources including NRF and
       Communities for Health).
    Project 6 in Keighley is a drug and alcohol treatment and support agency, and
       offers advice, information, assessment, casework, complementary therapies,
       as well as a multi-agency anti-natal service for pregnant women, and a
       relatives‟ and carers‟ service.
    Substance misusers who are in treatment, whose primary drug is an illegal
       one, but who also misuse alcohol, will be offered treatment for their alcohol
       misuse as part of their treatment.

Tier 3
    Caleb Café, a Christian project, offers a range of activities including a
       structured five days a week programme based on the 12-step model. 15 of the
       43 clients who joined this structured day programme in 2007-8 had primary
       alcohol misuse problems, and five more had secondary or tertiary alcohol
       problems.
    Bradford Community Drug and Alcohol Team (Bradford CDAT) and Airedale
       Community Drug and Alcohol Team (ACDAT) provide professional NHS care
       and treatment for those experiencing drug and alcohol use problems.
       Services available include comprehensive psycho-social assessment,
       counselling, advice and support, information and education, programmes of
       controlled use, and detoxification (home or hospital).

Tier 4
    Inpatient detoxification is carried out at Lynfield Mount and in the community,
       but Lynfield Mount is generally considered inappropriate by clients as it is a
       mental health unit.
    Residential rehabilitation is commissioned by Adult Services from out-of-area
       providers. The current annual budget is £50,000.
    In December 2007, the PCT made £196,000 available to increase both the
       volume and range of settings for alcohol detoxification and aftercare services
       (in-patient detoxification, and structured day programmes). This is enabling a
       step change in the quality of provision offered to local residents.

Referrals


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       Only 24% of referrals for treatment in the Bradford district are initiated by GPs,
        in comparison with 36% self-referral (Whittingham p13). In other words,
        effective early identification and assessment, and subsequent provision of
        advice and brief interventions, are not occurring consistently.

General Medical Services
 Up to 300 alcohol detoxifications a year take place in general hospital wards, being
necessary before medical treatment can be administered. Funding was made
available in December 2007 to enable specialist staff to be employed in Bradford
Royal Infirmary to provide brief interventions, treatment, support and follow up for
these patients and also for patients attending A&E with alcohol related injuries or
problems. Much alcohol-related morbidity is treated in general medical settings, i.e.
general practice/primary care; A&E; medical and surgical wards; out-patient clinics,
and also in psychiatric wards. Funding was agreed by the PCT in December 2007

Housing and Accommodation
Appropriate housing or accommodation is an essential component of treatment for
alcohol misuse, and is also required so that those unable to respond to treatment
have somewhere suitable to live. This has been recognised in the Housing and
Substance Misuse Strategy, and its accompanying operational protocols, which were
agreed by the Safer Communities Executive in November 2007.

The following specialist housing/accommodation services are currently available in
Bradford:
“Damp House”
    New Cross Street (Horton Housing Association), funded by Supporting
       People, is an 8-bed facility that provides support and assistance to men with
       alcohol misuse problems, aiming to provide a safe and secure environment in
       which people can adopt a less chaotic lifestyle, and move to a less damaging
       lifestyle, whether that be abstinence, controlled drinking, or other harm
       reduction strategies. It aims to enable clients to move on into Community
       housing provision.

Community Support
   Horton Housing Association‟s Community Alcohol Support Team (CAST)
    provides accommodation and tenancy support services to residents in
    dispersed units throughout the Bradford area, and is designed to be flexible to
    the specific needs of clients at any given time.

“Wet” Accommodation
   Oak Mount (Horton Housing Association), funded by Community Care, is a 10-
      bed facility that offers long-term residential care to men whose lives are
      severely affected by their chronic alcohol use problems. Care and support is
      given appropriate to clients‟ needs, respecting their choice of lifestyle.
   Although not a residential facility, Horton Housing Association‟s Bradford Day
      Centre in Edmund Street is a drop-in centre for people who have housing
      difficulties and provides toiletry and laundry facilities and subsidised meals.
      Many clients are homeless street drinkers.

Reintegration Services


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       The Cathedral Centre helps those with alcohol or drug problems to develop
        skills to enable them to (return to) work including personal development, work
        experience, help with funding further education and on-site training in various
        subjects including basic skills, computing and art and design. It also provides
        support services including signposting, lifestyle change support, and housing
        and benefits advice.
       The Russell Street Project in Keighley provides education and training for
        people who need help to gain qualifications and specific skills to enable them
        to enter full-time education or employment
       A number of non-alcohol specific services offer reintegration services. These
        include the Cellar project, the Isis Centre, the Helios Centre and Springfield
        Day Centre.
       A number of non-alcohol specific services offer reintegration services. These
        include the Cellar project, the Isis Centre, the Helios Centre and Springfield
        Day Centre.
       Safer Communities Bradford runs a comprehensive District Workforce
        Development programme for all workers involved with substance misuse
        (drugs and alcohol) and those in other fields (Tier 1 services) who may come
        across drug or alcohol misusers. The programme includes:
            o Basic awareness – substance misuse training
            o Substance use and parenting capacity
            o Training programme for specialist treatment workers.
       Training for primary care workers using the PACE tool kit.

Workforce development.
The Safer Communities Workforce Development Team, based in Adult Services, are
already delivering a broad programme across Tiers 1-3 (see section on aim G3
above).

The Drug and Alcohol National Occupational Standards (DANOS) offer the
opportunity to determine training against agreed standards for all Tier 2 and 3 staff,
and also some Tier 1 staff, such as those in A&E, hospital wards and primary care.
A coherent plan of training between social care and health should be developed and
implemented, targeting appropriate staff.




FUTURE ACTION
The following recommendations are primarily drawn from Dr.Simon Padfield‟s needs
assessment (2006):

Detoxification
    Provision needs to be increased as a priority, and waiting times for treatment
      reduced
    In-patient services need to be developed away from the Lynfield Mount site,
      as this is considered an inappropriate setting for detoxification from alcohol.
    Provision for supervised home detoxification needs to be increased



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       Detoxification should be linked to structured aftercare programmes whether
        residential or community-based, and overall co-ordination of care needs to
        improve.
       Caleb Alcohol and Drug Services are to receive funding from the Department
        of Health to establish Bradford District‟s first purpose built detoxification unit
        for those dependent on alcohol or illegal drugs. The £1.24m project will
        provide a 12-bedded unit catering for both men and women. The unit is
        scheduled to open in Summer 2009.

Acute hospital services
Acute services are a key location for engaging with younger adults, not infrequently
as a consequence of alcohol misuse (accidents, violent injury, unsafe sex). The
introduction of a designated alcohol health worker to hospital departments, to carry
out assessments and offer interventions, should be considered as an initial action to
implement to reduce harm and the resultant burden on hospitals:
     To review care protocols of alcohol-dependent patients within the hospital
       trusts
     To improve mechanisms for liaison and support between primary care and
       specialist care and secondary care in the management of dependent patients
       in a more co-ordinated and collaborative approach to care
     To review care protocols of alcohol-dependent patients within A&E and to
       review the need for liaison psychiatric involvement.
     To ensure adequate support for those discharged from hospital following an
       alcohol-related admission.

    Primary Care
     To roll out the Allerton pilot project of alcohol workers in a primary care setting
       across the District.
     To support primary care to increase the delivery of brief interventions to all
       identified or suspected harmful and hazardous drinkers
     To improve mechanisms for liaison and support between primary care and
       specialist care in the management of dependent patients in a more co-
       ordinated and collaborative approach to care, including prescribing and care of
       dependent patients who do not wish to stop drinking
     To continue and develop educational programmes for primary care staff
       around alcohol and related conditions
     To improve communication and ensure that clear messages are given to
       dependent patients about their drinking
     To evaluate the need for further provision of community based support to
       enable the management of dependent patients in the community
     To increase the awareness of the barriers to detection and treatment of
       alcohol misuse among ethnic minorities, in particular the Muslim community
       and to develop appropriate primary care services


    Other Community Services
     To develop and expand of Tier 2 and 3 support services to include a greater
       variety of provision including psychosocial, structured day care, and
       recreational activities



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       To expand and develop non statutory services to decrease waiting lists
       To improve access to care outside of normal office hours and review the
        feasibility of 24-hour support
       Service Level Agreements to specify improvements in accessibility to services,
        and including for people in full-time employment, and their cultural
        appropriateness for both genders, and for different ethnic and other minority
        groups.
       To improve co-ordination across statutory and non statutory bodies involved in
        individual patient care particularly following detoxification
       To provide wet house provision across the District, to provide for the needs of
        those whose problem-drinking is beyond treatment.
       Dentists are well placed to offer brief interventions.

Supported housing
       As part of the reconfiguration in 2008 of the Supporting People budget, Supporting
        People will be commissioning both building-based and floating support services for
        alcohol misusers.

Complex needs
The growing need associated with people presenting with dual drug and alcohol
problems, which appears to be a significant issue in Bradford, must be addressed by
ensuring that all drug agencies provide alcohol-specific assessments, in order to
provide treatment interventions appropriate to their alcohol need. “Alcohol Misuse
Interventions: Guidance on Developing a Local Programme of Improvement” (2005)
confirms that the use of the pooled drug treatment budget can be used to facilitate
this.

Commissioners will need to work with current providers, to identify priority areas for
action, with regard to vulnerable people/people with complex needs. Key issues
will be:
      identifying unmet need, and developing proposals to address such needs.
      improving ways of engaging with individuals who are often unwilling to access
         services
      the need to ensure effective assessments of need include aftercare,
         particularly alternative accommodation, and “floating support”.
      there is a significant need in Bradford in respect of people with severe
         mental health problems and alcohol misuse (Dual Diagnosis), coupled
         with concerns about the lack of sufficient and consistent services to treat such
         people appropriately. A dual-diagnosis strategy was launched in April 2008 ,
         and will be followed by the development of action plans to develop
         appropriate services, in line with the requirements of the “Dual Diagnosis
         Good Practice Guide” (DoH Mental Health Policy Implementation Guide).
     There is an urgent need for the provision of „dry house” and “dry supported
        housing”, to increase the chances of those misusers who have been detoxed
        remaining abstinent.
     There is an urgent need for the provision of supported accommodation for
        women, with and without children.
     Provision for housing support for those with severe and unresponsive alcohol
        dependency should be expanded.



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Community awareness
   There is a general need to improve awareness of alcohol-related harm and to
    address issues of stigma across the whole community

Equal opportunities
   All treatment services to ensure that they are physically accessible to people
      with disabilities, and that they are able to provide additional support, or meet
      special needs, where this is needed for reasons of language, religion,
      physical. or learning disabilities, mental health problems, gender, sexual
      orientation or gender identity.
   Commissioners to work towards providing a range of services are
      geographically accessible with reasonable ease for residents in all parts of the
      district.



A5 TO REDUCE THE HARM CAUSED BY ALCOHOL MISUSE WITHIN
FAMILIES AND RELATIONSHIPS, INCLUDING DOMESTIC ABUSE
AND THE “HIDDEN HARMS” CAUSED TO THE CHILDREN OF
ALCOHOL-MISUSING PARENTS
Alcohol misuse can have a damaging and sometimes devastating impact on families
in a number of ways. This includes domestic abuse, child neglect,
marital/relationship tensions and break-ups, financial problems including debt and
home repossessions. Victims of alcohol-related domestic violence can themselves
turn to alcohol for relief from the trauma, fear and guilt. Children may become young
carers for problem-drinking parents and may experience isolation.

Babies born to mothers who have drunk alcohol during pregnancy (and possibly pre-
conception) may suffer from Foetal Alcohol Syndrome (FAS), a devastating and
irreversible condition, affecting the intellectual and behavioural development of the
child. Up to 40% of women who drink chronically during pregnancy will have a child
with FAS, which is the most commonly known cause of mental retardation. (White &
Hawkins 2007). There are also growing potential concerns about the impact of pre-
conception paternal drinking, with some fears about sperm quality.

Babies born to alcohol-dependent mothers may suffer from Neo-Natal Abstinence
Syndrome. These babies can be at highest risk of morbidity and mortality due to
both withdrawal symptoms and diminished parenting capacity.

Children growing up in problem drinking households are more likely to develop drink
problems themselves, and also to suffer from depression, anxiety and relationship
difficulties (GLA, 2003).

There is a strong correlation, but no causal link, between much domestic abuse and
alcohol; 43% of domestic abuse incidents reported to the police involve use of
alcohol. There are only limited services available in the District to perpetrators who




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wish to change their behaviour i.e. the Worth Project, Keighley (with integrated
support service for partners), and the BRAVE Project, Bradford.

Misuse of alcohol can be a coping mechanism for those experiencing/surviving
domestic abuse.

WHAT BRADFORD IS DOING.
 Bradford has a dedicated Domestic Abuse Policy Officer and a Domestic Abuse
  Partnership.
 Several refuges in the Bradford District have allocated places for women with
  alcohol and/or drug dependency. This is unusual in the UK.
 Dedicated social workers undertake specialist substance use and parenting
  capacity assessments within the child protection framework. Additionally, these
  specialist staff deliver multi-agency training to the Bradford Safeguarding Board.
 Significant levels of substance misuse (including alcohol misuse) training are
  delivered in the District by the Safer Communities Workforce Development Team.
  This includes a “Basic awareness-substance misuse” programme of training that
  is available free of charge to all paid and voluntary workers to enable early
  identification of problematic alcohol use, and screening, assessment and onward
  referral to specialists when appropriate; those trained are also able to give correct
  knowledge and information to members of the public and users of generic (“tier
  1”) services.


FUTURE ACTIONS.
   Provide more support for women wanting to reduce their drinking.
   Provide more support for women with alcohol problems, and for their families
   Sure Start, health visiting and other family support services to provide
    interventions to reduce the risk of child accidents in those families where
    hazardous or harmful use of alcohol or illegal drugs is a factor.
   Improve data collection e.g the Ambulance Service to be asked to record calls
    related to substance misuse.
   Communicate clear messages to professionals that alcohol is often a factor in,
    but not the underlying cause of, domestic abuse.
   Introduce single access-point services e.g specialist multi-agency drop in
    services


A6 TO REDUCE THE NUMBER OF BABIES BORN WITH A
DISORDER IN THE FOETAL ALCOHOL SPECTRUM DISORDER
RANGE, AND TO DECREASE THE RISK OF RELATED PROBLEMS
EXPERIENCED BY CHILDREN BORN WITH ONE OF THESE
DISORDERS.

Babies born to mothers who have drunk alcohol during pregnancy (and possibly pre-
conception) may suffer from Foetal Alcohol Syndrome (FAS), a devastating and
irreversible condition, affecting the intellectual and behavioural development of the
child. Up to 40% of women who drink chronically during pregnancy will have a child
with FAS, which is the most commonly known cause of mental retardation. (White &


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Hawkins 2007). There are also growing potential concerns about the impact of pre-
conception paternal drinking, with some fears about sperm quality.

Babies born to alcohol-dependent mothers may suffer from Neo-Natal Abstinence
Syndrome. These babies can be at highest risk of morbidity and mortality due to
both withdrawal symptoms and diminished parenting capacity.


FUTURE ACTIONS
   Frontline workers need clarity as to how to advise women who are pregnant or
    want to become pregnant.
   To advocate a major national campaign aimed at reducing the number of
    women drinking during pregnancy, and during periods when conception is
    being attempted.
   There needs to be more support for women with alcohol problems, to help
    them to reduce or eliminate their drinking.




A7 TO REDUCE ALCOHOL-RELATED ACCIDENTS AND FIRES,
THUS REDUCING AVOIDABLE PREMATURE DEATH, DISABILITY
AND OTHER INJURIES
Alcohol-related accidents take place on the road, at home, at work and in other
situations. Road (and other transport) accidents are regarded as the most serious
because the lives of third parties are endangered.

Between 1993 and 2003, there was a 30% rise in the number of drink-drive incidents
(“accidents”-RTAs); a small rise (4%) in drink-drive deaths, despite the increase in
passive car safety features; a small decrease (4%) in serious injuries (perhaps
because of improved car design); and a 35% increase in slight casualties.

In 2006, 540 people were killed in drink-drive crashes, up from a low of 460 in 1999.
About 95,000 drivers a year are banned from driving for failing a breath test or
refusing to give a sample. ((Times 21.4.08)

Drivers are less likely to be breath tested in Britain than in most European countries.
A study in 2004 found that 9% of drivers in Britain had been tested in the previous
three years, compared to 64% in Finland, 32% in France, and an EU average of
29%. (Times 21.4.08)

The percentage of breath tests failed is highest on Saturdays (7.3%) and Sundays
(8.1%). The peak hours for failing are between 10pm and 2am.

4.8% of drivers involved in injury accidents failed a breath test in 2003; the figure was
26% for under-17s and 6.6% for 17-29-year olds.

Most drink-drivers are male (m/f ratio of drivers convicted of drink-driving in 2004 was
7:1), but nearly a third of casualties are women. (Daily Telegraph 19.06.07).


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However, there was a 58% rise in drink and drug-driving convictions of female drivers
between 1995 and 2004, whilst the number of men convicted has remained stable.
Around 200 pedestrians and 30 pedal cyclists are killed or seriously injured by drink-
drivers each year, and 1200 children are killed or injured (all injuries). 80% of
pedestrian deaths on Fridays and Saturday evenings are alcohol-related.

All the above references to drink-driving refer to driving above the current legal blood
alcohol level for driving in the UK, which is higher than in most other EU states (UK
80mg/100ml (0.08%) - most of EU 50mg/100ml (0.05%), as are all Australian states.
A 50mg/100 litres limit has recently been announced for all Ireland. (BBC website).
Some countries have lower limits for young drivers, novice drivers, HGV drivers and
PSV drivers (all other data sources: ROSPA, 2005).

Ireland introduced random breath testing in July 2006; in the following twelve months,
there were 20% fewer fatalities than in the corresponding period in 2005/6. (Overview
6. Health related consequences of problem alcohol use. Health Research Board,
Ireland. 2007).

Recent research in Australia has demonstrated that a combination of even low
alcohol consumption (0.03% blood alcohol concentration) with sleep impairment
significantly increases the level of impairment (www.medicalnewstories.com 01.10.07
– research by M.E. Howard, PhD, in journal SLEEP)

A study of US college students aged 21-29 found that binge drinkers, when legally
intoxicated, believe they have adequate driving abilities (Marczinski C et al; summary
published as “Drinking and Driving: Binge drinkers have a disconnect between
assessing their driving abilities and reality”, www.medicalnewstoday.com 13.5.08)

In Greater London (1996-2000), 29% of fire-death-in-the-home victims had been
drinking, with nearly half of these having 200mg/100ml of alcohol in their blood
stream (GLA 2003). West Yorkshire Fire and Resource Service report that 70% of
fire deaths in West Yorkshire are alcohol-related.

In 2005, Y & H Region had the highest percentage of breath-tested drivers in injury-
causing road accidents who provided a positive test (12.3%) (5.2% of the 42.2% of
drivers tested), but this may be because it tested the second lowest percentage of
such drivers. (adapted from DfT data in APHO 2007, P.71).

In 2005, the casualty rate of 27.1 per 100,000 population for casualties from road
accidents involving illegal alcohol levels in Y&H was just above the England average
and the third lowest (best) amongst the nine GO Regions. In Bradford, the figure was
15.2, but this is lower than the true figure due to problems regarding the non-
availability of local data. By 2007, the comparable figure for Bradford had declined to
14.2 per 100,000 population (Thornton S, Bradford Council, by email.)

Research by University College London found that lowering the drink driving limit
would save 65 lives and 230 injuries a year. It would also save the economy
£119million a year by reducing medical costs and lost working time resulting from
accidents. (Webster B, The Times, 21 .4;08)




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Recent research in Australia has discovered that mixing alcohol with energy
drinks can double people‟s chances of being hurt or injured after drinking, needing
medical attention, and travelling with a drunk driver (Australian Drug Foundation,
2008, www.adf.org.au )

Most deaths after falling down stairs are associated either with a heart attack, or with
intoxication.



WHAT BRADFORD IS DOING
 Anti binge-drinking social marketing campaign December 2005/New year 2006.
 An anti binge-drinking social marketing campaign to take place in February 2007,
  with enhanced funding from Communities for Health.
 Local anti drink-driving social marketing campaigns.


FUTURE ACTION
 Lobby the Government directly and via local MPs to reduce the legal limit of
  alcohol for driving to 50mg/100ml, with lower limits for young and novice drivers.
 Police to keep data on all those breath-tested, involved in accidents and involved
  in fatal accidents who have a blood alcohol level of 50mg/100ml.
 Police to increase enforcement of the existing drink-driving laws.
 Existing alcohol-related education in schools to be reviewed, with head teachers
  asked to ensure their schools are adequately discussing the relationship between
  alcohol and accidents, and the social consequence of those accidents.


A8 TO REDUCE THE ECONOMIC COSTS OF ALCOHOL MISUSE
The majority of hazardous and harmful drinkers are in employment. Nationally, an
estimated 17 million working days a year are lost due to alcohol misuse, and the
overall annual cost of lost output caused by alcohol related deaths, sickness and
absenteeism, is estimated at between £5.2bn and £6.4bn. (2000/2 data, PM‟s
Strategy Unit).

 Alcohol impairment is a significant cause of health and safety problems in
workplaces, with the greatest risks being in transport, followed by those operating
industrial or agricultural machinery. A survey by Norwich Union Healthcare Fund
found that 77% of employers consider alcohol to be the number one threat to
employee well-being , and that it encourages sickness absence (18.5.08).
http://www.norwichunion.com/media-centre/story/4048/uk-employees-admit-that-
regular-drinking-affects-t/

Alcohol misuse prior to, and during, the working day can be reduced if workplaces
adopt and enforce an alcohol policy. Effective elements of a workplace policy
include:
     training for managers in identifying alcohol problems at work.
     training for occupational health departments in best practice regarding
       employees with alcohol misuse problems.



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       providing employees who have alcohol problems with information, advice and,
        where appropriate, referring them for treatment.
       enforcing a ban on the consumption of alcohol in the workplace.
       in cases of regular offending by non-dependent drinkers, taking firm action
        where employees come to work under the influence of alcohol or take sick
        leave for the same reason.
       taking a zero tolerance approach to being under the influence of alcohol in
        occupations where public, colleague or personal safety is put at risk.
       using the workplace to stage health promotion events or disseminate health
        promotion information relating to alcohol.


WHAT BRADFORD IS DOING
 There is no information currently available on the percentage of employers who
  have introduced alcohol policies for employees. Bradford Council does not
  currently have a policy, but is in the early stages of developing one. The NHS,
  Police, Fire and Rescue and Probation all have policies.

FUTURE ACTION
 Bradford Council to develop a comprehensive workplace policy regarding the
  misuse of alcohol.
 Safer Communities Bradford and its partners to work with employers and
  employers‟ organisations to develop workplace alcohol policies.
 Caleb Alcohol and Drug Services are seeking to work with employers to support
  employees with alcohol misuse problems.


A9 TO ENSURE THAT INFORMATION IS AVAILABLE TO, AND
SERVICES ARE ACCESSIBLE AND WELCOMING TO ALL
SECTIONS OF BRADFORD‟S DIVERSE POPULATION
Bradford has a diverse population, with recent migrants from Eastern European
countries supplementing the longer-established Muslim, Sikh and Hindu populations
originating from Pakistan, Bangladesh, India and East Africa, and the small Afro-
Caribbean population.

Whereas the majority of Muslims do not drink alcohol, the same is not true for other
minorities.

English language difficulties are encountered amongst some of the Eastern
European migrants, and also within the ranks of the Pakistani and Bangladeshi
heritage communities who were not born in the U.K.

Diversity is not confined to ethnic origin or religion. Services should be accessible,
both physically and attitudinally, to everyone – including other minority groups such
as people with physical and/or learning disabilities, and the LGBT community
(lesbians, gay men, bisexuals and transgender people).




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In his needs assessment, Padfield (2006) made the following recommendations for
Bradford:
     All services should be reviewed with regard to appropriateness for ethnic
        groups including cultural appropriateness, language and confidentiality
     Opportunistic screening for ethnic minority groups needs to increase
     Opportunistic intervention and engagement in services needs to improve for
        presentations in A&E and secondary care, as this may be more effective
     There is no clear evidence of need for separate specialist services for ethnic
        minority groups
     Awareness raising in the community of alcohol issues and addressing
        associated stigma

WHAT BRADFORD IS DOING
   Project 6 has a South Asian project relating to substance misuse as part of its
    role; it is tracking alcohol use amongst this population in Keighley.

FUTURE ACTION
   Future needs assessments need to ensure that they include mechanisms for
    capturing the needs of people from all minority populations.
   All services to carry out Equality Impact Assessments (EIAs); the need for
    these is to be written into contracts and service level agreements.
   Services to address shortcomings highlighted in EIAs.
   Information about safe drinking, and about services, is to be accessible to all
    target groups.




A10 TO RECORD AND ANALYSE THE DATA NECESSARY
TO MEASURE OUR PROGRESS.
A good, evolving strategy requires good information and evidence. Currently, there
is only a limited amount of local data regarding alcohol-related harm.

PERFORMANCE INDICATORS – HOW WE WILL MEASURE OUR PROGRESS
Although the national Indicators are the only targets which LSPs have to measure, it
is necessary that the alcohol harm reduction strategy has a range of additional
indicators to demonstrate how the implementation of the strategy is making an
impact on people‟s lives.

The following National Indicators which are particularly relevant to this strategy are
part of the Bradford Local Area Agreement:
NI 17 Perceptions of anti-social behaviour
NI 20 Assault with injury crime rate (proxy indicator for alcohol-related violence)
NI 49 Number of primary fires and related fatalities and non-fatal casualties
NI 115 Substance misuse by young people
NI 112 Under-18 conception rate




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All other national Indicators are being measured, and many have some cause or
effect relationship to the misuse of alcohol. The following are particularly relevant to
this strategy:
NI 39 Alcohol-harm related hospital admission rates
NI 41 Perceptions of drunk or rowdy behaviour as a problem
NI 32 Repeat incidents of domestic violence

NI 39 will measure the rate of hospital admissions for alcohol-related harm per
100,000 population, using Hospital Episode Statistics. The rationale is to reduce the
trend in the increase of alcohol-related hospital admissions. The collection interval
will be quarterly.

NI 41 will be measured through the new Place Survey, and through the British Crime
Survey. Guidance on the methodology will be published in due course. The rationale
is that activity by local authorities, the police and partner agencies to deliver local
alcohol strategies will, in combination with public awareness campaigns, contribute to
reducing the overall problem of drunk and rowdy behaviour in local communities.
Collection will be at least bi-annually.

NI 17 data will also be collected through the Place Survey. One of the reasons for
this indicator is the role of local authorities as the Licensing Authority. Collection will
be at least bi-annually.

NI 20 measures the number of “assaults with less serious injury” (including racially
and religiously aggravated) offences per 1000 population as a proxy for alcohol
related violent offences. Collection is monthly by the Police from Crimesec 3, from
HOCR codes 8G “Actual bodily harm and other injury” and 8J “racially or religiously
aggravated actual bodily harm and other injury”.

NI 115 exists to measure progress in reducing the proportion of young people
frequently misusing substances (illegal drugs, alcohol, and volatile substances). It will
be measured through the Ofsted TellUs survey in years 6, 8 and 10. Participation by
schools is voluntary and the collected data will be weighted to match local area
profiles based on school census data. Frequent use is here defined as being drunk
twice or more in the last 4 weeks. Collection interval is annual.

NI 32 is relevant because of the association between drunkenness and a large
minority of domestic violence cases. The measurement of this indicator has not been
finalised, but it is proposed as the percentage reduction in repeat victimisation for
those domestic violence cases being managed by the local MARAC.

NI 49 will measure (i) the total number of primary fires per 100,000 population; (ii) the
total number of fatalities due to primary fires per 100,000 population; (iii) total number
of non-fatal casualties (excluding precautionary checks) per 100,000 population. A
primary fire is any fire involving property (including non-derelict vehicles) and/or
casualties and/or involves 5 or more fire appliances. Data will be collected quarterly
by CLG based on statistical returns from Fire and Rescue Authorities.

NI 112 is relevant to this strategy in that some teenage conceptions occur whilst the
participants are under the influence of alcohol.


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The North West Public Health Observatory collects and publishes annually a number
of alcohol related statistics for districts. These relate to alcohol-related mortality
(attributable and specific), alcohol-related hospital admissions (attributable and
specific), and synthetic estimates of hazardous, harmful and binge drinking amongst
the 16+ age group.

As well as the indicators above, the partnership will collect and track additional
performance data for Bradford district (or parts of), some of which is not yet available.
This may include data on:
     incidence rates of certain alcohol-related medical conditions, by age group
       and gender; and alcohol-related mortality and morbidity data by age and
       gender.
     Number of dependent drinkers
     Ratio of treatment places (Tier 3 and 4) to dependent drinkers
     Number of primary care practices offering brief interventions
     Number of brief interventions delivered in (i) primary care (ii) hospital settings.
     A&E data following the Cardiff model, to enable prevention and enforcement
       measures to be implemented in injury hotspots
     Prevalence and qualitiative data re drinking behaviour amongst younger
       adults
     Number of positive breath tests
     Number of drivers involved in road traffic accidents whose blood alcohol level
       exceeded (i) 8omg/100ml, and (ii) 50mg/100ml
     Number of injury causing road traffic accidents in which (i) a pedestrian and
       (ii) a cyclist with more that 80mg/100ml alcohol was involved.
     Alcohol-related data in respect of the information collected for NI 49.
     Number of employers with alcohol workplace polices meeting a defined
       minimum standard
     Number of employees covered by alcohol workplace policies
     Number of working days lost for alcohol related reasons.
     Number of referrals from alcohol abuse services to alcohol services
     Number of children on the Child Protection Register, where parental alcohol
       use is identified as a contributory factor.




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APPENDIX 1
Guiding Principles for Commissioning
(Whittingham A, “An Alcohol Treatment Strategy for Bradford”, 2006.)
   It must be acknowledged that alcohol harm is not confined to a distinct group
       of “problem” drinkers, as harm-generating drinking is found in a significant
       proportion of the population. This strategy must ensure that a multi-faceted
       approach is adopted to provide targeted intervention at both individuals and
       communities.
   Assessment of need should be area/community specific: the pattern of harm in
       one community will not necessarily be replicated in another.
   Individuals must receive services according to their level of need; and they
       must be treated holistically. All factors that are causing, or exacerbated by,
       problematic drinking should be recognised and addressed for the individual.
   There should be equal access to prevention, education and treatment services
       across Bradford.
   The role and rights of service users in being involved in planning and
       monitoring services must be effectively recognised and facilitated.
   Individual drinkers should be offered both a route to behaviour change; and,
       where their behaviour makes them significantly risky or vulnerable, have
       access to services which contain and protect them.
   The needs of families and carers of problem drinkers should be accorded a
       priority response, particularly in respect of young people with alcohol-misusing
       parents.
   In line with National Standards, Local Action, Health and Social Care
       Standards and Planning Framework 2005/06/07/08, commissioners must
       ensure that their alcohol strategy: targets its population needs, addresses
       local service gaps, delivers equity, is evidence based, is formed through
       effective partnership working, and provides value for money.
   it is essential that the JCG prioritise initial strategic action in line with
       remaining existing barriers to service enhancement, and implement evidence
       based action which will rapidly reduce the rise in alcohol misuse, and develop
       both the capacity of quality of services in order to treat more alcohol misusers.
   A lack of clarity and certainty exists about elements of some of the currently
       commissioned services, primarily as a consequence of the failure to undertake
       service audits in recent years. Issues exist around value for money; adequacy
       of funding, service output and outcome, and the degree to which elements of
       certain services would meet all criteria of effectiveness, equity, etc. It is,
       therefore, essential, that commissioners identify those services that require
       the clarification of a service audit, and undertake such audits as a priority.


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             Planning strategic action without a comprehensive understanding of the
             appropriateness and effectiveness of existing services may cause key
             elements of the locally-specific need to be overlooked.




a       APPENDIX 2 NATIONAL LEGISLATION, POLICY AND
          GUIDANCE

        A number of key national policies and guidance documents have been taken into
        consideration when deciding what we need to do locally to address alcohol-
        related problems.
        “Safe. Sensible. Social. The next steps in the National Alcohol Strategy”
        (2007)
        This is the second national alcohol strategy> It sets out the way forward in
           addressing alcohol related problems. It identifies the next steps as:
               Sharpened criminal justice for drunken behaviour.
               A review of NHS spending for alcohol treatment.
               More help for people who want to drink less.
               Toughened enforcement of underage sales.
               Trusted guidance for parents and young people.
               Public information campaigns to promote a new “sensible drinking” culture.
               Public consultation on alcohol pricing and promotion.
               Local alcohol strategies.

        The strategy highlights the main problem drinkers as:
               18-24 year old binge drinkers
               Young people under 18 who drink alcohol
               Harmful, adult drinkers who don‟t necessarily realise their drinking is
                  damaging their physical and mental health including older drinkers.

       The Violent Crime Reduction Act 2006
       The Violent Crime Reduction Act contains a package of measures that give police and local communities further powers to
       tackle violent crimes. It introduces new powers to address alcohol-related violent crime including the:


                     Introduction of Drinking Banning Orders. These can last for up to two
                      years and can impose restrictions including bans from licensed
                      premises for those who commit offences under the influence of alcohol.
                     Introduction of Alcohol Disorder Zones (ADZ). These are a last resort
                      and give local authorities and police powers to designate areas affected
                      by serious alcohol-related crime and disorder as an ADZ. Licensed
                      premises within these zones are expected to contribute to cost of
                      dealing with the disorder.


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                Creation of a new power that gives the police and trading standards
                 powers to close a licensed premise persistently selling alcohol to
                 youths for up to 48 hours.
                Creation of a new power to allow police to ban, from a particular locality
                 for up to 48 hours, those who represent a risk to committing an alcohol-
                 related crime or disorder offence.




    Every Child Matters
    Every Child Matters: Change for Children is a new approach to the well being of
    children and young people from birth to 19. The Government's aim is for every
    child, whatever their background or their circumstances, to have the support they
    need to:

                Be healthy
                Stay safe
                Enjoy and achieve
                Make a positive contribution
                Achieve economic well-being

    This means that the organisations involved with providing services to children -
    from hospitals and schools, to police and voluntary groups - will be teaming up in
    new ways, sharing information and working together to protect children and young
    people from harm and help them achieve what they want in life. Children and
    young people will have far more say about issues that affect them as individuals
    and collectively.

    Every Child Matters aims to make radical improvements in opportunities and
    outcomes for children, by reforming the delivery of children‟s services. This
    systemic change will:
           Support parents and carers
           Develop the workforce, change culture and practice
           Integrate universal and targeted services
           Integrate services across the age range 0-19

    The Licensing Act 2003
    The Licensing Act 2003 reformed the licensing system for premises that sell
    alcohol or provide regulated entertainment or late night refreshment. The Act
    devolves licensing responsibilities to local authorities to ensure all license
    premises meet the four licensing objectives of:
           Prevention of crime and disorder
           Promote public safety
           Prevention of public nuisance
           Protection of children from harm

   Local areas are required to develop a local framework to ensure license premises
   in their area meet the above objectives.


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   The new licensing system enables licensees to propose their own hours and
   operating policies and unless successfully challenged, these could be granted
   even where problems are anticipated. However all responsible authorities (the
   Police, the City Council, the Safeguarding Children Board and the Fire Service)
   are able to make representations and request reviews of a license if there are
   concerns that the four licensing objectives may not be met. Local communities can
   also make representations about an existing or new license and can request
   reviews of current licenses.


Working with Alcohol Misusing offenders- a strategy for delivery
National Offender Management Service 2006
    The aim of this strategy is to reduce re-offending and alcohol-related harm and
    protect the public by meeting the following objectives:
        To identify alcohol misuse and offending needs at an early stage of contact
           with the National Probation Service (NPS) and refer offenders to
           appropriate interventions.
        To ensure that staff are fully competent to deliver brief advice and support
           to alcohol misusing offenders under their supervision.
        To improve advice and information provided to offenders about the risk of
           alcohol misuse and about help that is available locally.
        To develop and promote the delivery of evidence-based interventions to
           meet the needs of the full range of alcohol-misusing offenders.
        To increase the consistency of what is delivered across the NPS based
           upon evidence based practice.



Addressing Alcohol Misuse: - A Prison Service Alcohol Strategy for
Prisoners HMP Prison Service (2004)
   The strategy recognises the Prison Services contribution to reducing the negative
   impact of alcohol misuse. The strategy aims to
            Reduce the harm associated with the misuse of alcohol including that
             related to offending, by offering treatment and support to prisoners.
            Prevent the use of alcohol in prisons.

    These aims will be achieved by
        Improving education and communication.
        Improving the identification of prisoners who may misuse alcohol.
        Improving the capacity and quality of alcohol treatment interventions
          available to prisoners.
        Sharing good practice thus ensuring greater consistency across the prison
          estate.
        Reducing the use of alcohol by prisoners and the availability of alcohol
          both into and within establishments.




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    Alcohol Needs Assessment Research Project (ANARP) (Department of
    Health 2005)
    ANARP examined the need for and the availability of alcohol treatment services
    throughout England. The primary objective of the research was to identify gaps in
    existing provision. The key findings are:
            The North West region has the highest percentage of people drinking at
               hazardous/harmful levels but one of the lowest levels of dependent
               drinking.
            Nationally clients with more severe alcohol dependence were the
               largest group to access alcohol treatment services
            Using a North American model to determine high, medium and low
               access levels, 1 in 10 (10%) dependent drinkers accessing treatment
               per annum is considered low, 1 in 7.5. (15%) in considered medium
               and 1 in 5 (20%) is considered high
            There is a large gap between the need for alcohol treatment and actual
               access to treatment.
            There were low levels of formal identification, treatment and referral of
               patients with alcohol use disorders by GPs
            GPs tended to under-identify younger patients with alcohol misuse
               disorders compared with older patients.
            Whilst those from BME communities have considerably lower
               prevalence of hazardous/harmful drinking compared with the white
               population, there is a similar prevalence of dependent drinking.

Alcohol Misuse Interventions: Guidance on developing a local programme of
improvement (Department of Health, 2005)
This National Treatment Agency (NTA) document identified that:
           For every 8 hazardous or harmful drinkers who receive brief
              interventions one would reduce their drinking to low risk levels. This
              compares to one in 20 smokers who are offered brief interventions
           For every £1 spent on evidence based alcohol treatment services the
              public sector (NHS and Local Authority) saved £5
           There is also evidence that workplace policies are effective in
              promoting sensible drinking and managing alcohol problems.

Models of Care for Alcohol Misusers (NTA 2006)
Models of Care for Alcohol Misusers provides, best practice guidance for local health
organisations and their partners in delivering a planned and integrated local alcohol
treatment system for adult alcohol misusers. The purpose of the guidance is to assist
in improving practice in the commissioning and delivery of alcohol treatment,
improving the effectiveness of screening and assessment and developing an
integrated local treatment system through a four-tiered framework of provision. The
four tiers are:
        1. Alcohol-related information and advice, screening, simple brief
            interventions and referral
        2. Open access, non-care planned, alcohol specific interventions
        3. Community based, structured care planned alcohol treatment
        4. Alcohol specialist inpatient treatment and residential rehabilitation



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Review of effectiveness of treatment for alcohol problems (NTA 2006)
This review describes the effectiveness of various interventions and treatments. The
purpose of the document is to enable local areas to assess current provision and
plan services to meet the needs of local populations. It identifies that the majority of
people, including dependent drinkers, change their drinking habits without accessing
treatment services. Self-help, family and friends and mutual aid groups such as
Alcoholic Anonymous often facilitate unassisted or natural recovery.

The review mapped drinking typology to treatment interventions

Typology of drinking                         Treatment interventions

Severely dependent drinking                  More intensive specialist treatment

Moderately dependent drinking                Less intensive specialist treatment in generalist
                                             or specialist settings
Harmful drinking
                                             Extended brief interventions in generalist settings
Hazardous drinking
                                             Simple brief interventions in generalist settings
Low risk drinking
                                             Public health programmes- primary prevention




Alcohol/Strategies/Bradford as at 17.12.08                                                       97

				
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