NHS Drinking Responsibly Project

Background

The NHS Drinking Responsibly project aims to promote responsible drinking and a responsible drinking culture across Manchester primarily at point of sale. The project is managed within Manchester Public Health Development Service.

What is the problem you are trying to solve?

The project aims to solve the lack of information available to a large number of hazardous drinkers, and the need to raise the profile of harm reduction through point of sale information. Overall the project is aiming to provide better targeted communication and information to vulnerable groups. In Manchester, before the NHS Drinking Responsibly project, there was no formal training for front line alcohol retail staff. There was also a disproportionate need to develop workforce competence in delivering interventions and a lack of coordinated communication around what local services were available.

What local organisations are involved?

The project works closely with Greater Manchester Police (GMP) City Safe, an award winning initiative born out of the need to take a holistic approach to the management of the night time economy and address alcohol related crime. Since 2004, PCTs have needed to take an active role within crime and disorder partnerships. Other local organisations involved include Manchester Drug and Alcohol Strategy Team, Pub Watch members across the city, members of Pilot Off-licence Forum, HMP Manchester, Manchester Community Alcohol Team, Manchester Healthy Schools Team, Lesbian and Gay Foundation, Black Health Agency “Reach Out” Project. A pro bono advertising campaign was gratefully created and distributed by RedC Marketing and local media owners in advance of the licensing law change on 24 November 2005.

How many people are running this project and who are they?

The project is led by Liz Burns, regional mental nurse public health development project worker – alcohol. She is supported by a steering group comprising the local Drug and Alcohol Strategy team coordinator, deputy head of service of Manchester Public Health Development Service, Manchester Pub & Club network PR officer, and a police constable from GMP City Safe.

What local population are you targeting?

In 2005-6 we targeted on and off licence staff (pubs, clubs, bars, off-licences, convenience stores, supermarkets) as well as the following four targeted themes: women, older people, 18-25 year olds, alcohol and sexual health. Areas of Manchester facing the highest levels of health inequalities are prioritised. In 2006-7 we are targeting on and off licence staff (pubs, clubs, bars, off-licences, convenience stores, supermarkets) as well as workplace settings including schools, PCTs, the hospitality sector (including licensed trade) and the private sector. Super output areas of Manchester experiencing the highest levels of alcohol attributable conditions and the highest levels of alcohol attributable causes of mortality are prioritised.

How many people are you targeting?

In 2005-6 the aim was to engage 50 licensees and carry out four targeted campaigns. In 2006-7 the aim is to engage 50 licensees and 10 workplace settings in adopting health promotion around alcohol harm reduction for employees who use alcohol.

Interventions

What interventions are you using to address the problem?

Training in responsible alcohol retailing for pubs, clubs, bars, off-licences, convenience stores and supermarkets, publicity campaigns, production of educational booklets, electronic factfile, alcohol training for people working in non-specialist settings, radio campaign, campaigns in workplace settings including schools, PCTs, the hospitality sector (including licensed trade) and the private sector.

Is the project design based on evidence? If so, please state reference.

Yes, please see references. ^{1 2 3 4 5 6 7 8 9 10 11 12 13 14 15}

Outcome

What outcomes or planned outcomes are you measuring?

We do not have any local or national outcomes to measure against. Targets were set based on milestones, outputs, and feedback from licensees/their staff and campaigns.

Do you have any outcomes or results yet? If so, what are they?

• June 2005 - March 2006: Ninety five places were offered to staff across on and off-licensed premises of which 74 were trained in an award in a responsible alcohol retailing course accredited by the British Institute of Innkeeping Awarding Body (BIIAB). Also, 3000 copies of a locally produced booklet “Calling Time: helpful advice for staff" were distributed to licensed premises across Manchester.
• September 2005: Poster campaign aimed at women “Who’s looking out for you?” (Portman Group posters) distributed across 100 GP surgeries across Manchester. This was initiated in response to a telephone survey, “A big night out”, which showed high proportions of women disclosing unreported sexual assault after a night out.
• 24th November 2005: Launch of outdoor advertising campaign on the day the new licensing laws changed. Free media space was also provided on the inside of bus panels and local free press. Aimed at 18-25 year olds, this campaign used the parody of sales promotions (“2-4-1, buy now pay later, what will your next drink cost you?”) and was followed by an eight page leaflet which continues to be distributed across primary care, criminal justice and other community settings.
• January 2006: A full page colour advert aimed at women using the “2-4-1” creative was featured in Manchester 2006-07 Community Safety booklet and distributed across North Manchester (70 000 copies).
• January 2006: An alcohol factfile was produced and distributed electronically and in hard copy, detailing information about alcohol and care pathways into local services.
• January – March 2006: One training day was held each month. “Sexual Health and Alcohol Awareness” was advertised through Manchester Public Health Development Service Sexual Health Multi-Agency Schedule. The aim was to deliver alcohol awareness, screening and referral options to practitioners working in sexual health settings.
• February 2006: A one day training event was piloted with Manchester Adult Social Care, "Older People and Alcohol Awareness". The audience included case managers (over 65s) and also active case managers from the PCT.
• May – September 2006: Sixty subsidised places (half price rate of £35 + VAT per person) were offered to staff across on-licensed premises. Sixteen places were filled on the BIIAB. The main obstacle reported was cost implication to operators.
• May 2006: The Antisocial behaviour/"Think Safe, Drink Safe" radio campaign was broadcast on Galaxy Manchester.
• July 2006: Approximately 40 off-licences in East Manchester made “2-4-1” responsible drinking information available at point of sale. Members of the East Manchester Off-licence Forum reported that they inserted them into local shopping including newspapers.
• September 2006: The "Think Safe, Drink Safe" banner ad campaign (10 second visual) was broadcast at Manchester City FC Sport City Stadium.
• September 2006: "One drink isn’t always one unit" poster designed for GPs waiting areas. Distributed across 120 GP Practices.
• September 2006: Launch of partnership campaign advertising the Manchester Specialist Midwifery Service in pub and club washrooms. The campaign sets a clear message saying “in pregnancy, no alcohol = no risk of harm to your baby”.
• October 2006: Elizabeth Slinger Road custody suite commenced 12 month distribution of “2-4-1” responsible drinking information within every property bag.
• September – March 2007: One training day each month. “Basic Alcohol Awareness and Harm Reduction”, “Delivering the Alcohol Strategy in Your Organisation”, “Alcohol Dependency Syndrome and Harm Reduction” were advertised through Manchester Public Health Development Service Multi-Agency Training Schedules. The aim was to deliver alcohol awareness, screening and referral options to practitioners working in non-specialist settings.
• December 2006: Twelve out of 14 staff from East Manchester Off-licence Forum attended free training for the BIIAB Level 1 Award in Responsible Alcohol Retailing. Costs shared by NHS Drinking Responsibly Project and East Manchester Off-licence Forum budget.
• January 2007: A half page colour advert using the “One drink isn’t always one unit” creative was featured in Manchester 2007-8 Community Safety Booklet distributed across North Manchester (70 000 copies).
• January 2007: A two week outdoor advertising campaign launched on “tramliners” using the “One drink isn’t always one unit” creative.
• January – February 2007: Telephone follow-up and evaluation where possible of all alcohol retail staff who participated in either the BIIAB Level 1 Award in Responsible Alcohol Retailing or used the “Calling Time: helpful advice for staff” booklet.
• February 2007: "Calling Time: helpful advice for staff" reprinted and revised for national audience. Revised edition includes new training record form, guidance for “Premises Users” of temporary events, quiz questions on age acceptable ID, and sleeve insert for local flyers/memos.

Is your project relevant to a government target or guideline?

Manchester’s Local Public Service Agreement (PSA) target 10: Tackling health inequalities/increasing life expectancy.

Feedback

What obstacles did you have to overcome to set up this project?

N/A

What have you learned about the project so far?

The “them and us” perception of alcohol misuse remains prevalent and obstructs the detection of hazardous and harmful drinking patterns, either through self reflection or through the adoption of screening and brief interventions in non-specialist settings.

Workplace alcohol policies have more scope and opportunity to promote corporate social responsibility and health promotion activities to promote responsible drinking. They traditionally provide reactive management procedures on how to deal with situations once a problem has arisen. Again, this perpetuates the “alcoholism” view of alcohol misuse.

There is an opportunity to introduce an award scheme using GMP City Safe’s social marketing campaign. A "Think Safe, Drink Safe" award could advertise an information site providing alcohol advice in a workplace, school, health setting or probation office. Such an award scheme could establish a benchmark of good practice and support other performance indicators or quality standards. It would also create consistency of standards throughout Manchester, reduce the stigma associated with responsible drinking, make information accessible and provide environments conducive to making health choices easier.

Running the BIIAB Award for free in 2005-6 appears to have been a major incentive. Between April and December 2006 the course was offered at a subsidised rate and sign-up rates plummeted. Licensees have reported back to the project that even at the subsidised rate this is too expensive.

Offering free supplies of the self help guide, Calling Time: helpful advice for staff, appears to have been a popular alternative. One licensee uses the quiz to train staff during quiet periods in his convenience store. There is continual positive feedback around the usefulness for staff to understand the strength and unit content of products they are selling or supplying. In response to needs, its 2007 reprint includes a new training record form for staff.

We have also found there is a need to raise awareness among staff and managers across all social clubs, licensed premises and temporary event holders, including for example staff at the Manchester Deaf Centre Social Club.

Personal licence holders who have attended the BIIAB Level 1 Award in Responsible Alcohol Retailing have recommended that all licensees should attend a refresher.

Finally, we have become aware of the role of schools selling or supplying alcohol at school events and that this is an opportunity to reach adults/parents/carers and their roles in modelling responsible drinking.

What would you do differently?

• Training needs analysis of alcohol retail staff including the personal licence holders/designated premises supervisors;
• Pre-training knowledge and skills assessments are necessary to gain a baseline measure to compare against post-training; and
• We would produce a training manual for personal licence holders/managers of licensed premises to accompany the “Calling Time: helpful advice for staff” brochure.

References:

1. Hughes K, Tocque K, Humphrey G, Bellis MA. Taking Measures: a situational analysis of alcohol in the North West. Public Health North West Alcohol Strategy Group. 2004. http://www.cph.org.uk/cph_pubs/reports/CH/Taking_Measures.pdf (accessed 4 May 2007)
2. Prochaska, DiClemente. The Transtheoretical Approach. Illinois: Dow Jones-Irwin. 1984.
3. Department of Health. Sensible Drinking: The Report of an Inter-Departmental Working Group Department of Health. 1995 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084701 ( accessed 4 May 2007)
4. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT – The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care, (2nd edition). Geneva: World Health Organization. 2001. http://pubs.niaaa.nih.gov/publications/Assesing%20Alcohol/InstrumentPDFs/14_AUDIT.pdf (accesses 4 May 2007)
5. Waller S, Naidoo B, Thom B. Prevention and reduction of alcohol misuse: review of reviews. Health Development Agency. 2002.
6. Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P, et al. Comorbidity of substance misuse and mental illness in community mental health and substance misuse service. British Journal of Psychiatry. 2003; 183, 304–313. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14519608&dopt=Abstract (accessed 4 May 2007)
7. Alcohol Harm Reduction Strategy for England. Prime Minister’s Strategy Unit. Cabinet Office. 2004
8. Wood A. Why alcohol is good for health. Guidance for Primary Care Trusts, NHS trusts and Local Authorities on how tackling alcohol can help meet health priorities and targets. Alcohol Concern. 2004.
9. Manchester City Council. Taking Responsibility: A new approach to licensing in Manchester Licensing Policy Statement 2005-2008. Manchester City Council (based on Licensing Act 2003).
10. Manchester City Council. Manchester Alcohol Strategy 2005-2008. Manchester Drug and Alcohol Strategy Team. Manchester City Council.
11. Department of Health. Alcohol Needs Assessment Research Project (ANARP): The 2004 national alcohol needs assessment for England. Department of Health. 2005. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4122341
12. Forsyth AJM, Cloonan M, Barr J. Factors associated with alcohol-related problems within licensed premises. Report to the Greater Glasgow NHS Board. 2005.
13. Mental Health Foundation. Cheers? Understanding the relationship between alcohol and mental health. Mental Health Foundation. 2006.
14. Department of Health. Alcohol Misuse Interventions: Guidance on developing a local programme of improvement. 2005. www.dh.gov.uk. (search for 5694, accessed April 17).
15. Raistrick D, Heather N, Godfrey C. Review of the effectiveness of treatment for alcohol problems. National Treatment Agency. 2006.