LGA briefing: Alcohol harm House of Commons, 25 November 2021

• There are around 10 million adults in England who drink above the UK Chief Medical Officers’ low risk guidelines, including more than two million who drink at higher risk and an estimated 587,000 who are dependent on alcohol. In 2020, during the height of the pandemic, alcohol consumption and harm increased by 20 per cent. These figures are a stark wake up-call about the wider impact of COVID-19 on our general health, including for those with alcohol-related conditions. Furthermore, an estimated 200,000 children in England live with alcohol-dependent parents. 
• People with untreated alcohol dependencies have a disproportionate impact on our communities. For instance, last year, 12,500 households assessed by local authorities as being statutorily homeless were recorded as being alcohol dependent and almost a fifth of homicides every year are under the influence of alcohol. More working years of life are lost in England as a result of alcohol-related deaths than deaths from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.
• Councils, which are responsible for public health services, are committed to continue supporting people with alcohol and other substance misuse problems. Local authorities reported spending £623 million on drug and alcohol treatment in 2019/20, about a fifth of the public health grant for that year.
• The bulk of Government investment in drug and alcohol treatment comes through the local authority public health grant. It is a condition of the 2021/22 grant that local authorities improve the take up of, and outcomes from, its drug and alcohol misuse treatment services, based on an assessment of local need and a plan which has been developed with local health and criminal justice partners. 
• These services, working in partnership with other local services, can and do help thousands of people to stabilise and turn their lives around every year; reducing the risks to the individuals, their families and wider community and the burden on a range of other local services. For every £1 spent on drug treatment, there is a social return of £4. For every £1 spent alcohol, it is £3. That means these services are helping to save society more than £2 billion every year.
• However, funding for addiction services has not kept pace with demand and certainty over long-term funding is needed. Local authorities’ public health grant has been cut by 24 per cent on a real-terms per capita basis since 2015/16 (equivalent to a reduction of £1 billion). This has had an adverse effect on councils’ ability to invest in services and functions that prevent ill health, reduce health inequalities and support a sustainable health and social care system. This includes investing in services that can help towards preventing alcohol harm.   
• It was therefore disappointing that there was no real terms increase in public health grant funding in the Autumn Budget and Spending Review, despite this incredibly challenging period. This makes it harder to improve public health and invest in services which help towards preventing and reducing alcohol harm. Keeping people healthy and well throughout their lives reduces pressure on the NHS, social care, criminal justice and the benefits system.
• We have warned that while some councils will be able to provide more support for children living in households with an alcohol-dependent parent, the Government should provide sufficient funding to enable councils to provide all children with the support they need. We have therefore been calling for the restoration of the £1.7 billion early intervention funding.
• Furthermore, under the Licensing Act, councils can only currently consider four issues when deciding whether to grant licences – the prevention of crime and disorder; public safety; prevention of public nuisance; and protection of children from harm. Despite the established link between consumption and the availability of alcohol, councils currently find it challenging to ask for modifications to licences on health grounds. 
• The Licensing Act 2003 should be updated to include a public health objective. This would give councils the tools to act on local public health issues and place a legal requirement on businesses, including those that sell alcohol, to consider public health.

An estimated 200,000 children in England live with alcohol-dependent parents. In an average secondary school in England 40 pupils will be living with a parent with a drug or alcohol problem. About one in six Child in Need assessments carried out by local authorities last year record parental alcohol problems. Problem parental alcohol or drug use were each recorded in over a third (36 per cent) of serious case reviews where a child died or was seriously harmed. 

In 2018, the government's programme to support children of alcohol dependent parents recognised that there is more to be learnt about how systems and services can better identify and support children and families as well as to expand the capacity to do so. The Department of Health and Social Care and Department for Work and Pensions invested £6 million over two years in a range of projects across local authorities and the voluntary sector. This included £4.5 million across nine areas via an innovation fund, which areas used to explore a range of ideas for changing their systems and services to better meet the needs of their local communities.

The LGA have warned that while some councils will be able to provide more support for children living in households with an alcohol-dependent parent, the government should provide sufficient funding to enable councils to provide all children with the support they need. We have therefore been calling for the restoration of the £1.7 billion early intervention funding.

The Early Intervention Grant has been reduced by the Government by almost two-thirds – down from £2.8 billion in 2010/11 to £1.1 billion in 2018/19. As a result, many children’s services departments have been forced to cut back the universal and early help services – such as children’s centres and family support services – that can help tackle and prevent emerging problems before they reach crisis point. The LGA estimates that councils in England face a funding gap of more than £5 billion by 2024 to maintain children’s services at current levels.

Local authorities’ public health grant has been cut by 24 per cent on a real-terms per capita basis since 2015/16 (equivalent to a reduction of £1 billion). The lack of a real terms increase in public health grant funding at the recent Budget and Spending Review, despite this incredibly challenging period is very disappointing and makes it harder to address the stark health inequalities exposed by COVID-19 to level up our communities. Keeping people healthy and well throughout their lives reduces pressure on the NHS, social care, criminal justice and the benefits system.

Extra specific funding for public health will help address some short-term pressures, but we need a clear plan for the future which recognises the public health challenges we face as a country, addresses the current and future pressures on the public health workforce and supports the links with other parts of the health and care system.

The Licensing Act 2003 should be updated to include a public health objective, which would allow councils to take action to protect communities from alcohol related harm. 

Under the Licensing Act, councils can only currently consider four issues when deciding whether to grant licences – the prevention of crime and disorder; public safety; prevention of public nuisance; and protection of children from harm. Despite the established link between consumption and the availability of alcohol, councils currently find it challenging to ask for modifications to licences on health grounds. When considering licenses for new premises, such as an off-licence, pub or bar, councils are also unable to take into account whether a new license could exacerbate an existing localised public health issue such as high rates of alcohol-related hospital admissions. 

Amending the Licensing Act to include a public health objective would give councils the tools to act on local public health issues and place a legal requirement on businesses, including those that sell alcohol, to consider public health. To assist in decision making, council licensing teams would also benefit from greater access to NHS data, including hospital admissions and ambulance call-outs to understand where additional protections may be needed.