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A Measure of Change: an evaluation of the public health transfer to local authorities on alcohol

Alcohol misuse is having a significant impact on communities throughout England, severely affecting the health of local populations

There were approximately 1.2 million alcohol-related hospital admissions in England in 2011/121. In addition, alcohol misuse has a much wider impact than on health alone: in half of all violent incident perpetrators are believed to be under the influence of alcohol2 and a fifth of all young callers to Childline are worried about drinking by a parent or other significant person3. In financial terms, the cost to society is no less great: in England alcohol misuse accounts for approximately £21 billion a year4. Local communities are paying the price for excessive alcohol misuse, and it is essential that they develop effective local actions to combat the problems, alongside much needed national levers such as minimum pricing.

The Health and Social Care Act 2012 radically reformed the way in which health care in England is commissioned and managed. One of the key legislative changes in this Act was the transfer of public health to local authorities. Another was the introduction of Clinical Commissioning Groups (CCGs) – putting clinicians in charge of shaping health services. Many of the changes in the Health and Social Care Act, including the two mentioned above, came into being on 1st April 2013. From this date, the commissioning and funding of alcohol services have been the responsibility of the 152 upper-tier London boroughs and unitary local authorities in England. Funding for alcohol services comes from the ring-fenced public health grant that each local authority receives to provide a wide range of public health interventions and services. The National Treatment Agency for Substance Misuse has been abolished, with its functions transferred to Public Health England, now the national lead for public health.

The 152 upper-tier local authorities are required to have a Health and Wellbeing Board that sets out local health needs and priorities through Joint Strategic Needs Assessments (JSNAs). Joint Health and Wellbeing Strategies (JHWSs) are the documents that set out how local authorities will meet the needs identified in JSNAs. Local authority and CCG commissioning plans are expected to be informed by both the JSNA and JHWS, which are continuous processes. Health and Wellbeing Boards (HWBs) will decide when to update and refresh the JSNA and JHWS and must encourage integrated working between health and social care commissioners. As a minimum, HWBs must comprise the following members:

• One local elected representative
• A representative of local Healthwatch
• A representative of each local CCG
• The Director of Public Health for the local authority
• The local authority Director for Adult Social Services
• The local authority Director of Children’s Services

The return of public health to local authorities provides a significant opportunity to reduce alcohol harm by bringing together many of the different levers into one arena. These levers include such measures as gathering data on local levels of alcohol-related harm; conducting a thorough needs assessment; developing local strategy and alcohol pathways; using licensing legislation to ensure the responsible marketing, promotion and selling of alcohol; running social marketing campaigns; and providing Identification and Brief Advice (IBA), hospital-based services, specialist treatment, peer support options and wider support including employment, training and housing.

However, there are significant structural challenges resulting from such a major reorganisation and local authorities are also currently tasked with implementing substantial budget cuts. One year on from the transfer of public health to local authorities, Alcohol Concern has sought to investigate the impact of the changes on tackling alcohol harm locally. ‘A Measure of Change’, an 18 month research project funded by Alcohol Research UK, was initiated in June 2013. This interim report publishes the first wave of findings; a final report will be published in November 2014.