Alcohol Overprovision in Dundee Dundee Alcohol

ALCOHOL OVERPROVISION IN DUNDEE

DUNDEE ALCOHOL LICENCE PROVISION ANALYSIS GROUP

REPORT

SEPTEMBER 2012 (Amended March 2013)

- - 1

Table of contents

Executive Summary

1. Background

2. Aim

3. Objectives

4. Evidence linking availability of alcohol to consumption and alcohol

related harm

5. Geographies for data analysis

6. Alcohol availability

7. Alcohol Consumption

8. Alcohol related harm

9. Alcohol overprovision assessments in West Dunbartonshire

10. Conclusions

Appendices

Appendix1: Dundee alcohol licence provision analysis group members

Appendix 2: Alcohol logic models

- - 2

Executive Summary

This report includes information on alcohol licence provision and alcohol related harm in all the Local Community Planning areas of Dundee City.

The overall aims of the report are: • To collate information relating to alcohol-licence provision and alcohol-related harm across Dundee City • To provide the Dundee Licensing Board with a better overall picture of alcohol availability and alcohol-related harm • To inform the overprovision policy that will be developed by the Licensing Board.

The report does not include a definition of ‘overprovision’ but instead the focus has been to: • Agree appropriate areas of analysis within which data are available that would be meaningful to local people, LCPPs and elected members

• Identify indicators that will allow the overprovision policy to support all 5 licensing objectives (not just the public health objective)

• Examine the data in relation to occasional licences and extensions, as well as premises licences

• Contribute to the work of the Dundee Licensing Forum and support the decision-making process of the Licensing Board by improving the information available

• Present local information with a specific focus on the relationship between alcohol availability and alcohol related harm

The report provides Dundee City Licensing Forum and the Licensing Board a more accurate picture of alcohol availability and alcohol related harm across the City.

Key findings

The data presented in the report shows that the distribution of licensed premises and the pattern of alcohol-related harm is not a simple one. This is unsurprising given that: • Drinking at home, rather than within on-sales establishments, is increasingly becoming a common pattern of consumption

• People will travel a few miles to purchase cheap alcohol from off-sales premises

• Alcohol-related health and social harms often takes some time to develop and will be recorded on the basis of a person’s place of residence, which may not be closely related to their place of alcohol purchase

• The recording of acute alcohol-related presentations to A&E departments is still based on place of residence (although work is in progress to gather information about place of alcohol consumption prior to alcohol-related presentations).

As at 31 st March 2011, there were 430 premises licences in force in Dundee City, 17 (3 on-sale, 14 off- sale) of these being new applications in 2010/11. There were also 854 personal licences in force in Dundee City, 164 of these being granted during 2010/11. There was also 1 personal licence application refused in 2010/11.

- - 3 At a national level, the overall annual cost to the public purse of alcohol related harm (including health, crime, fires etc.) is estimated at £3.5 billion. At an individual level, there is harm to an increasingly high numbers of children and young people whose parents and carers have alcohol misuse problems.

The Licensing Board, through its Licensing Policy and enforcement of current Licensing Law, has the ability and responsibility to contribute to a shift towards a healthier relationship with alcohol in Dundee City.

More specific findings:

Across the City as a whole, and in 6 of the 8 multi-member wards, there are more on- than off-licensed premises.

In Community Regeneration Areas, however, a very different pattern is seen with 3 of the 6 areas having a far greater number of off- than on-licensed premises, and the overall balance being much more towards off-licensed premises. This is significant because:

• Off-licences sell alcohol at a markedly cheaper prices

• Off-licence sales allow for much more unsupervised and unregulated alcohol consumption, especially (but not exclusively) amongst young people

• Under-age drinkers are far more likely to purchase alcohol from off-licence than on-licence premises

There is a clear association between greater deprivation and greater levels of alcohol-related health harm, alcohol related hospital admissions, alcohol related A&E attendances, alcohol related deaths, and alcohol related mental health problems. Individuals from the most deprived areas account for more than 5 times the number of presentations compared with those from the most affluent areas.

The rate of alcohol related A&E attendances across Dundee varied from 1,994.5 per 100,000 in Lochee to 445.6 in the LCPP area of The Ferry. In 2010/11, there were 1,028 alcohol related hospital discharges for Dundee City residents, showing a 10% increase since 2009/10.

Coldside, Maryfield and Lochee have had consistently higher alcohol related hospital admission rates than the Dundee average. In 2010/11, the discharge rate varied from 974.1 per 100,000 population in Lochee to 366.1 in The Ferry.

The overall alcohol related death rate for Dundee for the period 2005-9 was 186 deaths per 100,000 population compared to the highest rate of 288 per 100,000 in Coldside and the lowest of 76 in The Ferry.

- - 4

1 Background

Section 7 of the Licensing (Scotland) act 2005 requires Licensing Board Policy Statements to include a specific statement of the extent to which the Board considers there to be overprovision of either licensed premises generally, or a particular type of licensed premises (such as vertical drinking establishments, or off-licensed premises) within any designated locality within the Board’s area.

Interpretation and implementation of this section of the Act has been variable. A few Licensing Boards have developed detailed overprovision statements (see section 5 below).

In 2011, Dundee City Local Licensing Forum agreed to ask the Alcohol and Drugs Partnership (ADP) to lead work to develop information that would help the Licensing Board progress its commitment to add a supplementary statement on overprovision into its 2010 Licensing Policy. This report is the output from that work. This report has been developed by the Dundee alcohol licence provision analysis group, chaired by Dr. Kirsty Licence (see membership list at appendix 1).

2 Aim

To collate from the Alcohol and Drugs Partnership (ADP) agencies information relating to alcohol licence provision and alcohol related harm across Dundee City. This is in order to provide the Licensing Board with a better overall picture of alcohol availability and harm and to inform the overprovision policy of the Licensing Board. The group will not aim to define a ‘cut-off’ level of licences as a target/limit to be aimed for within local areas of the City.

3 Objectives

• Agree appropriate areas of analysis within which data are available and which would be meaningful to local people, local community planning groups, and elected members • Identify indicators that will allow the overprovision policy to support all 5 licensing objectives, including the public health objective • Examine the data in relation to occasional licences and extensions, as well as premises licences • Contribute to the work of the Dundee City Local Licensing Forum by improving the information available to that group • Present local information in the context of the evidence of the relationship between alcohol availability and alcohol related harm

It was agreed that the report would initially be presented to the Dundee City Local Licensing Forum, as the statutory body responsible for overseeing the Licensing Board’s application of the Licensing Act (2005) and the licensing objectives, including overprovision.

4 Evidence linking availability of alcohol to consumption and alcohol related harm

There is a substantial body of evidence that increased availability of alcohol is associated with increased consumption, and that measures to limit availability, accessibility and affordability are likely to have a beneficial impact on both consumption and alcohol related harm. In this context, restrictions on availability may include:

• Reducing economic availability (pricing) • Reducing the hours or days when alcohol can be purchased • Restricting the number of outlets where alcohol can be purchased • Increasing the minimum effective age of alcohol purchase

- - 5 A review undertaken for the Scottish Executive in 2003 1 concluded that the relationship between general restrictions on alcohol availability and alcohol related harm was complex, but there was evidence that measures including restricting hours of sale, enforcement of purchase age limits, staggering closing times, and controlling outlet density were associated with reductions in alcohol related crime and disorder.

A further review examined the impact of off-licence premises in particular.2 This examined features of off-licence selling including promotions, sales to under-age and intoxicated customers, and the impact of outlet density. The review concluded that:

• Sales to underage customers were common in off-licence premises • Saes to intoxicated customers were also common, although there was less evidence of this than of under-age selling • There was evidence of a relationship between outlet density and assault • There was evidence of a relationship between outlet density and homicide • There was evidence of a relationship between outlet density and drink-driving/alcohol related crashes. In some cases, this relationship was specific to on-licence premises density, but in one study the relationship was significant for off-licence density. • There is evidence from the USA that as licensed premises density increases over time in defined geographical areas, so has the rate of violence and anti-social behaviour.

Analysis of local data in Glasgow demonstrated the relationship between alcohol outlet density and alcohol related crime.3 This replicated evidence gathered in a recent systematic review of 36 studies looking at the impact of alcohol outlet density on alcohol-related harms.4 The review found significant positive relationships between high outlet density and: • increased levels of violence • alcohol-related traffic accidents • self-reported injuries and suicide • sexually transmitted disease • child abuse or neglect. One longitudinal study included in the review found a 10% increase in the number of off-sales premises and bars was related to a 1.67% and 2.06% increase in violence rates respectively. Another study found the number of bars per 1000 of the population was positively related to the rate of physical abuse of children.

In addition, there are identifiable characteristics of retail alcohol outlets that may influence levels of alcohol consumption and harm: 5

• Outlet size (physical size of the retail premises or volume of sales) • Clustering, with competitive pressure from neighbouring outlets driving down prices and fuelling increased consumption • Location-the proximity of retail sites to places of concern, such as schools or places of worship • Neighbouring environmental factors, such as community demographics, and the degree of isolation of a community • The size of a community (which may affect access to other retail sites) • The type and number of alcohol outlets (bar, restaurant, liquor store, grocery outlet) in a community may also influence whether and how outlet density affects drinking behaviour • Alcohol outlets may be associated with illegal activities, such as drug abuse, which may also contribute to public health harms

1 Reid-Howie associates. Liquor Licensing and Public Disorder: Review of literature on the impact of Licensing and other controls, and audit of local initiatives. Edinburgh: Scottish Executive Social Research, 2003 2 Pattoni L, Emmerson C, Sudbery m, et al. The relationship between off-sales and problem drinking in Scotland. Edinburgh: Scottish Executive, 2007 3 The relationship between outlet density and crime in NHS GGC. Dr Catherine Chiang, 2009 4Popova S et al. Hour and days of sale and density of alcohol outlets: Impacts on alcohol consumption and damage: A systematic review. Alcohol & Alcoholism;44(5):500-516, 2009

5 Campbell CA, et al. The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol related harms. American Journal of Preventative Medicine.: 37(6):556-569, 2009 - - 6

Several of these are amenable to positive influence via Licensing Law.

Alcohol affordability is, to an extent, influenced by physical availability. Increasing the numbers and range of outlets licensed to sell alcohol increases competitive pressures and drives down prices. The effects of this are clearly seen in the supermarket chain sector, where alcohol can be sold below cost price in order to increase general footfall. 6 Whilst proposals for the alcohol minimum pricing legislation could have a beneficial impact on this, competitive pressures between high density alcohol outlets remain a challenge.

Where there is a high density of alcohol outlets and economic pressures that may reduce custom, on- trade premises are at risk of significant under-capacity. This could increase the purchasing of alcohol from off-sales, which would increase consumption within people’s own home in a less controlled environment and greater risk of harm. This was demonstrated in the report for West Dunbartonshire Licensing Board, where overall on-licence capacity was under-used by 97%. 7

The World Health Organisation has reviewed the evidence for interventions likely to reduce alcohol consumption and alcohol related harm. 8,9 Restricting the availability of alcohol consistently emerges as amongst the most effective interventions for reducing alcohol consumption (Box).

Impact of interventions to reduce alcohol related harm MEASURE IMPACT Pricing High

Availability High - Age limit - Outlet Density

Harm Reduction Mid - Server training - Local Policing - Nightime Transport

Treatment High - Brief Interventions

Regulating Ads Mid & Promotions

Education Low - Schools - Public Education Source: WHO. Alcohol: No ordinary commodity

As a means of supporting local Licensing Fora and Boards, Alcohol Focus Scotland convened an Expert Workshop Group in 2011. This included representatives from public health, substance misuse services, Scottish Health Action on Alcohol Problems, academic institutions, and legal representatives including a QC.

The output from the workshop was a report-Re-thinking Alcohol Licensing 10 -which presents much of the evidence linking provision of alcohol licences with alcohol related harm, as well as providing practical

6 Groceries Market Investigation: provisional findings report, Appendix %, 6. Competition Commission, Oct 2007. 7 West Dunbartonshire Alcohol and Drugs Partnership. Alcohol Overprovision-Licensing Board Consultation. June 2010 8 WHO. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol 9 Babor TF, Caetano R, Casswell S, et al. Alcohol: no ordinary commodity. Oxford: Oxford University Press, 2003 10 AFS and SHAAP. Re-thinking Alcohol Licensing. Sep 2011 - - 7 guidance to Licensing Boards and Fora on the application of the public health objective in licensing policy.

5 Geographies for data analysis

Information gathering across agencies is complicated by the different ways in which data are recorded. Tayside police record crimes and incidents by grid reference, whilst health service data are recorded by postcode. Postcode level data can be aggregated to a variety of levels, including Data Zones, Intermediate Zones, Local Community Planning Partnerships and Local Authority multi-member wards. It is important, however, that information is presented in a way that is meaningful to the user. For residents within Dundee City, there will be a number of clearly defined communities with which people may associate themselves. Representation is also an important consideration, as the views of communities are often expressed through geographically defined bodies such as Local Community Planning Partnerships and Electoral Wards. It is often through these structures that change can be implemented within a local area.

For the purpose of this report, Local Community Planning Partnership (LCPP) areas have been selected as the core unit of analysis. The rationale for this was:

• These represent areas for which there are designated representative groups with whom a dialogue can be established on these issues • The LCPP areas are coterminous with the multi-member wards, making them meaningful to elected members on the Licensing Board and other Council groups, and to the electorate • Data available on population and from health and the police can be aggregated to the level of the LCPP areas

Because the effects of alcohol related harm are manifested to a much greater extent amongst populations with higher levels of socio-economic deprivation, the impact of alcohol within regeneration areas was also examined where data were available. The relationship between these various geographies is illustrated in the maps in Appendix 2.

6 Alcohol availability

The data reported in this section are drawn from a variety of sources including industry sales (The Nielson Company), official government statistics and population surveys.

Retail sales data indicate that in 2010, 11.8 litres of pure alcohol were sold per adult in Scotland compared with 10.7 litres in 1994. This equates, on average to 22.8 units drunk in 2010 per adult per week, higher than the recommended low risk drinking limits for either men (21 units per week) or women (14 units per week).

Over this time period, on-trade sales decreased by 28% to 3.9 litres between 1994 and 2010 whereas off-trade sales increased by 52% over the same time period to 7.9 litres.

The average price of a unit of alcohol sold through the off-trade in Scotland was 45 pence per unit and 134 pence per unit through the on-trade.

6.1 Premises licences

Figure 1 shows the rate of liquor licences in Dundee. Although the overall rate of licences has consistently been lower than the overall Scottish rate of 43 per 10,000 in 2007, it should be noted that, in comparison with other areas of the UK, Scotland has very high levels of alcohol related harm (see section 8). In turn, the UK has higher levels of alcohol related harm than other comparable countries including many European neighbours, the USA, and Australia. If as a community we are serious about wanting to reduce the levels of alcohol related harm, we should be seeking much healthier comparators than Scotland or our UK neighbours in terms of availability and consumption. - - 8

Figure 1: Liquor licence rate per 10,000 population aged 18 and over 1994 – 2007 Dundee City

Rate per 10,000 population (aged 18+) 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

Source: Scottish Government

There is marked variation in the distribution of licences across geographical areas, leading to high concentrations in some localities (table 1 and 2). The implications of high outlet density have been discussed above.

Table 1; Current premises licences in Dundee City by Ward as at Dec 2011 Ward On-sales premises licences Off-sales premises licences Coldside 36 16 East End 9 18 Lochee 29 16 Maryfield 98 23 North East 7 8 Strathmartine 17 9 The Ferry 39 15 West End 75 17 TOTAL 310 122

Table 2; Current premises licences in Dundee City by Community Regeneration Area (CRA) as at Dec 2011 Community Regeneration Number Rate per 100 000 population Area On-sales Off-sales On-sales Off-sales premises premises premises premises licences licences licences licences Ardler/St Mary’s/ Kirkton 1 5 15 75

Menzieshill/Charleston, 17 11 245 158 Lochee/Beechwood Mid 5 15 67 200 Craigie/Linlathen/Douglas Mill 3 5 49 81 O’Mains/Fintry/Whitfield Stobswell/Hilltown/Fairmuir 47 28 360 215

All non-CRA 263 94 328 117 - - 9

Across the City as a whole, and in 6 of the 8 multi-member wards, there are more (and in most cases substantially more) on- than off-licensed premises.

• Off licences sell alcohol at markedly cheaper prices • Off licence sales allow for much more unsupervised and unregulated alcohol consumption, especially amongst young people • Under-age drinkers are far more likely to purchase alcohol from off-licence premises than on- licence premises

Bearing in mind that people will travel to purchase cheaper alcohol, the distribution of licences on a ward by ward basis may appear irrelevant. Such physical clustering of alcohol outlets will, however, have impacts on local communities in terms of:

• Visibility and normalisation of alcohol • Competitive pressures • Noise • Litter • Gatherings of people • Absence of other social or other activities within communities

Maps in Appendix 3 illustrate the range and number of alcohol outlets available within 500m, 1km and 3km of the mean centre of each ward. These demonstrate that for residents of a compact, fairly small City such as Dundee, availability of alcohol cannot be adequately assessed on a small area basis. A city-wide approach is required. Appendix 4 provides the full report on licence provision across Dundee city.

6.2 Extensions and occasional licences

6.2.1 Occasional Licence

An occasional licence can be applied for by either a personal licence holder, premises licence holder or a voluntary organisation (there is no description in the legislation as to what a voluntary organisation has to be!)

An applicant can not apply for an occasional licence for a premise that already has a premises licence excluding members clubs. A social club may apply for this occasional licence if they were holding an event that would see non members attending e.g. open day at a bowling club in an attempt to raise membership or a birthday party where non-members would be attending.

Both social clubs and voluntary organisations are limited as to how many occasional licenses they may apply for. There are no limits on applications for personal licence holders and / or premises licence holders.

If the board receives an occasional licence application and has not received any notice from the chief constable or a report from the LSO's or an objection in relation to that application the board must grant the application. If the board do receive any form of objection/report they may hold a hearing regarding the grant.

Data are not available on the number of occasional licences the Board grants.

6.2.2 Extended Hours

- - 10 In 2011, licensing extensions were routinely available to all licensed premises, upon application, for 77 days of the year (over 20% of days). These were general extensions where the Licensing Board allowed all premises in an area the option of extra hours (e.g. over the festive period).Take up of these extensions by number of premises is shown in the table for 2011.

There are other occasions when licensed premises, including social clubs, can apply. These would be for a special event being catered for on the premises and an event of local or national significance. Applications for extended hours are uncommon outwith the dates shown in table 3 below.

6.3 Capacity of licensed premises

Applications for on-licence premises are required to include the capacity of the premises in terms of the number of customers. For off-licence applications, these are required to include the area of shelf frontage that will be dedicated to alcohol displays. This information actually provides very limited information on actual sales or even sales capacity because shelf capacity varies, re-stocking has an impact, and inspection often shows that the actual shelf frontage for alcohol displays varies substantially from operating plans. This lack of information has been noted in other overprovision assessments.

Table 3: General licence extensions for holiday periods. Dundee city, 2011/12 Holiday Number of days on Number of premises Number of premises which extension of applying for applying for licensing hours extensions 2011 extensions 2012 offered Spring holiday 3 days 17 22 Easter 3 days 25 23 May holiday 3 days 33 26 Victoria day 3 days 24 n/k Blues 10 days 27 26 Bonaza/Broughty Ferry festival Annual trades holiday 17 days 30 24 Autumn holiday 3 days 32 6 Christmas and New 33 days 77 n/k Year St Patricks Day 1 days 8 14 Halloween 1 days 19 n/k

6.4 Purchasing of alcohol by young people aged under 18 years

The Scottish Adolescents Lifestyle and Substance Use Survey (SALSUS) is carried out amongst 13 and 15 year olds every 2 years. Key findings from the 2010 survey of Dundee youngsters include:

• Of all the youngsters who had ever had an alcoholic drink (58% of 13 year olds and 75% of 15 year olds), 46% of those aged 13 years and 63% of those aged 15 years had purchased alcohol themselves.

• In the 4 weeks before the survey, 13% of the youngsters had bought alcohol in a shop, supermarket or off-licence, and 9% in a pub, bar or club.

• Overall, however, the most significant source of alcohol for under-age young people was older friends, relatives, and sometimes strangers, who were commonly reported to buy alcohol for the teenagers.

These statistics demonstrate the need for ongoing strong enforcement of existing licensing legislation and the application of new approaches to limit under-age and proxy purchasing. - - 11

7 Alcohol consumption

Consumption data have been obtained from the most recent Scottish Health Survey published in September 2009 but due to a small sample size, there are no recent data available at a Health Board or local authority level. There is, however, information presented for Tayside from the 2003 Scottish Health Survey.

Figure 2 shows the percentage of adults in Tayside and Scotland who drank over (and more than twice) the recommended guidelines’ daily limits (4 units for men and 3 units for women) on their heaviest drinking day in the week prior to the survey.

In 2003, the proportion of adults in the general population exceeding daily limits in Tayside was very similar to that of Scotland as a whole with 46% of men and 36% of women drinking above the recommended guidelines and 29% of men and 18% of women consuming more than twice recommended limits (or ‘binge’ drinking) on their heaviest drinking day. Results from the 2009 Scottish Health Survey suggest that the proportion of adults ‘binge’ drinking has decreased over this time period.

Figure 2: Percentage of adults (aged 16+) who drank over the recommended daily limits; Tayside and Scotland 2003 compared to Scotland 2009

50 45 40 35 30 25 20 Percentage 15 10 5 0 Consumed over 4 Consumed over 8 Consumed over 3 Consumed over 6 units units units units

Men Women

Scotland 2003 Tayside 2003 Scotland 2009

Source: Scottish Health Survey 2003 & 2009

This short term small reduction in self-reported alcohol consumption must be set in the context of the longer term trend described above for marked increases in alcohol purchasing. Despite the slight fall in consumption, these data show that almost a half of all adult men and a third of adult women regularly consume alcohol above low risk limits. This dramatic fact is reflected in high levels of alcohol related harm.

In terms of alcohol consumption by young people, the 2010 SALSUS showed that, amongst Dundee teenagers who had ever had an alcoholic drink, 64% of 13 year olds and 77% of 15 year olds had been drunk at least once.

8 Alcohol related harm

8.1 Health harm - - 12

Excessive alcohol consumption can result in a wide range of health problems. It can cause short-term problems such as acute intoxication and poisoning. Over the longer term, excessive consumption can cause serious damage to parts of the body such as the liver and brain. Alcohol misuse can lead to mental health problems such as alcohol dependency. There are many conditions where alcohol is known to be a contributory factor such as cancer of the mouth, pancreatitis and stroke. United Kingdom comparisons show that Dundee City is amongst the worst local areas for alcohol related deaths in the whole of the UK (figure 3 and 4). For the period 1998-2004, the alcohol related death rate amongst men was the 5 th highest in the whole of the UK, and for women the Dundee City death rate was the 2 nd highest in the whole of the UK.

Figure 3 (see p. 12): Alcohol related death rate in males by local area 1998-2004

- - 13

Figure 4: Alcohol related death rate in females by local area 1998-2004

- - 14

Internationally, England and Wales, and to an even greater extent Scotland, have a far higher burden of alcohol related liver disease than other European countries (figure 5 p.14).

- - 15

Figure 5: Liver cirrhosis mortality 1990-2002 updated from Leon and McCambridge, Lancet 367 (2006)

Men aged 45-64 years Women aged 45-64 years 80 80

70 70 Scotland Other European 60 60 countries

50 50

40 40 Scotland 30 30 Other European countries 20 20 England 10 and Wales 10

Age standardised mortality rate per 100,000 England and Wales 0 0 1950 1960 1970 1980 1990 2000 1950 1960 1970 1980 1990 2000

8.1.1 Alcohol related A&E Presentations

A NHS Quality Improvement Scotland audit report published in November 2006 found that alcohol was a contributory factor in 11% of attendances to A&E departments across Scotland.

Building on this report, this section shows attendances to the A&E department at Ninewells Hospital by Dundee City residents, where either an ‘alcohol intoxication’ diagnosis was recorded or where the ‘misuse of alcohol’ was recorded.

Figure 6 shows alcohol related attendance rates per 100,000 population by the Local Community Planning Partnership (LCPP) area of residence of those presenting. The rate across Dundee varied from 1,994.5 per 100,000 in Lochee to 445.6 in the LCPP area of The Ferry.

- - 16 Figure 6: Dundee City alcohol related presentations to A&E (Ninewells) by LCPP 2010/11

2500.0

2000.0

1500.0 Dundee City 1000.0

500.0

Rate per 100,000 population 100,000per Rate 0.0 Lochee Coldside East End East West End West The Ferry The Maryfield North East North Strathmartine LCPP area

- - 17 8.1.2 Alcohol related Hospital Discharges

Alcohol related hospital discharges give a measure of the amount of harm to physical and mental health that alcohol misuse is causing.

In 2010/11, there were 1,028 alcohol related hospital discharges for Dundee City residents, showing a 10% increase since 2009/10. Two thirds of the discharges were males.

Comparisons of alcohol discharge rates across Dundee can be made by examining LCPP areas of residence as shown by Figure 7. This chart also shows trends over the five years 2006/07 – 2010/11. Despite some fluctuations, the overall Dundee alcohol related discharge rate (represented by the blue line on the graph below) has remained fairly steady in the time period. There has, however, been some change over time within the LCPP areas of the city but Coldside, Maryfield and Lochee have had consistently higher rates than the Dundee average. In 2010/11, the discharge rate varied from 974.1 per 100,000 population in Lochee to 366.1 in The Ferry.

Figure 7: Dundee City alcohol related acute hospital discharge rates by LCPP 2006/07 - 2010/11

1400.0

1200.0

1000.0

800.0

600.0

population 400.0

200.0

0.0 Age standardised rate per Age 100,000 2006/07 2007/08 2008/09 2009/10 2010/11 Year

Coldside East End Lochee Maryfield North East Strathmartine The Ferry West End Dundee City

Source: SMR01

- - 18

Over half of alcohol related discharges in 2010/11 had a diagnosis of ‘mental and behavioural disorders due to the use of alcohol’. Other common diagnoses for alcohol related discharges were the ‘toxic effect of alcohol’ and ‘alcoholic liver disease’.

8.1.4 Alcohol Related Deaths Figure 8 shows the pattern of Dundee City deaths over the last 32 years where alcohol was the underlying cause of death. The figures show that, despite some fluctuations, over time there has been an increase in such deaths.

Figure 8: Dundee City alcohol related mortality 1979 - 2010

30 Number of deaths 20

5 3 5 3 5 981 98 991 99 99 001 00 00 009 1979 1 1983 1 1987 1989 1 1 1 1997 1999 2 2 2 2007 2 Year

Source: GRO Scotland - - 19

To allow for comparisons of alcohol related deaths within Dundee, five years of deaths (2005-2009) have been added together and a crude death rate calculated to give more meaningful data at LCPP geography. The overall Dundee rate for the period was 186 deaths per 100,000 population compared to the highest rate of 288 per 100,000 in Coldside and the lowest of 76 in The Ferry (figure 9). Figure 9 shows that Dundee City’s alcohol-related mortality is greater than the Scottish average.

Figure 9: Alcohol –related mortality: Crude cumulative death rate2005-2009 per 100 000 population. Dundee City, Dundee LCPPs and Scotland

350.0

300.0

250.0

200.0

150.0

100.0

50.0

0.0

t y d nd ee as ine nd E ch E Ferr t E tlan ast Lo es co Coldside E Maryfield orth The S N W trathmart Dundee City S

Source: GRO Scotland

- - 20

8.1.5 Alcohol related health harm and deprivation

There is a clear association between greater deprivation and greater levels of alcohol related health harm- alcohol related hospital admissions, alcohol related A&E attendances, alcohol related deaths, and alcohol related mental health problems. This is illustrated in Figure 7 for A&E attendances. Individuals from the most deprived areas account for more than five times the number of presentations compared with those from the most affluent areas.

Figure 10: Dundee City alcohol related presentation rate to A&E (Ninewells) by deprivation 2010/11

2500

2000

1500

1000

500 Rate per 100,000 popn

0 1 (most deprived) 2 3 4 5 (least deprived) SIMD Quintile

Source: A&E Information Analyst

8.2 Crime and disorder (see also detailed analysis at appendix 5)

There were 581 drunk-driving offences reported in Tayside in 2010/11 by the Recorded Crime in Scotland 2011 statistics published by the Scottish Government. This equated to a rate of 14.4 per 10,000 population. In addition, 362 drunkenness offences were recorded; this is a rate of 9.0 per 10,000 population.

Offences data recorded by Tayside Police show that alcohol is an aggravator in a large percentage of incidents. Figure 27 details crimes in Dundee and their relationship with alcohol. It must be noted that this is by no means a true reflection of alcohol involvement and is likely to be underestimated. Alcohol involvement has to be stipulated by the reporting officer as an aggravator which can be subjective. The table shows that the highest rate of alcohol related offences per 100,000 population were for petty assault and breach of the peace. Although a far smaller number of offences for serious assault were recorded, alcohol was thought to be an aggravator in 61.9% of the incidents.

- - 21

Table 4: Offences recorded in Dundee and their relationship with alcohol 2010/11 Incidents where alcohol is Alcohol related Total involved incidents per Offence Type number of 100,000 incidents Number Percentage population Petty Assault 2,513 1,164 46.3% 808 Breach of the Peace 1,408 586 41.6% 407 Vandalism 2,946 217 7.4% 151 Serious Assault 118 73 61.9% 51 Drugs Offences 1,189 98 8.2% 68 Culpable & Reckless 98 22 22.5% 15 Conduct (not with firearms) Indecent Assault 37 18 48.7% 13 Source: Tayside Police

In addition, a small number of alcohol related offences for culpable & reckless conduct (with firearms), malicious mischief and wilful fire raising were recorded.

Table 5 details the 8 LCPP wards by number of licensed premises and alcohol related incidents. The Maryfield ward had the highest absolute number of incidents. This is not unexpected as this ward covers the city centre where alcohol related incidents are much more likely to occur given the number of persons frequenting the area (particularly over weekends), and the number of licensed premises. In contrast, the North East ward appears to have a high level of police incidents relative to the number of licensed premises in the area, and The Ferry has a low level of incidents in the context of a relatively high number of licensed premises (figure 11).

Table 5: Licensed premised and alcohol related police incidents by ward, Dundee city, 2010/11

*No. of Multi-member ward Licensed No. of Alcohol Related area Premises Incidents Coldside 35 243 East End 27 237 Lochee 33 259 Maryfield 75 769 North East 6 236 Strathmartine 17 136 The Ferry 43 57 West End 62 206

*The number of premises in each ward area is a snapshot during the incident data collection period, as the actual number of active premises licences varies.

- - 22

Figure 11: Licensed premises and offences with an alcohol aggravator by LCPP ward

Licensed Premises & Offences with Alcohol Aggravator by LCPP Ward

900 769 800 700 600 500 400 259 300 243 237 236 206 136 200 75 43 57 62 100 35 27 33 6 17 0

e d in n rt Ferry Lochee ma e Coldside East End Maryfield th Th West E North East a Str

Fixed Penalty Notices (FPNs)

Figures for consuming alcoholic liquor in a public place and urinating or defecating in circumstances causing annoyance to others are obtained through FPNs. Due to the recording of FPNs the ‘easting’ and ‘northings’ were not obtained therefore could not be mapped along with the crime offences. Furthermore, it could not be ascertained without a manual check whether those urinating or defecating in circumstances causing annoyance to others were under the influence or not. Figures for 2010/11 are noted below.

• Forty Five incidents of consuming alcoholic liquor in a public place. • Two hundred and forty three incidents of urinating or defecating in circumstances causing annoyance to others.

Incidents that have taken place where there has been a domestic concern are marked with a domestic aggravator.

• Of the 8448 offence types examined 23.1% (1948) had a domestic aggravator. • Of the 1948 incidents which contained a domestic aggravator 48% (936) of those also contained an alcohol aggravator. • Of the 73 serious assaults with an alcohol aggravator 2.7% (2) contained a domestic aggravator. • Of the 1164 petty assaults with an alcohol aggravator 30.9% (360) contained a domestic aggravator.

As with the other crime types this is by no means an exact figure primarily due to the underreporting of domestic incidents, however, it gives an indication of alcohol involvement in domestic incidents as well assaults.

8.3 Social harm

Information from the Scottish Children’s Reporter Administration (SCRA) shows that in Dundee City in 2010/11, 14 children were referred for alleged misuse of alcohol and/or drugs. The majority of referrals were male, aged 14 or 15 years and had been referred to the Reporter by the police.

The 2010 SALSUS found that around 20% of the 13 and 15 year olds who responded had been in trouble with the police as a result of drinking alcohol. Eleven per cent had tried drugs, 10% had stayed off school and 17% had been involved in a fight as a result of alcohol consumption.

- - 23

8.4 Economic harm

Although alcohol sales and alcohol outlets contribute much to the overall income and night-time economy of Dundee city, this must be set against the costs of alcohol related harm. A study from the University of York estimated the total costs to the Scottish economy of alcohol related harm to be between £2.48 billion and £4.64 billion, with a mid-point estimate of £3.56 billion. These are broken down as follows:

• 7.5% health service costs • 6.5% social work costs • 20.4% crime associated • 24.3% due to loss of productive capacity • 41.2% wider societal costs associated with such things as alcohol relate deaths and family breakdown

For details of alcohol cost see: http://www.alcohol-focus-scotland.org.uk/local-cost-profiles For details of cost in Dundee: http://www.alcohol-focus-scotland.org.uk/view/download/271-cost-of-alcohol-harm-profile-dundee-city

- - 24

8.5 Summary comparison table across Dundee City wards with comparators for Dundee City and Scotland

Multi- Licences at Oct 2011. Alcohol related Alcohol related Alcohol related Offences with an member Rate per 100000 presentations to deaths. Crude hospital alcohol aggravator ward population of working A&E (Ninewells). rate per 100000. admissions. 01/04/2010 to and pensionable age. Rate per 100000 2005-2009 Directly 31/03/2011 population. standardised rate Presented per 100000 between population. 01/04/2010 and 01/04/2010 to 31/03/2011 31/03/2011 On Off Coldside 232 103 1534 288 901 1240 East End 73 146 1280 211 835 1489 Lochee 191 105 1995 275 974 1420 Maryfield 638 150 1895 244 767 4591 North East 58 66 1656 159 857 1563 Strathmartine 117 62 1248 155 473 730 The Ferry 242 93 446 78 366 300 West End 389 88 1109 94 568 978 Scotland 260 150 139 695 Dundee City 1377 186 701

- - 25

9 Alcohol overprovision assessments in West Dunbartonshire

In June 2012, the West Dunbartonshire Alcohol and Drugs Partnership presented a report to its Licensing Board based on analysis of:

1. The rate of Licensed Off Sales, normalised to represent the number per 100,000 population, and comparison with the West Dunbartonshire figure 2. The rate of Licensed On Sales, normalised to represent the number per 100,000 population, and comparison with the West Dunbartonshire figure 3. The rate of alcohol indicative crimes (see Appendix 2 for list), normalised to represent the number per 100,000 population, and comparison with the West Dunbartonshire figure 4. The rate of alcohol indicative incidents (see Appendix 2 for list), normalised to represent the number per 100,000 population, and comparison with the West Dunbartonshire figure 5. The rate of alcohol hospital admissions, normalised to represent the number per 100,000 population and the comparison with the Scottish rate (where Scottish rate = 100%) 6. The rate of alcohol related deaths, normalised to represent the number per 100,000 population and the comparison with the Scottish rate (where Scottish rate = 100%)

The report also included an analysis of the level of utilisation of the existing on-licensed capacity. In response to this, the Licensing Board accepted that there was overprovision of licensed premises in 15 of the 18 Intermediate Zones within the Board’s area. The Board agreed the following policy:

There is overprovision of the following types of licensed premises, namely :

• Vertical drinking establishments (including hotels where the bar facilities are not ancillary to the accommodation or dining), nightclubs, off-sales and local convenience stores and supermarkets.

• There is one area within West Dunbartonshire which comprises15 sub localities. The view was taken that there was doubt in terms of the act whether the Board could have an overprovision policy covering the whole area.

• Nor did the Board wish to do this as figures for 3 of the 18 areas were better than average. On the other hand it was difficult to show clear causal link between problems, particularly health problems occurring an intermediate data zone and the premises therein. Thus the 15 intermediate data zone where problems occurred, now form 1 overprovision locality, albeit the 15 areas are retained as sub localities for statistical purposes. The policy is map based.

Applications Against The Policy:

• The Board will expect applicants seeking the grant of a new licence or to increase the capacity of an existing licence within the above categories and localities to provide robust and reliable evidence to the Board why the benefits to the licensing objectives through the grant of their application outweighs the detriment to the licensing objectives and the overprovision policy. In particular the Board expects to be addressed on the benefits in terms of each licensing objective.

• If an existing licence ceases to be in force, any application seeking to replace capacity so relinquished may be subject to an individual overprovision assessment.

• This recognises that the overprovision assessment merely shows that there is a problem, but does not show the necessary reduction in premises to remove this problem.

• For applications within the 3 areas outwith the overprovision policy, if it is likely that there will be trade draw from the overprovision area then such an application will also be subject to an individual overprovision assessment. In practice trade draw is likely for an off-sale were it is the nearest off-sales for part of the over provision locality. Similarly a nightclub or super pub might draw from the over provision area.

• On the other hand a small village pub located well away from the boundary of an over provision area would not (and the Board has just granted one of these).

- - 26

10 Conclusions

Tackling excessive alcohol consumption and alcohol related harm is a multi-agency task that requires action to be taken by a wide range of bodies influencing national, local authority, community, family and individual practices. The contribution of different agencies has been represented in logic models (appendix 6)

The achievement of shared goals requires the contribution of all partners to tackle the inter-linked and complex drivers of alcohol related harm. At a national level, the overall annual cost to the public purse of alcohol related harm in terms of health, crime, fires etc is estimated at £3.5 billion. At an individual level, there is harm to an increasingly high numbers of children and young people whose parents and carers have alcohol misuse problems.

Within this report, the Dundee City Local Licensing Forum and the Licensing Board has a picture of alcohol availability and alcohol related harm across the City that should be of use in the further development of the Board’s Licensing Policy, especially the overprovision statement. This should then guide the consideration of individual licence applications.

The data presented here show that the distribution of licensed premises and the pattern of alcohol related harm is not a simple one. This is unsurprising given that:

• Drinking at home is becoming an increasingly common pattern of consumption, rather than on-sales consumption • People will travel a few miles to purchase cheap alcohol from off-sales premises • Alcohol related health and social harms often takes some time to develop and will be recorded on the basis of a person’s place of residence, which may not be closely related to their place of alcohol purchase • The recording of acute alcohol-related presentations to accident and emergency departments is still based on place of residence. However, in addition, work is in progress to try and gather information about place of alcohol consumption prior to alcohol-related presentations.

Specific recommendations for the consideration of the Forum and Board are:

• The information presented in this report could be improved, especially in relation to the capacity of off- licensed premises. We recommend that work should be undertaken involving the Licensing Board, Trading Standards, Planning, Rates and other relevant departments to try and establish a much better measure of alcohol sales volume from retail premises. This would provide more accurate information on which the Board could bases its licensing decisions, taking into account the likely impact on the amount of alcohol to be made available within any community.

• Consideration should be given to the frequency and duration of general licensing extensions, where all licensed premises in an area are allowed the option of extra hours, (e.g. in the summer period and around Christmas/New Year ). There should be no assumption of regular extensions. All extensions should be specifically applied for and justified.

• Consideration should be given to adopting a much more targeted and focussed approach to licensing extensions and occasional licences that are granted for specific local events, for example the Dundee Jazz week and Broughty Ferry festival.

• The Licensing Board should explicitly acknowledge the added risk of making alcohol available in close proximity to other specific premises, including for example schools and betting shops. This should then be considered by the planning board.

- - 27 • This report presents a large amount of routinely available and specifically collected data. It does not include the views of local people and communities, and these are vital in planning the future direction of alcohol licensing in any locality. We therefore further recommend that Dundee City Local Licensing Forum should, with support from the ADP and community planning partners, lead a process of consultation with communities around overprovision. All the Local Community Planning Partnerships in the City have identified alcohol as a problem issue for their area, more proactive and direct engagement with these groups should be used to inform the Forum’s response to both this report, and the overall Licensing Policy for the City.

- - 28 Appendices

Appendix 1 : Membership List

Organisation Nominee Mark Duncan Tayside Police Simon Goulding Licensing Standards officer Vered Hopkins ADP Support Team Liz Kay Community Safety Manager Dr Kirsty Licence NHS Tayside Graeme Petrie Licensing Standards officer Carole Robertson Dundee City council Caroline Snowdon ADP Support Team Kirstie Wilkinson Dundee Focus on Alcohol Brian Woodcock Dundee City Council/Licensing Board

- - 29 100 200 300 400 500 0 12 01 21 41 61 81 02 22 42 62 82 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 53 4 12 8 6 2 2 14 4 30 39 5 Licensed Premises & Offences with & Offences Alcohol Premises Aggravato Licensed 12 6 52 221 429 4 29 27 213 2 60 4 88 5 Intermediate Zones Intermediate 19 6 26 3 94 21 82 1 41 2 42 r by Intermediate Zonerby Intermediate 15 92 9 109 7 47 5 82 25 58 09 10 179 83 1 9 2 13 9 23 3 28 2 31 105

- - 30