Dr Alastair MacGilchrist, Chair of SHAAP, comments on new findings suggesting that alcohol policy measures could reduce drink-related ambulance callouts

 

 Alcohol policy measures could reduce ambulance callouts, study finds

New alcohol policy measures should be considered to reduce drink-related ambulance callouts, according to researchers studying data from Scotland during the COVID-19 pandemic.

The University of Stirling-led team made the recommendation after their study found that ambulance callouts related to drinking in licensed premises fell significantly during the first lockdown – but were replaced relatively quickly by alcohol-related callouts to homes.

Professor Niamh Fitzgerald, Director of the Institute for Social Marketing and Health at Stirling, led the study and believes its findings present policymakers with an opportunity to reflect on how to sustain the positive outcomes of lockdown for the NHS and emergency services – including a reduction in what paramedics described as “mass public intoxication” over weekends – but also tackling other issues, such as the increase in problems caused by drinking at home.

Professor Fitzgerald said: “During the pandemic, both in the UK and abroad, licensed premises – including bars, restaurants and nightclubs – faced significant restrictions, including closures and curfews, which helped to reduce spread of the virus. However, we know that these restrictions also led to many people drinking more alcohol at home.

“By looking at data from the frontline of the NHS – the Scottish Ambulance Service – and adjusting for the fact that ambulance callouts fell during this period for other reasons, our study shows that there were disproportionately large short-term reductions in alcohol-related callouts in April and May 2020, when licensed premises were closed, compared to the previous year. This was a situation that paramedics described as a ‘welcome break’ from the hostile, alcohol-fuelled scenes experienced in towns and cities on weekend nights pre-pandemic.

“However, we also identified public health risks caused by increased home drinking during this period – with those night-time callouts quickly replaced by alcohol-related ambulance callouts on all days of the week, likely to be linked to home drinking. For example, in June 2020, when premises were still closed and weekend night-time callouts for alcohol incidents were still lower, the proportion of alcohol-related callouts had almost returned to pre-pandemic levels. Overall, there were 18,832 alcohol-related callouts at the height of the pandemic, in April to June 2020 – 16 percent of all callouts.

“Our findings suggest that policymakers here in Scotland, but also around the UK and abroad, need to consider how to build upon the lessons learned during the pandemic. As the night-time economy recovers, how can we avoid a return to pre-pandemic levels of alcohol-related callouts arising from the night-time economy, but also reduce callouts and harm from home drinking?”

 

Reduction in callouts

The research team – involving academics from ISMH and the University of Glasgow – analysed interviews with licensing stakeholders, to understand how COVID-19 has affected licensing and alcohol-related harms; explored the experiences of ambulance clinicians in further interviews; and conducted descriptive and time series analyses of alcohol-related ambulance callouts in Scotland, before and during the first lockdown.

Overall ambulance callouts for all causes between March and June 2020 – when lockdown was in place – decreased in comparison to the previous year. However, alcohol-related callouts fell much more sharply – with a 23% reduction in April 2020, compared to the same period in 2019. The drop was even more stark at weekends – down 31.8% – and at weekend night-times, down 48.9%.

After April, despite licensed premises remaining closed, the proportion of alcohol-related callouts gradually started to return to pre-lockdown levels. However, the resurgence in alcohol-related callouts was generated by calls spread throughout the week rather than concentrated at weekends, which still experienced substantially lower callouts in June 2020 than the previous year.

 

“Massive drop” in alcohol related incidents

Ambulance clinicians reported that the number of late-night callouts relating to alcohol “plummeted” when premises closed completely or operated under a curfew. However, there were perceived increases in domestic callouts and concerns raised about home drinking.

One paramedic said that during this time there had been “nowhere near the same amount of public intoxication or mass intoxication… there’s been much less in the way of assaults that involve alcohol, unconscious people outside that involve alcohol, falls that involve alcohol. All these things we’ve noticed a massive drop in.”

Another said: “It’s so nice to go to work on a Friday night knowing that you don’t have to go into pubs and clubs... it’s made a huge difference”

Several reported that the reduction in alcohol-related calls meant that they were spending more time on other calls.

 

Policy implications

Professor Fitzgerald said: “The views expressed by paramedics are powerful and give pause for thought about whether business recovery post-COVID has to mean a return to the ‘mass intoxication’ described.

“This is surely an opportunity for politicians and clinicians to show leadership in pushing for better alcohol policies that protect the NHS and frontline services. At a time when policymakers want to support the hospitality sector, but also wish to protect health services, there is an opportunity to put in place win-win policies that can do both.”

The research team suggest that one such policy could be to increase the minimum unit price of shop-purchased alcohol to reduce consumption within homes without affecting prices in bars. Other possibilities discussed are restrictions on online sales and licensing changes.

The research teams are analysing separately if and how the 50p minimum unit price, introduced in Scotland in 2018, has impacted alcohol-related ambulance callouts, as well as exploring expert and stakeholder views on this and other ‘win-win’ policies.

The researchers used data from the ‘Evaluating the impact of alcohol licensing in England and Scotland (ExILEnS)’ project, funded by the National Institute for Health Research’s Public Health Research Programme; and the ‘Impact of minimum pricing for alcohol on ambulance callouts in Scotland (IMPAACT)’ and ‘Lockdown and Licensed Premises’ studies, both funded by the Scottish Government Chief Scientist Office.

The new paper, Lockdown and Licensed Premises: COVID-19 Lessons for Alcohol Policy, is published in Drug and Alcohol Review.

 

Dr Alastair MacGilchrist, Chair of Scottish Health Action on Alcohol Problems (SHAAP), said:

“This research shows just how deep our relationship with alcohol goes: the initial reduction in alcohol call-outs at the start of the first lockdown when pubs closed was swiftly reversed as ambulance call-outs for people who had consumed alcohol from the off-trade went up.

“Solving Scotland’s problem with alcohol cannot be done with a quick fix, however there are a range of options at the Scottish Government’s disposal. Firstly it could increase the level of minimum unit pricing of alcohol from 50p to 65p, then it could restrict alcohol marketing so that children are not exposed to it, it could ban alcohol sponsorship of sports and it could restrict the availability of alcohol. This could be done, for instance, by introducing an ‘alcohol curtain’ in shops to stop alcohol being regarded as an everyday commodity, as Ireland has now done, or even by introducing alcohol-only stores as is the case in other parts of the world.

“These measures would not simply reduce alcohol consumption but they would contribute to the much-needed cultural shift in Scotland and would ultimately reduce the immense social, health and economic harms caused by alcohol each day in our communities.”