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Bulletin November 2008
Internationally proven community alcohol crime and harm reduction programmes trialed in Britain
Though unable to securely document outcomes, three projects have shown that British communities can generate the kind of coordinated action which new reports from the USA and Sweden have shown to curtail alcohol-related violence and injury, creating substantial cost-savings for society. Rather than targeting risky drinkers, all the projects targeted high-risk neighbourhoods, aiming to modify features of their social and physical environments which generated alcohol-related violence and disorder. 
Findings 
UK From 2004, projects in Glasgow, Cardiff and Birmingham (jointly known as the UK Community Alcohol Prevention Programme) sought to generate action locally to promote responsible service of alcohol in bars and shops, enforce licensing and allied laws, limit alcohol outlets, and to modify the environment and transport services to improve safety. Awareness-raising initiatives aimed to stimulate support for these strategies from residents, politicians, licensees and local services. The projects were among only five in the UK found to meet international criteria for ‘multi-component’ programmes which simultaneously bring a range of influences to bear on alcohol problems. 
An independent report has documented how all three were able to generate activity of the kind they sought. In the absence of a systematic evaluation, the researchers collated official statistics and data gathered by the projects themselves to assess whether this activity reduced alcohol-related problems – an attempt hindered by the fact that the projects’ effects could not easily be isolated and by fluctuations in the figures due to factors other than the real levels of crime or injury.
Perhaps clearest was the impact in Birmingham, where in the targeted area (a transport corridor crossing three suburbs) the project started with a clean slate in terms of existing community organisation. Birmingham too seems to have had the strongest enforcement component, shown by research (see In context) to be the greatest single influence. Trading standards staff visited all the area’s alcohol outlets, alerting staff to their responsibilities and warning of future ‘sting’ operations to test whether they would sell to underage youngsters. Police recorded reports of licensing infringements and followed up with an advice visit. Highly visible police operations were mounted similar to those used in relation to illicit drugs. 
Possibly as a result, offences such as vehicle crime, domestic burglary and robbery in the targeted area fell by over a third compared to just 9% in a neighbouring area, and public place wounding fell by 30% compared to 17%, though the number of crimes involved was small. Unlike elsewhere, after the project was underway, few premises sold to underage test purchasers and most followed advice to ask for proof of age.
USA The US project targeted two poor neighbourhoods relatively crowded with alcohol outlets and blighted by crime and alcohol-related problems. Its evaluation documented reductions in violent crime and injuries, among the priorities for UK community projects. Staggered implementation at the two sites and before and after measures benchmarked against the rest of the city offered multiple checks on whether the interventions were responsible for any improvements. 
Local community organisations prioritised the control of alcohol outlets as a way to tackle underage drinking and alcohol-related violence. Training in responsible beverage service was taken up by 40–70% of outlets after personal and, if need be, repeated approaches by project staff and police. Shop managers were warned that police would mount random test purchases by underage youngsters. An accompanying officer immediately initiated proceedings against outlets prepared to sell. Given this backing, there was a clear reduction in sales, leading police to replicate the programme city-wide. An attempt to mount similar operations in bars, and to use undercover police to detect sales to drunk patrons, was hindered by police shortages. Without enforcement backing, staff training on its own did not lead more premises to refuse service to drunk patrons. 
Across both sites, the interventions were followed by significantly greater falls than in the rest of the city in assaults (both police and medical records) and in injuries due to traffic accidents. Before the waters were muddied by city-wide implementation, there was also a greater reduction in injuries specifically related to drinking or drug use. Some of the relative reductions were substantial – over a third for assaults and traffic accidents. Given the social costs incurred by such incidents, the project was likely to have been cost-beneficial.
Sweden The Swedish report showed that such programmes can indeed save society money. It attached monetary values to an earlier finding that a city-centre programme targeting licensed premises reduced violence (represented by reports to the police) by 29%. The resulting estimate was that it saved society 39 times more than it cost, primarily due to reduced criminal justice expenditures. Even when savings were limited to police work (the most securely estimated element), savings were seven times greater than costs. A dip in quality of life after being the victim of a crime meant that the interventions also gained one quality adjusted life year (QALY) for each 3000 Euros spent, well within the Swedish yardstick of 54,000 Euros as an acceptable outlay to gain one QALY. 
The programme was initiated by Stockholm County Council after an upsurge in violence when on-licence alcohol outlets expanded. Its aim was to curb the serving of drunk patrons in the central district. Test purchases by apparently drunk actors generated support for responsible beverage service training, later made a condition of licence renewal for late-night venues. Enforcement of liquor laws, especially the ban on serving drunk patrons, was stepped up by police and the licensing board, largely in the form of warning letters rather than formal proceedings. Resulting reductions in violence were estimated on the basis of before and after trends in the intervention district compared to the next most similar area. That the programme caused the benefits was reinforced by the fact that these grew in line with the unfolding of the interventions. 
Inevitably the calculations incorporated arguable assumptions, but the magnitude of the gains were such that substantial benefits seem certain. Once again, enforcement was thought to have been the main influence. Even in the comparison area, sales to apparently underage children fell after activists organised test purchases and notified offenders to the police, who banned some of the shops from selling alcohol. 
In context 
The UK projects’ environmental strategies were influenced by the work of Harold Holder in the United States.  Reviewers have concluded that his ‘environmental’ approach (controlling the geographic, retailing and social environments in which alcohol is distributed, sold or consumed, and stepping up enforcement) can be more effective than trying to affect the behaviour of individuals through education or persuasion. However, impacts sometimes remain modest, partly because the scope for local action is limited by national (or regional) laws which in the UK and elsewhere increasingly favour a free, deregulated market. While deregulation may make such projects more necessary, at the same time it robs them of their most important tools – effective enforcement options. 
Police or licensing authority action backed by ultimate legal sanctions can on its own have a major impact, but requires other components to sustain and amplify its effects. Publicity makes authorities aware of the need for action and licensees aware of the potential consequences of failing to comply, while local lobbying helps gain support for the required intensity and persistence of effort.  Possibly enforcement works because it stimulates defensive management actions such as firm and clear policies on adhering to regulations and a system for monitoring staff compliance. Generated without the threat of enforcement, these are effective in themselves, but commercial considerations often mitigate against such policies. However, the same considerations can generate management action if the business faces closure or restrictions for breaching regulations.
British research includes a landmark study based on test purchases by underage youngsters which suggested that many vendors’ primary concern was not to avoid underage selling as such, but to avoid successful prosecution for selling to children who were clearly underage. In Cardiff, the main lessons of a programme to curb alcohol-related city-centre violence and disorder seemed to be that intensive implementation is needed to have a major impact, and that planning and licensing decisions which increase the density of drinking outlets, and competitive and financial pressures driving the policies of large club or pub chains, can counter the benefits. However, these remained and were probably enough to create substantial cost-savings for society. Though not formally evaluated, similar enforcement-led programmes stimulated by the 2004 English national alcohol strategy have encouraged licensee compliance and appear to have reduced alcohol-related crime and disorder. Sales to underage youngsters have also been curbed by recent test purchase operations allied with trading standards and/or police follow-up. 
Practice implications
The UK report’s authors argued for environmentally-based community projects on the grounds that these probably represent the best chance for minimising harm in the face of national deregulation and promotion of alcohol consumption. As they stressed, the leverage local projects can exert partly depends on the tools made available by national laws and policies both to them, and to the authorities they seek to influence. In turn, local lobbying and coordination serves to maximise the potential of those powers and can tackle factors beyond the reach of the law. 
So a crucial issue is how far national UK frameworks provide support and legislative tools for community action. New British alcohol strategies, attendant funding, and new laws, do provide a basis for projects similar to those featured, particularly the powerful tool of test purchases to expose underage service. But at the same time, especially in England and Wales, they greatly limit the scope for licensing authorities to respond to community concerns. Details below.
England England’s 2004 national alcohol strategy highlighted crime, disorder and antisocial behaviour related to underage drinking and drinking in urban centres at night, but made no clear call for coordinated community programmes. The 2003 Licensing Act covering England and Wales prioritised crime and disorder, public safety, public nuisance, and the protection of children, but also aimed to “give business greater freedom and flexibility [and] greater choice for consumers.” Licensing boards have little scope for reviewing, refusing or amending licences. New applications can be refused if the area is considered to suffer exceptional crime or disorder due to a high concentration of premises, but existing licences cannot be rescinded on these grounds. If these are experienced outside the premises, licensees are exempt from the consequences for the community of the alcohol they serve. Licensing authorities can respond to complaints but cannot initiate their own reviews of premises’ licences. The scope for public involvement is highly limited.
Previous legislation had legalised test purchases by underage children in England and Wales, placed the onus on licensees to take all reasonable steps to establish the age of a customer who might be under 18, extended responsibility for preventing underage sales to any employee who sells or allows a sale to happen, and made it an offence for an adult to buy alcohol on behalf of someone under 18. The Violent Crime Reduction Act 2006 enabled police and/or trading standards officers to ban the sale of alcohol for up to 48 hours at premises which persistently sell alcohol to under-18s, and police can apply for a fast-track review of the licences of premises associated with serious crime or disorder. 
Possibly more scope for public involvement is provided for in an action plan for implementing the English alcohol strategy which requires local crime and disorder reduction partnerships (inter-agency groups including non-statutory bodies) to develop a strategy to tackle (among other things) alcohol-related disorder and misuse. In 2008 in England, up to £30,000 is available for each partnership to fund activity to curb alcohol-related crime, disorder and antisocial behaviour. Also, health trusts must include alcohol in their needs assessments. Action by these authorities may be motivated by some of the indicators through which they are held to account, including public concern over drunk or rowdy behaviour, hospital admissions for alcohol-related harm, and alcohol-related violent crime and disorder, especially assault with injury. 
Wales Licensing law is the same in Wales as in England, but the 2008 Welsh substance misuse strategy is more explicit about its support for vigorous community action to make the best use of legal powers, and makes illegally serving drunk as well as underage patrons a priority. Echoing the environmentalists’ case, the strategy aims to “Look beyond licensees to take a holistic approach to the management of our towns and cities during the evening and night time so that everyone is able to visit them without the fear of alcohol-related crime and disorder”. An action plan commits the Welsh Assembly to by 2009 establish four pilot projects along these lines. Recognising the weak position of licensing authorities, the strategy commits Wales to explore whether the Government of Wales Act can be used to strengthen their hands and to lobby for stronger powers, including possibly mandating the code of conduct for the alcohol industry and adding public health to licensing act priorities.
Scotland In Scotland public health has already been added to the priorities licensing authorities can consider, one of several ways in which a law coming fully in to force in September 2009 will expand the scope for community action. The Licensing (Scotland) Act 2005 follows the same framework as in England and Wales, in particular divorcing licensees from any responsibility for what happens after their patrons leave. But it does gives greater scope for public participation in decisions on particular applications, which anyone can object to or seek to amend, not just immediate neighbours, and on overall licensing policy, the latter via a local advisory forum intended to ensure that policy has the backing and confidence of the local community.
The act also removes some of the limitations elsewhere in the UK on the freedom of action of licensing boards. In Scotland these will be able to mount their own reviews of licences and are actually required to proactively identify areas where new premises (or those of a certain kind) will not be allowed in the interests of public order, local amenity, or safeguarding health from the effects of increased drinking. Local authorities will employ special staff to investigate premises and report back to the boards. Irresponsible promotions of alcohol encouraging heavy drinking will be restricted. Boards can impose conditions including staffing policy, participation in good practice schemes and networks, and fairly detailed operational matters. All serving staff must be trained and personal licence holders are required to be retrained every five years. 
Scotland’s proposed national alcohol strategy encourages boards and police to take a tough line on both underage sales (direct or via an adult) and serving drunk patrons. It highlights a pilot community coordination project planned for Fife whose elements are typical of the Holder model of environmental action and encourages similar approaches across the country.
Guidance on local strategies is available from the London Drug and Alcohol Network and Alcohol Concern, while the latter’s HubCAPP database features examples. Regardless of the interventions built upon them, test purchasing and the construction of a database linking untoward incidents to particular premises are important in motivating and targeting action and assessing its impact. The visible and credible possibility of enforcement action against alcohol sales outlets must be persistently maintained if it is to have anything but a fleeting impact. Attention should be paid both to alcohol consumption and the factors (such as crowding, transport problems, divorcing alcohol from food, poorly kept or managed premises, glasses easily transformed in to weapons, inadequate training and monitoring of staff) which potentiate violence and disorder.
International lessons on how to generate and run community alcohol interventions have been usefully encapsulated by Canadian researchers. These include: the need to devolve decision-making to the community while supplying research-based knowledge; rapid feedback of results helps motivate participants and keep projects on track; recruiting influential and respected local leaders is vital; considerable lead-in time is needed to form the social and organisational infrastructure for community action, and projects need several years to fully deliver; project staff must expect and permit adaptation not just of methods but also objectives in response to the community’s strengths and self-perceived needs; success comes easier in communities where the project’s aims are already high on the agenda; community norms and alcohol availability restrictions have their greatest impacts in self-contained, stable communities whose residents and businesses can less easily escape their impact; a key element is the surer detection and sanctioning of transgressors brought about by the more intensive use of existing legal powers; however, these legal powers must in the first place have the potential to be effective.
Flexibility is essential because the impacts of commonly used tactics are dependent on the environment with which they interact, meaning that a different mix is required in different situations.  The ideal is when national support and regulations for controlling alcohol-related damage afford localities the required tools within an accountability framework which motivates effective action, but which also gives localities discretion on what to target and how. 

Appendix: Extended notes on the featured projects, related research and the practice context in the UK
UKCAPP
These notes consist largely of extracts copied from the project report with some slight rewording and rearrangement. The intention is not to summarise the report (for which see the report’s own summary) but to pick out salient points for the bulletin entry. Additional material between [ ] brackets.
In 2003–04 the Alcohol Education and Research Council part-funded three projects in the cities of Glasgow, Cardiff and Birmingham. The projects became jointly known as the UK Community Alcohol Prevention Programme (UKCAPP), and aimed to reduce alcohol-related harm and disorder. [The projects were influenced by the work of Harold Holder in the United States  which suggests that] efforts be directed toward policy-makers in positions to influence social, economic, and environmental structures in the local environment. Rather than attempt to reduce alcohol-related problems through the education and treatment of problem drinkers, efforts are directed toward local policy makers in positions to influence the local environment. Local alcohol policy can be used to alter local social, economic, or physical structures and put in place processes and priorities to reduce problems. [The three projects are some of only five found by a UK scoping exercise which “conformed to a strict definition of ‘multi-component’ programme derived from the international literature”, the remainder generally lacking an explicit theoretical framework.]
Process
In Glasgow and Cardiff the projects were city-centre focused, building on long-standing community partnerships. The Birmingham project was undertaken on a transport corridor across three southern suburbs, where community action had to be developed. The great majority of the data cited here is from 2005–2006.
The UKCAPP sites all identified four very similar interlinked areas for intervention:
1. Awareness-raising – both general public and political, in order to: promote local ownership of problems and solutions; warn of the dangers of excessive consumption; highlight interventions contributing to public safety.
2. Licensed Premises – engage with licensees to: promote server training; encourage Pubwatch; make Best Bar None awards; enforce licensing regulations.
3. General Environment – improve lighting and cleanliness of streets; increase police presence; set limits on licensing of local outlets.
4. Transport – improve transport links in order to assist with orderly dispersal of crowds, and improve safety.
The Cardiff project was piloted in April 2004, and ran from December 2004 to May 2006.
Prior to the Route 50 project in Birmingham there was no network of local partnerships to tackle alcohol related harm. Therefore, the primary focus of the Route 50 project was directed towards building a network of partners, encouraging community mobilisation, local ownership and local leadership.
 [Improvements were most easily documented in the mechanisms which can be expected to reduce alcohol-related problems.] 
• increasing awareness (both public and political) of factors impacting on alcohol-related harm and disorder;
• improving standards and relationships within the licensed trade;
• improving the environment in terms of lighting, cleanliness, CCTV, visible policing;
• improving late-night taxi and bus links.
Impact of the UKCAPP projects can also be seen in terms of:
• increasing collaboration across a wide range of community agencies;
• facilitating adaptability and flexibility in these agencies;
• building strong working partnerships between agencies;
• instigating positive community responses to alcohol-related harm;
• institutionalising partnership working.
[An enforcement element was most apparent in Birmingham.] Trading Standards agreed to visit all off- and on-license sites in the Route 50 area, meeting the licensee and providing an information pack and DVD about legal and social responsibilities, and the consequences of selling alcohol to underage young people. Licensees were asked to sign an overarching ‘code of conduct’, and informed that they may have a test purchase in the future.
Early in the Birmingham Route 50 project, a meeting of community stakeholders indicated contrary views to the police that ‘there is not a significant issue with drunkenness’ and ‘the actual problem is in public perception of the level of crime and the fear of crime’. The police then agreed that call-outs because of licensing infringements would be recorded and followed-up by a police advice visit. Operations similar to those tackling illicit drugs use were agreed. Operations in a bordering Operational Command Unit involved up to ten officers in high visibility jackets with drug dogs, who searched premises, checked for underage drinking and drunk and incapable people. By June 2006, the Route 50 project team noted that the police seemed more focused on underage drinking rather than the drunk and incapable, but that to get police to arrest people in this condition would be difficult.
A joint meeting with Off Licences to specifically address the issue of underage drinking was requested by Pubwatch. Actions taken included: display of posters in bars (stating the legal obligation not to serve to drunk people); making available to all pubs a list of offenders with lifetime bans; informative beer mats were to be produced in partnership with Trading Standards; and further police operations.
Barriers
[However, the teams were working against the tide of increasing accessibility from more premises, longer opening times, and reduced cost.]
The livelihood of licensees is dependent upon selling alcohol within an increasingly competitive marketplace, and this comes into play when licensees are expected to stop promotions such as ‘happy hours’; to contribute financially to training their staff in responsible serving practice; or to contribute to environmental improvements inside or outside their premises. 
The UKCAPP projects, despite efforts to promote and provide Responsible Beverage Service training, experienced great difficulty in recruiting bar-staff trainees. Nevertheless, the “Best Bar None” scheme has been an effective way of getting local licensees to recognise the importance of a safe drinking environment.
Interventions to improve transport links can be problematic because, in a deregulated free market, the local authorities do not commission or control the system. The teams in Glasgow and Birmingham, for example, had difficulties in fully involving local transport providers as key partners. This does not mean that improving transport is impossible, but that it takes considerable time. Negotiations have to be undertaken to allow more cabs on the streets when most needed; to get buses to run on perceived dangerous or unprofitable night routes; to get trains to continue later into the night. Negotiations can be complex and time consuming, involving representatives of the transport companies, workers’ unions, local and sometimes national governments.
The Birmingham team was called by the Police Safer Travel Team ‘saying that there is a huge problem on these routes and can we help’. The Route 50 team were unable to become actively involved as ‘commercial sensitivity’ limited information.
In England and Wales national political factors have made outlet density a difficult issue. Room (2004) contends that the Government’s draft guidance to licensing authorities in England and Wales is tilted firmly towards maximum permissiveness in licensing. The licensing power focuses upon “the prevention of crime and disorder; public safety; the prevention of public nuisance; and the protection of children from harm” but a close reading demonstrates that the guidance is concerned with the physical safety of the people using licensed premises, and not with broader alcohol-related harm or health issues which are supposedly addressed by other legislation. Licensing authorities may not impose conditions relating to management training or competency, or subject licensees to regular compliance checks. Nor can they attach conditions or promote generalised voluntary arrangements relating to “happy hours” or other promotions, as this could breach competition laws. Furthermore, the guidance does not expect licensees to take any responsibility for the behaviour of customers once they are beyond the licensees’ direct management.
With regard to outlet density in England, licensing authorities cannot consider that there may be no commercial demand for another licensed venue in the vicinity. 
In the face of the huge financial and cultural forces promoting consumption of alcohol, the community resources able to be mobilised to reduce alcohol-related harm within the UKCAPP sites are really relatively minuscule ... each community action programme may be likened to a barricade of small sandbags attempting to hold back the effects of a huge rising flood of alcohol consumption swollen by increasing accessibility from more premises, longer opening times, and reduced cost. These programmes can be effective in some places for some time, until either massive external pressures become overwhelming; or the cumulative effect of many relatively small local programmes begins to impact on the national drinking culture and national alcohol policy.
Outcomes
[In contrast, showing that problems levels actually had been reduced compared to the level they would have been without the projects was complex due to different recording systems and the fact that the projects being evaluated were interwoven with existing or new initiatives beyond the projects’ control. Interpretation too was difficult. For example, increases in recorded incidents may reflect success in tackling a problem and its reduction, or indicate that the problem got worse.]
Although the interventions undertaken in the UKCAPP have had considerable impact on the local community and environment, statistical data relating to alcohol-related harm and disorder in the UKCAPP sites are equivocal. 
Birmingham A report from Birmingham Community Safety Partnership (2007) provided an initial analysis of the impact of the Route 50 project. Data refer to the period October 2005–January 2007, compared to October 2003 – January 2005, unless otherwise stated. 
In Birmingham, public place wounding decreased by -29.5% within 800 metres of the project area. This reduction was greater than in the neighbouring police operational command unit (OCU) (-17.2%). Government targeted crime (PSA1) decreased by -37.6% within 800 metres of the project area, a greater percentage than in the neighbouring OCU (-8.6%). However, these are preliminary findings and the low number of offences makes valid comparisons difficult.
It was reported that ‘that the project area is responding well’ with the majority of premises following advice in asking for ID and using Refusal Books, with testers finding ‘minimal positive purchases’ at both on- and off-licensed premises. [There was a] statistical difference in favour of the R50 [Table 3].
An unexpected result from the awareness-raising interventions of the team was a special licensing policy for Moseley, similar to that of Broad Street in Birmingham, taking into account the cumulative impact of increasing numbers of licensed premises on the social environment, public disorder, or harm to children, in decisions about new licences. The special policy required a long process of public consultation with community groups and city councillors, agreement by the licensed trade, by the police, and fire service.
Glasgow In Glasgow city centre, over the period 2005–2007, available statistics demonstrate a decrease (-9.7%) in Police recorded crimes; and a decrease (-4.4%) in Ambulance incidents. At the same time there is a large increase (+74.4%) in police alcohol-related incidents; and an increase (+6.5%) in A&E attendance. It is unclear whether the police statistics represent a lower crime rate, perhaps owing to more effective police interventions, or to a change in recording and analysis procedures in 2006 which might have inflated the number of incidents (as suggested by a Glasgow Police report). In a much smaller ‘Nite Zone’ area, the focus of a 12 week project, highly visible, police officers, taxi wardens, and bus inspectors, in the last quarter of 2005 compared to the same period in 2004 were noted as contributing to the following decreases in police statistics between the last quarters 2004 and 2005: violent crime -19.1%; serious assault -4.4%; robbery -21.5%. During this period arrests for other specific offences increased dramatically: disorder +61.1%; drugs +200%; possession of knives +100%. The environmental improvements and additional police resources focused on the Nite Zone area, led to a very large increase in arrests for disorder, knives and drugs, and no doubt made a substantial contribution to the reduction in more violent crime, serious assault and robbery.
Cardiff. Over the period 2004–2006, there was a decrease (-25.7%) in A&E attendances; but an increase (+33%) in police recorded crimes/incidents. Community Safety Partnership data comparing 2005/06 with 2004/05 show the following increases: common assault +6%; wounding +15.2%; robbery +25.1%.
TASC data comparing 2005–6 with 2004–05 show a 33% increase in alcohol-related crimes and incidents recorded by police, but a 25.7% decrease in A&E alcohol-related incidents. It is not clear whether these increases reflect a worsening situation, or an increase in police activity and effectiveness leading to a greater number of arrests being recorded.
The decrease in A&E attendances would suggest a substantial reduction in alcohol-related violence and accidents. The increase in police recorded crime, especially Common Assault (+6% on 04/05), and Wounding (+15.2% on 04/05) could indicate that prompt police intervention is preventing more serious physical harm being inflicted.
In the licensed premises where staff had RBS training, there was no apparent impact in terms of ‘reducing drunkenness’. In fact, customers from venues where staff had not received training showed significantly lower levels of mean PBAL compared with those venues that did receive training.
The Cardiff report submits that this difference might be because of venue selection, or due to the fact that: a) ‘The mean levels of intoxication over the twelve months are fairly low ... Thus, servers may not have the opportunity to refuse service to the already inebriated in sufficient quantities to allow a noticeable change.’ b) ‘Bar staff from almost all city centre licensed premises were trained in bar work. Thus the RBS training may not have added much to the existing high level of knowledge’.
South Wales Police test purchasing campaigns found, in December 2005, that 12 of 40 premises (30%) with almost equal proportions of trained and non-trained staff were willing to sell alcohol to an underage police confederate.
Medical records
[Glasgow Ambulance Data (not alcohol-related). Fell from 9905 between February 2005 and January 2006 to 9467 between February 2006 and January 2007, a decrease of 4.4%, consistent in all but two of the months.
Glasgow A&E data. There was a 6.5% increase in alcohol related A&E attendances at Glasgow Royal Infirmary in the period February 2005 to January 2007 from 10663 in 2005/6 to 11358 in 2006/07. These figures were just as consistent as the reductions in ambulance incidents but in the opposite direction, and were alcohol-related.
In Cardiff alcohol-related A&E incidents increased from 228 in 2003/04 to 245 in 2004/05, but then decreased to 182 in 2005/06. The latter may be a reflection of the project’s initiatives coming on stream.]
Because of the nature of the Birmingham route 50 project, data from Police, Ambulance or A&E services were not expected. 
Interpreting the outcome data
Interpretation of these data in order to make definite statements about impact, or to make valid comparisons over time or between UKCAPP and comparison sites, is practically impossible. In brief, the outcomes reflected in the data vary both between and within sites over time, affected by the practice, judgement and motivation of those recording, analysing, retrieving and presenting the data. There is little doubt that an increased police presence in specific areas and the targeting of certain behaviours leads to increases and decreases in specific statistics. Therefore, statistics available to date are unable to clearly demonstrate that interventions have led to a significant reduction in alcohol-related problems over a prolonged period of time. 
The MHRDU team has been less than satisfied with the quality and quantity of statistical data obtained from the sites. Despite numerous discussions of requirements the site teams were unable to provide clear data from which a judgement could be made as to the effectiveness of interventions over time. We do not believe that this was from a lack of willingness on the part of the UKCAPP site teams, but due to two main factors:
1. Interventions were not necessarily applied in a programmatic manner following a logical progression planned for maximum cumulative impact. Nor were they systematically evaluated at a local level. There are a number of reasons for this [which mean that] presentations of outcomes are produced when necessary to meet particular deadlines and local political needs.
2. Different methods of data collection, analysis and retrieval employed by Police, Ambulance and A&E departments make data validity very difficult to verify and comparison across sources or sites exceedingly problematic.
One reason was the impossibility of controlling for confounding factors both within the UKCAPP areas and within comparison sites. None of the communities is isolated, and interventions to reduce alcohol-related harm are underway across the UK. At the time of the first visits, the MHRDU team became aware of the extent to which each of the UKCAPP projects was part of a complex web of other local projects, partnerships, and interventions. The complexity of local partnerships meant that it was impossible to consider each project as a discrete set of interventions, clearly delineated in space and time, which could be evaluated using a before-after methodology.
The Sacramento Neighborhood Alcohol Prevention Project
Compared to the rest of this Californian city, the two neighbourhoods targeted by the US Sacramento Neighborhood Alcohol Prevention Project were poor, suffered high rates of crime and alcohol-related problems, and had high concentrations of alcohol outlets. Local community organisations were sympathetic to environmental approaches. They prioritised the reduction of alcohol-related violence and young people’s access to alcohol by controlling alcohol outlets. The concrete interventions included a training course in responsible beverage service to help staff meet legal obligations not serve drunk or underage customers. Proactive personal and, if need be, repeated approaches by project staff accompanied by police officers netted participation by 40–70% of outlets. Owners and managers of retail outlets were warned that police would mount random test purchases by underage youngsters. An accompanying police officer immediately initiated proceedings against outlets prepared to sell. An attempt to mount similar operations in bars, and also to use undercover police to detect sales to drunk patrons, was hindered by the reluctance of the police due to staff shortages. Supporting these were local committees to mobilise support and publicity organised by the research team intended inform and motivate the community and to alter young people’s perceptions of the community’s tolerance of drinking and risky drinking.
The interventions were implemented for a year first in one neighbourhood then after a half-year break in the other. After the first phase the second site could act as a comparison for the first, then later the project could test whether this site also reacted the same way to the interventions. Meantime trends in the rest of the city acted as an extra check on whether the interventions or city-wide trends were responsible for the any changes in alcohol-related problems. Randomised allocation is rarely feasible in community interventions, but this methodology is a powerful alternative because it offers multiple checks on the attribution of effects to interventions.
Before the interventions and then after each phase of the project, apparently underage project staff attempted to buy alcohol from retail outlets and apparently drunk staff ordered drinks in bars. After the first phase underage sales fell in the first intervention site but rose elsewhere, indicative of the intended effect. Seeing this, Sacramento police implemented test purchasing city-wide, spoiling the researchers’ plans to measure the impacts in the second site but apparently leading to large city-wide drops in the proportion of outlets which failed the test. In contrast, there was no evidence that the interventions led bars to more often comply with laws about selling to drunk patrons. The difference the researchers reasoned was that the project’s underage sales intervention was backed by immediate enforcement while police did not get involved in the bar-based interventions.
The bottom line was whether the project’s impacts on access to alcohol, enforcement levels and community sentiment, led to reductions in police and emergency medical service records of actually or potentially alcohol-related injuries and incidents. Across both sites the interventions were followed by significantly greater falls than in the rest of the city in police and medical records related to assaults, and in medical records of injuries due to traffic accidents. The effects were most consistently observed in the first intervention site, which also saw reductions in alcohol/drug related injuries. City-wide take-up of some of the interventions pioneered by the project obscured impacts at the second site, where only assault levels (both injuries and police incidents) were reduced. Some of the relative reductions were substantial – over a third for assaults and traffic accidents at least one of the sites. Given the social costs associated with such incidents, the researchers reasoned that the project was likely to have been cost-beneficial, though no economic analysis was undertaken.
The project effectively tested what could happen when substantial investment and outside help kick-started action in high-problem communities with a will tackle those problems. 
Stockholm STAD
A cost-benefit analysis of a community programme targeting licensed premises in Stockholm estimated that by cutting violent crime it saved society 39 times more than it cost, primarily due to reduced criminal justice expenditures. The intervention formed part of the STAD programme (STockholm prevents Alcohol and Drug problems). Concerned about an increase in violence after on-licence (pubs, bars, restaurants, nightclubs) alcohol outlets expanded, Stockholm County Council initiated interventions to curb the serving of drunk patrons in the central district. It featured community mobilisation to raise awareness of alcohol-related problems related to on-licensed premises. Studies of overserving (with actors simulating drunkenness and ordering beer at licensed premises) conducted by STAD in 1997 and 1999 were intensively covered in the media. One aim was to generate support for action among sectors such as the hospitality industry, authorities and local politicians. These sectors formed an advisory committee which developed a two-day responsible beverage service training course for servers, doormen and restaurant owners about alcohol law, medical effects and conflict management. The group also helped encourage a change in municipal alcohol policy which from January 2000 strongly recommended training to owners of licensed premises in Stockholm open until 1am or later and made this a condition of licence renewal. Enforcement of alcohol laws and in particular the serving of drunk patrons was stepped up by the licensing board and the police authority. Central to this was an increase in the number of letters sent notifying premises of reports of such problems rather than formal proceedings. 
That this element did reduce violence was the main finding of the earlier evaluation. It compared trends in police-reported violence occurring from 10pm to 6am in the central district versus the next most similar (in terms of outlet density and its entertainment profile) district in the city. Records covered January 1994 to September 2000. STAD began in January 1998 and increased in intensity until the end of the study period. Based on pre-intervention trends and what later happened in the control district, the analysis estimated what would have happened in the central district without STAD. These estimates were compared with the actual figures to assess the likely impact of the project. 
As expected reports of violence in the central district gradually decreased as the intervention intensified while, those in the control district increased slightly in line with national trends. Assuming that the intervention became gradually more influential until reaching a peak at the end of the study period, its estimated impact (at full intensity?) was to reduce reported violence by 29%. The alternative assumption of a step change at the start of the intervention period did not fit the data. This seemingly ‘dose-related’ impact is strong evidence that the interventions were a causal influence. 
Based on these findings, the cost-benefit analysis estimated cost savings on the assumption that in the central district over the life of the project (January 1998 to September 2000) there had been 29% fewer of each of the types of violent crime reports represented in the earlier evaluation. If (this is not clear to the present writer) 29% is an estimate of impact at maximum intensity, this overestimates actual impact over the life of the project but does represent the estimated impact once the project was fully implemented. A survey of 604 victims of such crimes of whom 194 responded was use to estimate the financial impacts of the crimes over the following year in terms criminal justice expenditures (police, public prosecutor, court and prison/probation – the latter extended to long-term costs and forming the great bulk of total expenditure), productivity (sickness absence, and other effects on working hours/salaries), health care (transport from crime scene, emergency treatment, inpatient care, outpatient care and pharmaceuticals) and other damage (technical support, personal assistance and personal belongings). The respondents also answered questions about their health before and after the crimes and at present. Intervention project records and those of the partners to the project were used to estimate the costs of the relevant strand of the STAD programme. Cost-savings were 39 times are great as intervention costs and seven times greater when only the most securely estimated element of costs-savings – related to police work – was accounted for. A dip in health-related quality of life after victimisation (recalled for the following two weeks and assumed to recover linearly to current levels) meant that the interventions gained one quality adjusted life year (QALY) for each 3000 Euros spent, well within the Swedish yardstick of 54,000 Euros as an acceptable expenditure to gain one QALY. The assumptions on which these calculations were based are subject to a possibly major sources of over- and under-estimation but the magnitude of the social cost savings and the quality of life gains in relation to costs are such that substantial benefits can safely be assumed. 
One important concern about the findings is that some of the mechanisms through which the extra gains should have been realised in the central district failed to differentiate this district from its comparator. Though STAD itself operated only in the central district, enforcement of alcohol laws and in particular the serving of drunk patrons was common across the intervention and control sites because the licensing board operated equally in both. Perhaps partly as a result, there were increases in the refusal rate in both districts in regard to serving apparently underage patrons from before the project started to 2001. The main determinant in whether a youngster was served was whether the premises employed doormen, who usually intercepted them before they could order. Whether staff from the premises had undergone responsible service training had no impact. Similarly, while just 5% of premises refused service to apparently drunk patrons before the project started, by 1999 this had risen to 38% in the control district, to 48% in untrained central district establishments, and 55% in trained. These differences were not statistically significant but the dramatic rise across both districts was. With respect to serving both apparently underage and apparently drunk patrons, the likelihood, commented the researchers, was that the enforcement element, equal in intensity in both areas, was the main influence rather than the training. Since the STAD project was partly responsible for this gearing up of enforcement, its own success in spreading this to the city as a whole would have partly obscured this success when intervention and control districts were compared. 
One problem is that though it was the closest comparator, the control district had a much lower level of reported violence throughout suggesting a degree of non-comparability. The fact that the central district had larger nightclubs meant that engaging these could have a larger impact than engaging the smaller clubs in the control district. They were also more likely to have doormen whose improved performance as a result of participation in the training could augment the impact of bar staff. Both were reasons the researchers suspected why increased refusal of drinks to drunk patrons in the comparison district did not reduce reported violent crime. They are also by the same token reasons why duplication of the interventions in the central district might not have the same impact in other areas. 
The study concerning apparently drunk patrons gathered data just before municipal alcohol policy strongly recommended mandatory training for late-night establishments from January 2000. In 2001 project activities were disseminated to the former control area. Further research in the winter of 2001 showed that refusal rates rose again, especially in the former control area now newly subject to training and other project activities. There 82% of premises refused while in the central district 61% did so. In both districts, but especially (and significantly) in the central district (72% v untrained 40%), refusal rates were higher in premises whose staff had been trained, but few establishments in the former control area had yet taken up training. 
Sales to minors in retail outlets were also targeted by STAD in another district of the city with another control area. A committee of shopkeepers police and parents steered the project. In the first phase test purchase surveys were conducted and in the intervention area the results were fed back to parents and to retailers who were visited by teams of STAD staff, parents and police. Other activities raised awareness among parents and retailers. The next phase added visits to retailers who were informed of the results of test purchases at their own shop. None who had sold previously and were visited did so again in a later survey. In the intervention district the first phase did retard the growth in sales to apparent minors seen in the comparison site, but in both this increased. After the second phase the proportion of shops which sold to apparent minors decreased from 73% and 86% respectively to in both areas 44%. The decrease in the comparison area was probably due to activists who organised test purchases using minors and informed police who revoked the beer-selling rights of five shops. In the intervention area persuasion stiffened somewhat by a police presence rather than enforcement was the tactic, moderated perhaps by the involvement in the steering group of shopkeepers, who as a whole strongly favoured educating staff as the prime control tactic. Despite these changes, local schoolchildren did not notice any increased difficulty in buying beer and there were only minor changes in the number who admitted actually buying beer. The suspicion was that in this urban area it was not difficult to find shops inside and outside the two affected areas prepared to sell, and young people simply concentrated on those. 
Through to the end of 2002, in the intervention district there was strong evidence that the interventions had become embedded in the work or the participating institutions and that activity levels to maintain the progress made remained high. In particular there was a boost in the demand for training (and a bid by licensed premises association to organise this) when from January 2000 this was made a condition of licence renewal for licensed premises open until 1am or later. 
Later an attempt was made to spread the model outside the city to communities in Stockholm County identified by STAD as potentially interested in the programme. Of the 14 communities contacted, by the time of the report, seven had agreed to finance and implement the programme. Positive results on police-reported statistics on violence from the studies in Stockholm City were used to promote take-up.
Reviews
After reviewing trials of community action to reduce tobacco and alcohol problems Norman Giesbrecht concluded: “These projects suggest that to achieve any change in the local community, local leadership needs to take a major interest in the issue and to devote substantial resources to it. The experiences also suggest that both project managers and local change agents need to constantly pay particular attention to fostering interventions with the greatest potential, rather than treating interventions as equal contenders or assuming that one strategy can be a substitute for another ... Community-based prevention and research initiatives have indicated that policies and social practices can be changed through intense initiatives. They have also demonstrated that consumption and attendant harm can be reduced through these efforts. They have suggested that controlling the geographic, retailing and social environments in which alcohol or tobacco products are distributed, sold or consumed, and stepping up enforcement can be more effective than education or persuasion programmes with an individual focus. Interventions that involve taxation, controls on density, advertising codes, and improved enforcement and inspection policies, may be contemplated at the local level, and in some cases, carried out there. However, if enacted at higher levels of government their potential for impact is considerable, although at this level the commercial stakes are higher and therefore challenges to these agendas will be greater. The combined orientation involving producers as villains and smokers as deviant and marginalised victims, opens up the door for two very different interventions: on the one hand strong controls and system level interventions that control tobacco production, distribution, marketing or sales and, on the other, intense person- oriented cessation efforts at the individual level. Broadly oriented interventions, such as taxation measures, controls on access, public and private distribution policies, and class action litigations all potentially have parallels with regard to alcohol. Their potential for impact is significant. However, looking at the tobacco experience, one might ask if it feasible that these types of intervention can be widely considered and enacted without the intervening steps of vilification of the industry and/or victimisation of the drinker?”
After also reviewing interventions related to illegal drug use, the same author added this appreciation of the limits of local action: “However, as is the case in the tobacco literature, as noted below, the gains in harm reduction with regard to alcohol problems tend to be important but modest. Even intense and well-planned initiatives that benefit from local support face formidable challenges in environments where alcohol is widely promoted and marketed, and where consumption is common and deeply integrated into everyday social events and activities. The secular context and developments at the regional level and national levels – often involving a deregulation of access controls and enhanced promotion of alcohol – probably play an important, but contrary role, in determining the outcomes of these projects as do the specific local interventions ... Communities often seek ways to make the situation better for residents living there, and probably understand better the resources and abilities of their members to achieve this. However, this dynamic may vary greatly between licit and illicit drugs. With regard to alcohol, for example, a community may seek to control or manage access, such as imposing a ceiling on on-premise or off-premise outlets, but find little support at the national or provincial levels for interventions. The alcohol producers who are most effective at the national or international level can put pressure on national governments more efficiently to deregulate controls or allow increased promotion than in doing this municipality by municipality. Thus, communities with awareness of high rates of damage from alcohol may seek population-level interventions which find limited support, or a cold reception at the next level of government.” This line of argument was later developed in relation to alcohol when the author pointed out that national deregulation deprived local communities of the tools and the supportive environment needed for the most effective programmes.
Joel Grube and colleague make the point that in-house, management enforced rules with training, monitoring and sanctions for transgressing staff can have an impact similar to formal enforcement strategies: “Policy development and implementation within outlets may be as important, if not more so, than server training per se in determining RBS effectiveness. Research indicates, for example, that establishments with firm and clear policies and a system for monitoring staff compliance are less likely to sell alcohol to minors. Key elements of successful outlet policies are: (a) minimum age of 21 for all servers and sellers; (b) staff awareness of legal responsibility; (c) staff awareness of outlet policies and consequences for staff violating those policies; (d) identification required for all patrons appearing to be under 30 years of age; (e) guidelines and training as to what constitutes acceptable service practices; and (f) retailer-initiated compliance checks and enforcement of consequences for violation of policies.” They conclude that “Implementation, enforcement, and public awareness are essential to the success of any policy approach to preventing drinking problems. Alcohol policies are most effective when they are adequately implemented and vigorously enforced and when there is awareness of both the policy and the enforcement efforts on the part of the intended targets. Another potentially important element in effective policy is public support. The difficulty of implementing effective polices in the face of public opposition may be considerable given perceptions on the part of law enforcement officers and community leaders that there is little community support for such activities.”
Harold Holder has argued that “many alcohol problems are not simply the actions of a set of definable high-risk individuals, but rather the cumulative result of the structure and flow of complex social, cultural, and economic factors within the community system”. As such they cannot adequately be addressed by targeting services at high risk individuals or groups but demand environmental strategies which use policy levers to changes the community system or the social, economic, physical, and social environments. But such are the attractions of the argument that “all problems involving alcohol are the problems of the individual”, and if that if we could find the “physiological, genetic, personality, or familial conditions that cause dangerous drinking, the alcohol problem can be solved”, and such also is the relative difficulty and conflict involved in system approaches, that “little of what is done in alcohol problem prevention throughout the world is based upon this systems perspective”.
In the context of preventing sales to underage drinkers and problems related to underage drinking, the same author observed that community projects often feature “education efforts designed to produce attitude change. Such educational strategies often are focused on information alone, based on the assumption that an informed community will necessarily experience a reduction in alcohol-related problems. However, there is no evidence that education alone can reduce alcohol-related problems at the community level”. In contrast, “Even moderate increases in enforcement can reduce outlet sales of alcohol to minors, especially when combined with media campaigns and other community and policy activities”.
In relation to US college students, “alone, training programs at alcohol establishments are unlikely to prevent sales to underage youth”. However, “two studies found that regular compliance checks can be effective in decreasing the likelihood of alcohol sales to individuals below age 21”. In respect to the college student population as a whole, “The authors of six college-specific studies published since our last review conclude that increased alcohol prices or taxes are associated with decreases in risky alcohol use and alcohol-related problems. Bans on alcohol use in college residences or throughout campus also have been shown to be associated with lower levels of consumption and related problems”.
Extracts from previous Findings analyses
Restrictions on the availability of alcohol backed by actual or potential enforcement are probably the major active ingredient in community alcohol programmes. Previous research has demonstrated the potential for such action to reduce heavy drinking, drink driving, and alcohol-related accidents, injuries and deaths.      Police action backed by enforcement can on its own have a major impact. For example, a simple system enabling police to target licensed premises associated with alcohol-related crime was implemented across New South Wales after a trial showed it was feasible, acceptable to licensees, and resulted in a drop in alcohol-related incidents. The Alcohol Linking Programme systematised enforcement of a law requiring responsible alcohol service by finding out from offenders where they had last had a drink. The relevant licensees were sent written feedback comparing incidents linked to their premises with the local average, together with notification of a police visit the following week for a 30-item responsible service audit. After state-wide adoption, audited premises were associated with up to 22% fewer alcohol-related incidents than before. A similar project in Cardiff (see UK studies) also had a positive impact. 
Research on responsible beverage service in bars has shown that staff training can reduce excessive drinking and disorder   but also that unenthusiastic implementation by managers often undermine such schemes unless they are backed by the credible and well publicised threat of legal or regulatory action.     
An alternative approach which does not threaten commercial interests and may increase the venue’s attraction is to target violence and disorder itself in the training of staff, an approach trialed in Toronto where the support from police and licensing authorities needed to sustain a campaign based on restricting access to alcohol was lacking. In the main entertainment area other developments had already minimised violence and created a receptive environment. As in Sweden, among these conducive factors was adequate numbers of well-trained and supervised security staff. Incidents involving aggression by customers decreased in intervention but increased in control premises, most noticeably severe incidents. Per 100 observation periods, these fell from about 7 to about 5 in intervention premises but rose from 2 to 7 in control premises. An increase in severe staff-initiated incidents was seen in both sets of premises, but was significantly attenuated in intervention bars. High turnover of managers and door staff significantly reduced the impact of the intervention. Its main effect seemed (as intended) to be to prevent minor encounters escalating to severe incidents. 
Features of the project which probably also aided implementation included the recruitment through personal contacts of an advance set of premises prepared to take on the intervention which then acted as recruiting agents, the employment of a training agency already working with and closely linked to local entertainment venues, and financial compensation for the managers and staff undertaking the intervention. Premise managers committed to the project’s goals were crucial to its implementation and to successful outcomes. The importance of a credible background threat of enforcement was apparent in the persuasiveness of arguments that the training would bolster the management’s defence (‘We did all we could’) against lawsuits or allegations of licensing violations.
As in a project in Cardiff, identification of high-risk premises was an important way of focusing effort where it can make the most difference. The featured study used its specially recruited observers but Cardiff shows that a similar role can be played by the creation of an ‘incidents database’ collating and perhaps augmenting routinely collected statistics.
Where (as in the featured UK study) licensing and planning decisions remain market and economy driven, projects intending to ameliorate the fallout face an uphill struggle.  Without a focus on regulatory action and availability restrictions, media campaigns and community mobilisation are less effective.   However, these can help generate and sustain support for intensified regulation and may in their own right reinforce existing social norms against drink driving. 
Preventing sales to underage children also relies largely on credible, visible and persistent enforcement of regulations. One US study of community mobilisation to reduce alcohol-related accidents found that underage sales to minors were halved by staff training, regulating off-licence locations and hours, and, especially, by the threat of law suits against licensees.  Another project mobilised communities and authorities to reduce sales to young adults under 21 years of age with regular test purchases and administrative penalties playing key roles. Though the small number of project sites made it difficult for results to achieve statistical significance, the pattern of outcomes strongly suggested that access had been reduced by the intervention and that as a result reductions had occurred in drinking and arrests for drink-driving among 18–20-year-olds. Community coalitions can provide informal checks on whether licensees are prepared to sell to children and exert pressure in response to violations which come to their attention, but backing by formal enforcement procedures is important in gaining leverage for less formal action. In a competitive environment, where staff training is an added cost and refused sales represent foregone income, cross-industry regulations backed by the credible prospect of sanctions   and/or significant financial threats to businesses for non-compliance or irresponsible practice have been found necessary to promote widespread adherence to law or best practice. Even where licensees locally have agreed and adopted a code of conduct covering (among other issues) underage sales, a credible legal sanction is important to prevent individual businesses opting out or breaking ranks to gain a competitive advantage, threatening the entire agreement.
Similar lessons about the importance enforcement have been learnt in the effort to prevent underage tobacco sales. It also seems that tobacco sales to underage children can be reduced by measures such as storing products behind the counter where they have to be asked for and by publicity which gives young children the impression that they are likely to be refused, as much as by an actual increase in the percentage of requests which are refused.
Improvements in treatment access may also help. Treating people seeking help for their alcohol problems and screening and intervention among emergency patients both reduce accidents among the patients concerned. Though yet to be clearly demonstrated, such effects may cumulate into public health benefits visible at a community level, including impacts on accidents and drink-driving.
UK studies
In Britain community alcohol programmes targeted typically at crime and anti-social behaviour in urban centres are not unusual but theoretically based and comprehensive strategies are rare. 
Arising from the English national alcohol strategy, the Alcohol Misuse Enforcement Campaign conducted in 2004 and 2005 was led by the Police Standards Unit (PSU) and the Association of Chief Police Officers (ACPO). It was designed to send a clear message that those committing alcohol-related violence or encouraging underage drinking would not be tolerated. Among the case studies spotlighted by the Home Office were two relevant projects which recorded concrete gains. Both featured a strong enforcement element.
1. Under Greater Manchester Police’s Citysafe scheme drinking venues falling short of good practice were placed on a ‘top 10’ list and attracted closer police attention. This was accompanied by posters to remind people to drink sensibly, taxi marshals patrolling cab stands and bus wardens, and the Manchester Best Bar None awards to promote good practice in pub management and lay-out with police offering advice on what constitutes a ‘good pub’. Since the scheme was introduced, late-night disorder in the city centre has fallen by more than 12%. 
2. The Bolton Community Protection Unit was set up in November 2003 to tackle alcohol-related crime in and around licensed premises in Bolton city centre. Comprising the fire service, the police video-evidence gathering team, trading standards and the licensing authority, the unit carried out structured visits to licensed premises to vet every aspect of their operations. These visits include detailed checks on: compliance with licence requirements; health and safety, eg, number of customers present versus capacity of premises; fire exits; evidence of underage drinkers and drug use; general safety issues, eg, first aid training, number of discarded bottle and glasses; quality of door-staff and existing procedures for dealing with drug searches. Following these visits, reports are issued to the licensee highlighting areas of bad practice. These reports are then jointly discussed; a plan of action is developed and reviewed by Greater Manchester Police. Success in reducing the number of alcohol-related incidents in the city is attributed largely to the police team’s collation of indisputable evidence; evidence which is used to compel licensees to take action. To date, all licensees have been cooperative, taking the necessary steps to ensure that their premises meet the standards set. Previously, 89 incidents of alcohol-related disorder were reported at two particular nightclubs in the area. After the Community Protection Unit visits began, this was reduced by a third, with just 24 reported thereafter. Meanwhile, another bar saw 32 reported incidents reduced to zero following the initiative.
According to the 2007 English alcohol action plan, as a consequence of the test-purchase component of the Alcohol Misuse Enforcement Campaigns (AMEC), retailers strengthened their procedures and training of staff in relation to alcohol sales. Most retailers adopted the ‘Challenge 21’ policy, whereby anyone appearing to be under 21 is asked to produce a valid form of identification prior to any sale of alcohol. Test purchase failure rates dropped accordingly, indicating that it is increasingly difficult for under-18s to purchase alcohol illegally. During AMEC 1 in 2004, the overall test-purchase failure rate was 50%: by AMEC 4 in the summer of 2006, it had reached 29% and 21% for the on- and off-licence trade respectively, and 18% for supermarkets.
A survey on behalf of the Local Government Association indicates that most public authorities in England do not believe that the Licensing Act 2003 has reduced alcohol-related crime but that it has improved local coordination. The report observes that “The results of the national Tackling Underage Sales of Alcohol Campaign (TUSAC), during which 2683 premises were targeted by police and council trading standards officers during a 10-week campaign between 4 May and 13 July 2007, show that in nearly 9000 test purchase operations children were only able to obtain alcohol in 14.7 per cent of cases. Only 22 premises (0.8 per cent of premises targeted) sold alcohol to children on three separate occasions. The figures signal a further improvement in the test purchase failure rate since national enforcement campaigns began three years ago. In 2004, the overall test purchase failure rate was 50 per cent. In 2006, it had dropped to 20 per cent. In this latest and more targeted campaign it now stands below 15 per cent overall. Whereas earlier enforcement campaigns were conducted on a random sample of premises, good and bad, this campaign targeted premises known to be problematic. A further reduction in the failure rate is therefore particularly encouraging. The evidence suggests that action by councils to address drinking by young people is effective.”
In the run-up to Christmas 2007 the Home Office’s Responsible Alcohol Sales Campaign (RASC) targeted one and off-licence premises which sell alcohol to drunk patrons, contrary to the Licensing Act 2003. No stooge operations were planned. Instead undercover officers would enter bars and observe or officers would follow drunk customers in to premises to see if they are served. 
TASC
Led by police, from June 2000 the multi-agency tasc project sought to prevent alcohol-related violence and disorder in Cardiff’s main night-time entertainment areas. A continually updated database of relevant incidents was used to target police interventions and to persuade high-risk establishments that they had a problem. Another key achievement was the creation of a local licensees’ forum which liaised with police and championed the business case for a safer city centre. Also effectively implemented were the project police officer’s visits to advise managers of their obligations and to promote violence prevention. The project enforced an existing obligation to hire only trained and registered door staff and introduced a new training and supervision scheme, though its enforcement was undermined by concerns over potential legal challenges. Less successful in the short-term were attempts to influence licensing and planning decisions or to counter the competitive and financial pressures driving the policies of large club or pub chains.
The database revealed a 4% decrease in incidents of alcohol-related violence from the 12 months before the project started to the 12 months after. Routine police records recorded a 2% drop in assaults in the targeted areas but an 8% increase elsewhere in South Wales. Such statistics were used to estimate that over its first year the project prevented 100 violent incidents. If (highly likely) at least one would have been very serious, the initiative paid for itself in overall cost savings to society. 
However, unlike the number of alcohol-related incidents, the number of people injured and especially those seriously injured rose substantially in the project areas. There may also have been a disproportionate rise in alcohol-related non-violent disorder. That this does not indicate a failing in the tasc strategy is suggested by the micro-examination of particularly problematic premises where it was most actively and comprehensively implemented. Here there were large falls in disorder incidents, injuries, and serious injuries.
The potential for increased violence is apparent in the rises in drinking and disorder in the targeted areas, but this potential seems to have been held back by the project. Improved procedures during the project are likely to have inflated the number of incidents and injuries recorded, especially serious injuries, making any observed before-after reductions all the more significant. The initiative’s impact appears to have been weakened by planning and licensing decisions which increased the density of drinking outlets in the city’s major violence hot spot. Excluding this area, the number of violent incidents fell by 15%. Measures which embedded change in management and staff practices and in logistics such as improved taxi access had a lasting impact, not the case for police operations which for a period simply targeted certain streets or areas. 
Maguire M. et al
The first scientific study in Britain in which children attempted to buy alcohol found that the prospect of being caught out by test purchases created a short-term dip in sales to children under 18 (illegal in the UK) which did not outlast the perceived risk period. Evidence from this study helped justify inclusion of test purchases as one of the main planks of a new UK law aiming to make significant cuts in the level of teenage drinking and drink-related problems. 
Two serendipitous events enabled the featured study to test an intervention similar to that being implemented under the Criminal Justice and Police Act 2001. In late 1998 in two English cities, one of a same-gender pair of 13- or 16-year-old boys or girls tried to buy alcohol while the other bought a non-alcoholic drink, observed by a researcher posing as a customer. About 83% of the 307 test purchases by 16-year-olds resulted in a sale, significantly more often to girls (88%) than boys (77%). Among 13-year-olds the gender gap was even more marked: 42% of girls completed a purchase but just 4% of boys. There was a significantly greater reluctance to sell stronger drinks to the 13-year-old girls (nearly all the boys were refused, whatever the drink). Refusal to sell was slightly more likely when another vendor was present. 8 in 10 of sales to 16-year-olds and two-thirds of sales to 13-year-old girls were unchallenged. Challenges were responded to by displaying a non-standard proof of age card with the child's true date of birth. Despite this, half the 16-year-olds who showed the card and a fifth of the 13-year-old girls were sold alcohol. In less than 1 in 8 purchase attempts did the vendor ask for the alcohol industry's Prove It! card. 
Surveyed by telephone, most of a random sample of the same vendors said they rarely encountered underage customers or if they did they refused sale. 90% said that if suspicious they requested proof of age; just 1 in 7 specified the Prove It! card. Only two out of 95 believed that there was much chance of their being penalised for selling alcohol to minors.
The first piece of serendipity was that (alerted by these results) police at one of the two research sites wrote to all licensees in the area reminding them of the legal obligation not to sell to minors, recommending proof of age be sought from anyone who appeared under 21, and warning that police would soon be conducting test purchases to as a basis for taking action against transgressors. Extensive media publicity and personal visits to licensees reinforced the message. Eleven test purchases were conducted and the three vendors who sold were warned that further offences would be prosecuted. To test the impact of this intervention, over the next two months the study was effectively repeated, except that the 13-year-olds were all girls. A dip in sales in the intervention area not replicated at the other site would suggest that the police's intervention had succeeded. Overall, there was no such impact. In fact, where there was scope for the sales rate to significantly increase (among 16-year old boys and 13-year-old girls; it was already nearly 100% among older girls) it did so at the intervention site, but not at the control site. There was, however, some evidence of a short-term impact. Staff illness (the second piece of serendipity) meant that test purchases had to be conducted in two waves. Immediately after the intervention there was a large (but not statistically significant) drop from 44% to 25% in sales to 13-year-old girls. By the second wave (started three weeks later) this had reversed and many more (96%) of the purchases resulted in a sale than before the intervention. There was no similar impact among 16-year-olds. All these results held whether or not the analysis was confined to outlets sampled both before and after the intervention.
While the results indicate that the letter of the law is widely and often knowingly ignored, they also indicate that vendors do react to the apparent age of their customers. The younger a child appeared to be the more reluctant vendors were to sell alcohol (especially stronger drinks) to them. There was virtually universal refusal to sell to 13-year-old boys, the group most clearly under age. However, the pattern of results suggests that many vendors' primary concern was not to avoid selling to under 18s, but to avoid the threat of prosecution for selling to clearly underage children. Imminent threat of police action stiffened the resolve not to sell to 13-year-old girls, where the defence that they looked 18 would carry little credibility. But once it was clear that the police's limited term test purchasing operation was over and no prosecutions had occurred, it seems that vendors reverted to their previous assessment that the risk of legal sanctions was low and to their previous willingness to sell. In fact they were even more willing to sell, perhaps because they now felt in the clear as the police operation had ended. This suggests that all along most vendors were aware that the 13-year-olds might be under age but that whether they responded as legally required depended on their perceptions of the likely consequences. Sectors of the industry which might be expected to be more aware and rigorous in their application of the law (large supermarkets and off-licences and pubs, the latter tested by 16-year-olds only) were no more so than corner shops.
Practice implications
From the featured UK study
UK Government policy aims to devolve responsibility for dealing with alcohol problems to a local level, and promises ‘... new guidance and support for Government Offices for the English Regions and a wide range of stakeholder groups represented at a local level’.
UK government policy is based on the argument that ‘Local communities are best placed to tackle local problems, including alcohol-related disorder’ (DH, 2007). In line with this, and in recognition of the UKCAPP projects’ considerable success at instigating positive community partnership responses to alcohol-related harm and disorder, there are two main reasons for arguing that community prevention programmes should continue:
a) it is likely (although currently difficult to prove) that the deleterious effects of high levels of alcohol consumption would be even worse at a local level if the community interventions described in this report were not taking place;
b) it is likely (although currently difficult to prove) that these local actions are the current best chance for minimising the extent of harm in the face of a concerted push towards national deregulation and promotion of alcohol consumption.
English strategy and law
The 2004 English national alcohol strategy highlighted “crime, disorder and anti-social behaviour” related to underage drinking and drinking in urban centres at night. Though it mentions some common elements of a coordinated community approach. there is no clear recommendation for such approaches. and the national frameworks it introduced for licensing decisions restricted the scope for action via that route and also limited the degree to which public concern could rival commercial considerations.
In 2007 the strategy was followed by an updated action plan which acknowledged the “need to ensure that the laws and licensing powers we have introduced to tackle alcohol-fuelled crime and disorder, protect young people and bear down on irresponsibly managed premises are being used widely and effectively”. One of the actions was to stipulate that “by April 2008, all Crime and Disorder Reduction Partnerships (CDRPs) – comprising the police, local authorities, police authorities, fire and rescue authorities and primary care trusts in England, and civil society organisations – will be required by law to have a strategy to tackle crime, disorder and substance misuse (including alcohol-related disorder and misuse) in their area.” It also promised that “A new programme will help local partnerships and communities tackle alcohol-related crime and disorder – encouraging more and stronger local partnerships and industry participation”.
In 2007 national public service delivery agreement 25 for England referred to “collaborative work by all agencies to shape an environment that actively promotes sensible drinking” and promised that “Government will also ensure that the law relating to the irresponsible sale of alcohol is properly enforced. The Home Office will continue to prioritise reductions in the test-purchase failure rate for underage sales of alcohol by ensuring that enforcement agencies are making use of good practice and applying tactics and powers effectively”. Indicators in that or other agreements include: the percentage of the public who perceive drunk or rowdy behaviour to be a problem in their area; the rate of hospital admissions per 100,000 for alcohol related harm; and alcohol-related violent crime and disorder, especially assault with injury.
From April 2008, there is a statutory duty for CDRPs to have a local alcohol strategy. In addition, PCTs will be required to include alcohol in their Joint Strategic Needs Assessments.
In 2008 in England government funding of up to £30,000 is available to local crime reduction or community safety partnerships to fund “activity which seeks to reduce the harms caused by alcohol to the community as a result of associated crime, disorder and anti-social behaviour”.
As explained in official guidance, the 2003 Licensing Act prioritised “crime and disorder, public safety, public nuisance; and the protection of children” but also aimed to “give business greater freedom and flexibility ... greater choice for consumers ... a thriving and safe night-time economy.” The concern to safeguard businesses is apparent in the guidance’s insistence that “it will always be important that any detrimental financial impact that may result from a licensing authority’s decision is necessary and proportionate to the promotion of the licensing objectives in the circumstances that gave rise to the application for a review.” 
As cited in the featured UK report, draft guidance on the act was “tilted firmly towards maximum permissiveness in licensing ... a close reading demonstrates that the guidance is concerned with the physical safety of the people using licensed premises, and not with broader alcohol-related harm or health issues which are supposedly addressed by other legislation. Licensing authorities may not [normally] impose conditions relating to management training or competency, or subject licensees to regular compliance checks. Nor can they attach conditions or promote generalised voluntary arrangements relating to ‘happy hours’ or other promotions, as this could breach competition laws. Furthermore, the guidance does not expect licensees to take any responsibility for the behaviour of customers once they are beyond the licensees’ direct management. With regard to outlet density in England, licensing authorities cannot consider that there may be no commercial demand for another licensed venue in the vicinity.” These features remain in the published guidance. 
The guidance does consider that the “cumulative impact of licensed premises on the promotion of the licensing objectives [eg, in relation to crime and disorder or public nuisance] is a proper matter for a licensing authority to consider in developing its licensing policy statement” but only in relation to new or varying licences. Licensing authorities must grant properly formulated applications which are not objected to and cannot use their discretion to refuse or amend. Neither can they review an existing licence on the grounds that premises in that area are associated with violence or disorder unless that can be linked to those particular premises. Licensing authorities may not initiate their own reviews of premises licences. The act might also be seen to call for a light enforcement touch in its concern that licensing authorities should avoid “driving a wedge between the hospitality and leisure industries and performers and those charged with enforcing the licensing regime, including the police.”
In some respects the scope for public involvement has been curtailed in the act. Representations from local residents have to pass a number of tests before being considered at all including the test that the objection could have been made earlier in the process. Section 5 of the 2003 Act requires a licensing authority to prepare and publish a statement of its licensing policy every three years after consultation with residents among others. The guidance does promote open meetings of licensing boards and local community partnerships and liaison groups of the kind which might mount community programmes such as those featured in the studies. 
The Violent Crime Reduction Act 2006 added some powers, in particular enabling police and/or trading standards officers to ban the sale of alcohol for up to 48 hours at premises that are persistently selling alcohol to under-18s and expedited licence reviews, which enable the police to apply for a fast-track review of the licences of premises associated with serious crime and serious disorder. 
Welsh strategy and law
In Wales the 2008 substance misuse strategy commented: “We are concerned that partners are not yet making best use of the Licensing Act and Violent Crime Reduction Act to reduce the harms to individuals and communities from excessive drinking. CSPs and health bodies must do more to share data and information and work together on the preparation of the local substance misuse action plans to tackle alcohol related harm. In particular, they need to ensure that they: • Work with local trading standards departments to tackle traders who persistently sell or supply alcohol to children, and make it easier for responsible traders to identify those who may be underage. • Make the best use of current powers and legislation at a partnership level, and ensure that the full range of sanctions are brought to bear against the individuals who drink irresponsibly and become involved in crime and anti-social behaviour, and the licensees who continue to serve them regardless of their state of intoxication. • Look beyond licensees to take a holistic approach to the management of our towns and cities during the evening and night time so that everyone is able to visit them without the fear of alcohol related crime and disorder.”
In more detail the Welsh strategy says: “Managing the problems of crime and disorder associated with alcohol requires all partners working together in a co-ordinated way. Successful strategies to manage the evening and night time economy must include objectives relating to: • licensing • test purchasing • under age drinking • working with the licensed trade • making effective use of the wide range of sanctions and tools that exist to tackle the inappropriate availability of alcohol and the associated crime and disorder. These interventions also require a holistic approach to the evening and night time economy as a whole so that our town centres are attractive and accessible to all. This includes: • transport • environmental factors such as toilet facilities • lighting • street cleaning • CCTV • promote a more diverse range of activities so that our town centres are attractive and accessible to all.” An action plan commits the Welsh Assembly to by 2009 “Establish four pilot projects for managing the evening and night time economy, and disseminate the results” and to “Develop a programme of test purchasing, and consider need for stronger penalties for under age sales”.
The Welsh strategy seems to recognise the limitations of the Licensing Act 2003 and the relative impotence of licensing authorities. “We also highlight the need to work with UK Government and with retailers and the alcohol industry, and we highlight the areas in which we want to see action, including in relation to pricing and promotion, drink driving, the inclusion of safeguarding public health as a statutory objective of the Licensing Act, and strengthening or mandating the code of conduct for the alcohol industry. We will also consider whether there is scope under the Government of Wales Act 2006 to strengthen the hand of licensing authorities in Wales.”
Scottish strategy and law
A discussion paper on a Scottish alcohol strategy released in 2008 prioritised community coordination projects to tackle alcohol-related city centre nuisance: “Through the Safer Streets initiative, we have supported local partners, in particular Community Safety Partnerships, to develop effective and innovative measures to tackle the effects of alcohol misuse in town and city centres. Much of this practice builds on the success of the Manchester City Safe Scheme and latterly the Glasgow 'Nite Zone' initiative. The general principle of this approach is that by gathering good quality intelligence, which can then be analysed and used by a range of agencies, alcohol-related disorder can be more effectively managed and ultimately prevented.”
The paper highlights a pilot community coordination project in Fife. “A key objective of the Scottish Government and Alcohol Industry Partnership is to work in conjunction with local community stakeholders to design, develop and implement a series of interventions within a geographically focused pilot area. This will establish the cumulative effect of a multi component and targeted approach to tackling alcohol harm and misuse. Fife was chosen as the pilot area for this work. The Steering Group for this study consists of representatives from Government, Fife Drug & Alcohol Action Team, Police, NHS, industry and the voluntary sector. The pilot will run for a minimum of two years.” The plans include elements typical of the Holder model of environmental action. As in England, test purchasing legislation in the Licensing (Scotland) Act 2005 which comes into effect from 1 September 2009 enables effective action against underage sales. The paper also observes that “Effective enforcement of the new licensing regime will be key to its success”.
The Scottish paper also notes that: “Licensing Standards Officers (LSOs) are being recruited by local authorities and will have a key role in monitoring compliance with the Act and licence conditions. LSOs can visit licensed premises at any time and can make reports to the licensing board where they have concerns about the operation of a premises, allowing the licensing board to take swift action to protect the licensing objectives. Licensing boards also have new powers to take action against premises that breach licensing conditions including the power to suspend a premises licence (for any period) or revoke it. Ultimately it is for the licensing board to decide what sanction is most appropriate in response to a breach of licence conditions but it is clear that suspension or revocation of a licence is an effective measure to drive up standards and clamp down on irresponsible operators. At present the police are responsible for enforcing the law. Test purchasing allows them to crack down on those premises selling alcohol to children and young people. We will also support the police in finding ways to effectively enforce the law in respect of third party purchasing and selling alcohol to someone who is drunk. While the police continue to be the main enforcement authority, consideration is being given to the scope for local authority trading standards officers also having a role in enforcement in relation to off-sales ... Licensing boards have the ability to refuse new applications on the grounds of over-provision, for example, on the basis of the total number of premises in an area, or the number of premises of a particular type. This approach allows boards to respond to the negative impact that can arise from a large number of licensed premises in a particular area.”
The Licensing (Scotland) Act 2005 comes into force in September 2009. As noted by health campaigners, “the 2005 Act is in part based on the recommendations of the Nicholson Committee which was mandated to review all aspects of liquor licensing law and practice in Scotland with particular reference to the implications for health and public order and to recommend changes in the public interest. The Committee opined that any legislation following upon their report should ‘set out certain guiding principles or objectives which are to be the underlying basis for any decisions made by licensing boards’. Further to this recommendation, the 2005 Act sets out five licensing objectives that licensing boards must seek to promote and take into consideration when granting or reviewing licences. The five objectives are: preventing crime and disorder; securing public safety; preventing public nuisance; protecting and improving public health; and protecting children from harm. These objectives are similar to those contained in the Licensing Act 2003 (which covers England and Wales), except for the reference to public health which is absent from the Westminster legislation.”
In Scotland all councils are required to establish a Local Licensing Forum for their area. A web site set up to inform the public and licensees notes that: “The role of the Forum is to keep under review the operation of the licensing system in their area and to give advice and recommendations to the Licensing Board. This will be mainly at policy level and does not include reviewing or offering advice or recommendations in relation to any particular application or case before the Licensing Board. The Forum is independent from the Licensing Board and must have the capacity to be impartial. However, the Forum and the Licensing Board share a common goal of having the local community's best interest at the heart of any decision-making. The Forums will meet at least four times and have one joint meeting with the Board each year, and will consist of between five and 20 members, as the relevant council may determine. The members of the Forums are to be representative of the five key interest areas, which are: holders of premises licences and personal licences (licensees); the Chief Constable for the police area in which the Forum's area is situated; Licensing Standards Office for the council’s area; persons having functions relating to health, education or social work; Young people, persons resident within the Forum's area.”
“Under the Licensing (Scotland) Act 2005, all staff who serve alcohol must be trained by 1 September 2009. Councils will appoint one or more Licensing Standards Officers who will provide information and guidance on the requirements of the Act, supervise compliance with conditions of licence and provide mediation for resolving disputes.”
Official guidance points out that: “Licensing Board’s statements of policy should make clear that licensing law is not the primary mechanism for the general control of nuisance and antisocial behaviour by individuals once they are no longer on the licensed premises and beyond the direct control of the individual, club or business holding the licence, certificate or authorisation concerned. Boards should also be reminded that when considering licensed hours for premises, anyone can make representations to the Board. As such they may request a review of the licence. It is important that in developing its policy on licensed hours the Board must take account of the views of the Local Licensing Forum so that any policy published has the backing and confidence of the local community. Further to this, following a review, reducing licensed hours can be one of the sanctions applicable against a license holder.”
“The act requires Licensing Boards to take a pro-active position on over-provision and identify those localities in which it would not propose to grant new licences or licences for premises of a particular description; • allows Licensing Boards to take account of the ‘particular description’ of premises (that is to say, their styles of operation) when assessing over-provision; and; • directs Licensing Boards to have regard to the number and the capacity of licensed premises in localities. This approach: • allows Licensing Boards to take account of changing market trends, such as the development of so-called ‘hybrid’ premises; • provides potential entrants to the market with a clear signal that they may incur abortive costs if they intend to apply for a licence in a locality which the Licensing Board has declared to have reached over-provision; • improves public and licensed trade confidence in a system by setting out clearly the grounds on which over-provision should be determined. • recognises that halting the growth of licensed premises in localities is not intended to restrict trade but may be required to preserve public order, protect the amenity of local communities, and mitigate the adverse health effects of increased alcohol consumption resulting from growing outlet density.”
“Where a Licensing Board's policy statement has concluded that in a particular locality there is an over-provision of licensed premises, or licensed premises of a particular description, an application for a new premises licence or for the variation of an existing licence in that locality should normally be refused on the ground provided by Section 23(5)(e) of the Act, either: • because it would simply add to the number of licensed premises; or • because it would increase the number of premises of the relevant description, depending on the approach which the Licensing Board has taken in the policy statement. The application need not be the subject of an objection.”
“The duty to consult is subject to the over-arching obligation set out in Section 6(3)(b) of the Act. This means that the Licensing Board is also required to consult the Local Licensing Forum established for the whole of the Board's area[ or in its absence equivalent people]. The new licensing system allows anyone to object to or make representations to a Licensing Board about any application for a premises licence. Whilst any person may object, frivolous and vexatious objections can be rejected by Licensing Boards [note no mention of repetition]. At any stage following the grant of a premises licence, any person may ask the Licensing Board to review the licence in circumstances where one or more of the conditions to which the premises licence is subject has been breached, or on any other ground relevant to one or more of the licensing objectives.”
“Licensing Boards may initiate their own reviews of premises licences. Conditions that Boards may wish to consider include: • Active membership of any Radiolink or Pubwatch-type scheme: where a local scheme based on radio link to the Police or Pubwatch or a scheme with similar principles exist, the premises should be a member. In considering this option Licensing Boards should consider whether any scheme has the resources to support an influx of members. • Participation in the “Best-Bar None” schemes which aim to promote safer premises. • Closure Policy, e.g. the last 30 minutes of music must be slow and considerably quieter. • Last entry policy/curfew on entrance • Staff present who have undertaken Advanced First Aid training: Boards should take into consideration local arrangements on busy nights and link to the city centre triage may be a more appropriate option. • Premises to have a glass collection policy. • The use of plastic or toughened glass where non-glass or toughened glass receptacles are required to be used throughout the premises. • Agreed times for the disposal of glassware: disposal of glassware should be made at a reasonable time as agreed by the Licensing Board. • Noise control: steps should be in place to minimise noise leakage from the premises. • Staffing policy: a personal licence holder must be nominated as being in charge at all times and to be on the premises, each bar must be supervised by a personal licence holder. • Register of staff: a register must be maintained by the nominated person in charge each day and or at shift handover times. • Door control policy: consideration should be given to best practice used throughout the industry and again to which premises such measures are applied.”
“It should be emphasised that the proposals in the Act will restrict types of promotions, that encourage binge drinking and underage drinking, not products themselves. The proposals in the Act address the issue of binge and under age drinking and the length of time a product has been on the market is irrelevant. Those are promotions which: • Relate specifically to an alcoholic drink likely to appeal largely to people under the age of 18; • Is based on the strength of any alcohol; • Rewards or encourages – or seeks to reward or encourage – drinking alcohol quickly; or • Offers alcohol as a reward or prize, unless the alcohol is in a sealed container and consumed off the premises. Furthermore personal licence holders are required to undertake mandatory training every 5 years as set out in section 87 of the Act.”
Extracts from previous Findings analyses
Nugget 11.10
In England and Wales the time may be right for anti-violence programmes such as Safer Bars to be taken up more widely. The Licensing Act 2003 due to take effect in 2005 will give all parties a duty to prevent crime and disorder and transfer implementation responsibility to local authorities, which will be required to state how they intend to promote this objective. One of the required tactics will be a voluntary code for licensees which stipulates a minimum level of training for all bar staff on managing alcohol misuse. In addition, there is now a legal requirement for all door supervisors to be licensed, which entails training, and local authorities will be able to make hiring licensed supervisors a requirement an establishment’s licence.
At the same time, simply by increasing occupancy time, the extended licensing hours provided for by the act may increase the extent to which untoward incidents occur inside rather than outside premises. Safer Bars seems to provide a way forward with respect to on-premises violence which does not entail the years of generating media and political support and establishing interagency coordination mechanisms needed by some community-wide initiatives. However, ignoring such tasks would be a mistake, as Safer Bars and similar programmes work best and are most likely to be sustained when the context is right for them to be accepted. 
Nugget 10.9
The Cardiff experience provides an important model for other alcohol-based entertainment areas concerned over violence and disorder. Regardless of the interventions built up on it, the construction of an incidents database is a key element. Such databases can be used to make the case for intervention, precisely target those interventions, and to adjust the strategy or to motivate participants through ‘real-time’ evidence of impact. The appointment of senior police officers dedicated to the project created momentum and coherence in the policy and practice areas most susceptible to police influence. Also generally effective was the dual approach of bringing the industry ‘on side’ by appealing to the professional pride of managers and their staff and developing their expertise, whilst also reinforcing the possibility of sanctions. Such projects must however be seen and evaluated as long-term investments with the results of the earlier stages being used to extend public, industry, official and political support for the project, which in turn extends the project’s reach and creates extra gains. 
Nugget 5.12
Threats of legal action against alcohol sales outlets which serve underage children must be persistent and visible in their results if they are to have anything but a fleeting impact. Short-term initiatives risk being counterbalanced by vendors selling more once it is clear that the threat has been lifted. 
The Criminal Justice and Police Act 2001 legalised test purchases of alcohol by underage children in England and Wales under the supervision of police or trading standards officers, and placed a duty on the latter to enforce the law against underage sales. An official commentary on the act before it was passed explained that test purchases were not expected to be conducted on any significant scale or to result in many prosecutions; the threat that they might happen is expected to act as a strong deterrent against unlawful sales. Other provisions in the act placed the onus on licensees to take all reasonable steps to establish the age of a customer who might be under 18, an attempt to make refusal the presumption in case of doubt and to make illegal vendors easier to convict. However, what counts as having taken “all reasonable steps” is left an extremely vague potential loophole. 
In England and Wales the Licensing (Young Persons) Act 2000 extended responsibility for preventing underage sales to any staff member who knowingly sells or allows a sale to happen, and made it an offence for an adult to purchase alcohol on behalf of a person under 18. 
Nugget 4.13
Practice lessons common to community alcohol interventions in several countries include: the need to devolve decision-making to the community; while knowledge should not and cannot equate to power over self-governing communities, it does lend credibility to the experts seeking to generate community action; rapid feedback of results helps motivate participants and keep projects on track; recruiting influential and respected local leaders is vital; considerable lead-in time is needed to form the social and organisational infrastructure for community action and projects need several years to fully deliver; project staff must expect and permit adaptation not just of methods but also objectives in response to the community’s strengths and self-perceived needs; success comes easier in communities where the project’s aims are already high on the agenda; community norms and alcohol availability restrictions have their greatest impacts in self-contained, stable communities whose residents and businesses can less easily escape their impact; a key element is the surer detection and sanctioning of transgressors brought about by the more intensive use of existing legal powers; however, these legal powers (such as being able to test all motorists, not just those driving badly, and to levy immediate sanctions) must in the first place have the potential to be effective. Given such conditions, even when national drink-driving deaths and accident rates are declining, further reductions which more than pay for themselves can be achieved by concerted community action.
Other considerations
Alcohol Concern’s HubCAPP database features community projects among others.
Guidance on developing a local alcohol strategy is available from the London Drug and Alcohol Network Alcohol Concern. There is also a useful Australian guide.
The ideal situation national support for controlling alcohol-related damage and national regulations afford localities the scope and the tools to use within an accountability framework which motivates effective action, but which gives localities discretion how to achieve those objectives using the tools at hand. This is because the impact of commonly used initiatives is crucially dependent on the environment with which they interact, meaning that a different mix is required in different situations.  It is not uncommon for community programmes to have no noticeable impact on the targeted problems. Harold Holder has pointed out that “national as well as state or provincial laws often establish the base for local policies, including legal drinking ages, regulation of alcohol outlets, the legal blood alcohol level for drinking and driving, advertising restrictions, and service to obviously intoxicated persons and underage persons. Local policies often address the implementation and enforcement of these existing laws.”