Can Shetland Drink Better?

Shetland has been in the news again, and this time it was all about alcohol. Stories reporting on our Public Health Annual Report have invited a lot of comment on social media, from Shetland and beyond, and we're really pleased with the amount of interest and discussion it is generating. We thought it might be helpful to keep the discussion going - have a read of the information below, or get in touch on 01595 807497 or L.flaws@nhs.net if you would be willing to take part in a discussion group about drinking in Shetland.

If you’re looking for more information on the recent stories in the press then a good place to start is the report that has been the source of the headlines – it is available here:

NHS Shetland Public Health Annual Report

(The alcohol chapter is p18-32 if you’re short of time)

Almost everyone in Shetland has some relationship with alcohol, be it positive or negative, directly, through their own drinking, or indirectly, through family, friends, co-workers, patients – very few folk are left untouched. Alcohol doesn’t have to be damaging, but all too often it is, mentally, physically or socially.

The “alcohol problem” in Shetland is about much more than licensing, alcohol dependency and restrictions. It is about culture - culture in communities, in schools, workplaces, our traditions and history, the NHS, Emergency Services, everywhere. Culture is very difficult to change (and some people would rather it didn’t).

Alcohol misuse is a very difficult problem to assess and quantify – but, it being such a costly problem, there has been a lot of research done and statistics on costs, drinking levels, sales and alcohol related medical problems are routinely collected.

We aren’t alone in having an “alcohol problem” - Shetland is roughly in line with Scotland, which significantly outstrips England and Wales, as part of the UK which stands out in the world when looking at dangerous drinking patterns. “Dangerous” being drinking that significantly increase the risk of many health conditions, not to mention the social effects of alcohol on relationships, families and the community.  These aren’t judgements based on opinion, but taken from a vast collection of research looking at the effects of alcohol consumption at different levels, and the short and long term effects this has.

A lot of the comments on recent news pieces have spoken about “us” and “them” and a “minority” ruining it for “everyone else”. Unfortunately the stigma surrounding alcohol misuse, and the various driving forces behind dependency or substance misuse, is something that can only be tackled by a supportive, empathetic, inclusive community.  Unfortunately alcohol misuse isn’t something that can be “fixed” in the NHS – it takes much more than that – Shetland can be that supportive, empathetic, inclusive community in many situations, but for many that community doesn’t exist, making it really difficult to make changes.

And painting “them” in this light makes it increasingly difficult for someone who is struggling – friend, family member, colleague, you – to speak to someone about their worries. If that is our attitude to people who are drinking for the wrong reasons, wanting to change, finding their drinking is affecting their health, life, relationships, how easy is it for them to ask us for help?

Who are “they”? Well one of the standard tests for assessing drinking behaviours and likely effects is the “FAST” test – it is designed to help identify hazardous, harmful or problem drinking. How do you measure up? (there is a "click through" test here if you'd prefer)

"Scots NHS bosses suggest alcohol sale ban before 5pm!"

Did they really...?

Where does the “no alcohol before 5pm” headline come from? The Public Health Annual Report for NHS Shetland this year focuses on substance misuse and has a chapter on alcohol (pages 18-32 http://www.shb.scot.nhs.uk/board/meetings/2016/October/2016_51.pdf  please do have a look). A part of that chapter was a section on some research done with those in recovery from alcohol dependence in Aberdeen. One of the things they said would be supportive to them, as people in recovery, was:

Restricting licensing hours would be a big help, if off sales were not permitted until late afternoon or evening rather than from 10 am

In a recent report to the licensing board, NHS Shetland’s recommendations to the board were:

The Shetland Area Licensing Board should explicitly include in its overprovision statement the following:

  • that Shetland, and Lerwick in particular, is overprovided for in terms of alcohol off-sales licenses and capacity
  • that applications to increase capacity in existing off-sales premises will not be granted.
  • that there should be a significant reduction in the capacity of off-sales of alcohol in supermarkets

The Shetland Area Licensing Board should explicitly include in its Licensing Policy the following:

  • That licenses should not be awarded to or renewed for venues/premises that flout the licensing objectives by offering ‘super-strength’ alcohol or offering it as ‘value-brand’ or ‘everyday’ commodities.

Part of our role in the NHS is to try and help people to improve their health and wellbeing, and to give them the tools they need to make choices that reduce harm to their health. Alcohol provision is one small part of this, and when we look at the evidence of what works to reduce harm caused by drinking reducing availability is one of the top recommendations. In our ideal world people would choose to drink responsibly, in a way that supported good physical and mental health and wellbeing, but that ambition is somewhere far along the line – a change in culture and attitudes and behaviour. While we are working on that we need to look at other ways of reducing harmful alcohol use.

We are always open to suggestions and discussion and will be holding various focus groups on the topic of alcohol culture across Shetland – please get in touch with your details, and the areas you’d be able to attend a discussion in and we’ll get in touch when we have groups together. Groups are a good way to generate discussion and get new ideas but they aren’t for everyone – we’ll also have a paper and online survey, and can arrange one-to-one discussion for anyone who would like to be involved.

What will the focus groups involve?

Groups of 5-10 people in local areas discussing questions/topics/themes around alcohol culture and behaviour, for example why do people drink, what does problem drinking look like, how could we tackle problem drinking, are there particular topics around alcohol that people are concerned about.

The groups are meant to generate discussion and ideas that we can take forward and use in our work on alcohol in Shetland.

Contact Lucy Flaws on 01595 807497, or L.flaws@nhs.net with your details if you’d be interested in taking part.

We need to work together to make a difference in our community.