What might have been

In 1979 a report on alcohol policies was produced for the then Labour Government by the Central Policy Review Staff. However, the report was to become famous for not being offi cially published, either by the Government that commissioned it, or by any succeeding Government, for the next 30 years.

Here, Richard Lee gives his personal view as to why the report never saw the light of day, and what might have been different if it had been published, and acted upon.

Mr Austin Mitchell: To ask the Minister for the Cabinet Office if he will publish the report, Alcohol Policies, produced in 1979 by the Central Policy Review Staff. [217727]

Mr [David] Miliband: In common with other Cabinet Office records, the report will be considered for transfer to the National Archives after 30 years. The 1979 report is due to be transferred to the National Archives in 2010.

- Response to a written question from Austin Mitchell, MP for Grimsby, to future Labour Party leadership contender, then a Cabinet Office Minister, David Miliband, in Hansard, 7th March 2005

This question, posed by Austin Mitchell, hints at a very curious episode in United Kingdom alcohol policy, the effects of which we are living with to this day.

The Central Policy Review Staff (the CPRS, also known as the Think Tank) began life in 1970 as an independent, multidisciplinary unit within the UK Government’s Cabinet Offi ce, with a brief to work across departmental boundaries. In March 1979 it produced a review called Alcohol Policies which set out, anonymously and away from the public gaze, to examine not only the most effective but also the most feasible responses to Britain’s increasing alcohol consumption.

The 2 volume publication was shelved at the time for reasons discussed further below - and the public were protected from it by the 30 Year Rule (under which most UK Government records are transferred to the National Archives and made available again after 3 decades.

An unofficial, pirated version of the report was published in Stockholm in 1982 but the real thing has only been available in paper copy since September 2009, and that for a mere £456.60. Its final, belated release resulted in no comment in the serious press, even the Daily Mail - the fiercest chronicler of Britain’s drink problem. It was as though Alcohol Policies came out of prison only to be tagged and placed under house arrest.

One clue to where the Think Tank might have gone wrong at the start is in the foreword. They clearly failed to bring the alcohol industry ‘on board’ as ‘stakeholders in the process’. They admit with disarming honesty that the importance of the industry view came at the bottom of a long list that included 16 Government departments with interests in all aspects of alcohol (“production, sale and consequences of its consumption;” health and social services; the police and the judicial system; private sector bodies “..most of whom devote their efforts to people with alcohol problems.”) This mistake was not to be repeated in the preparation of the 2004 Alcohol Harm Reduction Strategy.

What was it that made the conclusions of the CPRS’s fact-finding so unpalatable? At first sight Alcohol Policies’ recommendations may seem, in a very British way, modest and sensible to a 21st Century reader brought-up with the public health model of alcohol control.

The review recognised the relationship between per capita consumption and resulting harms and suggested that the best outcome would be to hold it at the current level. This would be achieved by the active use of revenue duties, keeping them in line with the cost of living as measured in the Retail Price Index (RPI).

It acknowledged that alcohol created problems that went beyond a minority of irresponsible drinkers, highlighting young people in general and women in particular as vulnerable groups.

Alcohol should not become more easily available than it already was. Lowering the minimum age at which young people could legally buy alcohol to 17 was rejected.

More research, leading to action, on alcohol in the workplace.

Action on drinking and driving (a cause of excess morbidity and mortality in the under-30 age group) by implementing the recommendations of the 1976 Blennerhassett Committee: retaining the current upper bloodalcohol limit but introducing discretionary road-side testing (an idea first floated in a 1965 White Paper) with breath testing machines instead of blood and urine tests.

The setting-up of an Advisory Council on Alcohol Policies that would not merely advise but take ‘an activist role’.

But Alcohol Policies was spiked and instead, in 1981, the UK Department of Health & Social Security published Drinking Sensibly that, while covering much the same range of issues as the CPRS review, took no account of the cost of alcohol or per capita consumption. Drinking Sensibly was widely believed to be the Government’s answer to the Think Tank report: a document far more palatable to those nowadays described as the major stakeholders in alcohol policy.

The relationship between consumption and harm wasn’t a new or heretical idea in 1981. In 1956, the French statistician Sully Lederman had set out to demonstrate a relationship between average levels of alcohol consumption in a given society and the number of harmful drinkers. By 1975 Robin Room could assert that measures to control the availability of alcohol through interventions that included the manipulation of price were not only shown to be effective but “thoroughly traditional.”

Where did it all go wrong? The review laid down a challenge to the Government – not only that trends in misuse justified its concern but that it had the means at its disposal to begin acting immediately - and inevitably became a source of embarrassment. Despite being respected by civil servants, Ministers’ interest in the Think Tank had always been half-hearted. For those Government Departments concerned with employment, trade and tourism the recommendations contained in its review became a cause of tension.

The Conservative Party in the UK has traditionally been sympathetic to the drinks industry. And for obvious reasons the drinks industry didn’t like Alcohol Policies. As the review noted, strong growth in alcohol sales was predicted for the 1980s. The Party elected under Margaret Thatcher in May 1979 had embraced a neo-liberal ideology (rolling back the state, liberating business from restrictions, individual responsibility, choice - whether you wanted it or not) that sat even less comfortably with the CPRS’s interventionist recommendations.

Could it have been different? Alcohol Policies noted with concern the increase in per capita consumption that occurred in the 20 years up to 1977 accompanied by a 50% increase in liver cirrhosis, an 84% increase in diagnoses of alcoholism among men and a 145% increase among women. Interestingly, after 1979, due to economic recession, the real price of alcohol went up and consumption briefly dipped. Reports from the Royal Colleges of Psychiatrists and Physicians published in 1986 and 87 raised the alarm about rising consumption and harms, which had resumed an inexorable increase that would continue for the next two decades, while proposing similar countermeasures to Alcohol Policies.

During the same period, the use of pricing, an advertising ban and severe restrictions on where the product could be legally used, reduced tobacco consumption and changed the culture of smoking in the UK and much of Europe; the opposite of the situation with alcohol. Part of the explanation for this lies in the greater power of the drinks industry in comparison with the tobacco industry.

The Government knew what action to take - none of the CPRS’s recommendations were radical - but chose to do the opposite in full knowledge of the likely consequences. Which goes well beyond being embarrassed.

Neither the CPRS review, nor the Royal Colleges’ reports, had the prescience of Tim Ambler - at the time an executive with the Grand Met hospitality and brewing group. In an internal 1984 document Ambler identified 7 ‘threats’ to the alcohol industry’s growth which included the use of taxation to increase price, vigorous measures to counter drink-driving, restrictions on hours of sale, advertising restrictions, warning labels and most cynically of all, residential treatment for people misusing alcohol - thereby acknowledging that a minority of irresponsible drinkers are actually the best customers and should not be removed from the marketplace. None of these threats materialised - demonstrating that the leaked Ambler memo was by far the most authoritative guide to alcohol policy for a quarter of a century.

Richard Lee worked for 12 years in a specialist alcohol treatment team in the south of England and, at Glass Half Full Alcohol Training, he is an independent trainer on alcohol issues.