Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Data Collection
2.3. Analysis
2.4. Ethics
3. Results
3.1. Values and Beliefs about Alcohol and Alcohol Licensing
“We could endlessly explain the size of the problem for a particular area but action depends on having a general consensus that there is a problem but we don’t know where. It’s different if no-one is convinced that there’s even a problem to begin with.”[L357, Interview 1, ADP]
“When we’re trying to make a case that there is too much alcohol being sold and drunk and its causing people long-term health harm, I don’t think as a society, people are generally in agreement with that necessarily…There’s a perspective that other people’s drinking may be harmful but my drinking is perfectly alright.”[L704, Interview 12, Public Health]
“Boards are asked to make decisions based on the five [licensing] objectives however the key element that dominates the agenda is the local economy rather than any discussions about the licensing objectives…It is all about profit and has very little impact on what the licensing board are supposed to do.”[L46, Interview 4, ADP]
“[In one area], they still see attracting business to the town centre as important and they still seem to think that that business has to be associated with alcohol in one form or another which is a bit of a shame.”[L256, Interview 9, Public Health]
3.2. Values and Beliefs about Evidence
“The Licensing Board completely ignored the evidence. That let us see what an enormous task this is.”[L79, Interview 4, ADP]
“An extensive range of evidence was provided and referred to…to demonstrate concerns about the health and social impact…No evidence was identified that objectively indicated a lack of availability. So we were pretty shocked that the Licensing Board had taken that position [of not declaring overprovision]…We were quite flabbergasted actually.”[L327, Interview 11, ADP]
“You have no idea how [the licensing board] interpret data. They don’t understand data… I’m not saying they’re not clever, it’s just if you’re not used to thinking in an academic way, then you can’t look at it and say how this relates to you.”[L968, Interview 10, Public Health]
“There’s a whole group of non-believers out there. I had someone from the Licensing Board say to me that he didn’t believe any statistics ever.”[L380, Interview number and type withheld]
“I didn’t even have an obvious place to speak…it’s done in a very formalistic way, the Chair introduces a topic and then asks for comments on it and people put their hands up and me, as a supposed expert, simply have to put my hand up along with other Councillors who want to have their say.And then if one of the Councillors says something which is just completely ridiculous, which I have to say they do on occasions, you know, in the NHS I would be saying ‘excuse me but actually, they perhaps weren’t aware that this was the situation that had happened’. But you can’t just do that in these environments. So you get left looking as though you don’t know what you’re talking about and somebody who’s got completely no idea about a topic comes across as equally valid in their opinions to you as an expert”[L585, Interview 12, Public Health]
3.3. Role Perceptions
“Obviously in health we’re very aware of a lot of the problems and we think this is serious and we would like to do something about it. So it’s difficult to be completely neutral.”[L989, Interview 12, Public Health]
“Next time I think we need to get to licensing board members more directly and start to brief them a bit more about the problems. There are opportunities to do that and we probably didn’t do enough of that. They’re elected members so we can meet with them.”[L377, Interview 1, ADP]
“I think lobbying of board members would generally be counter-productive… [It] tends not to be something that goes down well with councillors that sit on a regulatory body…councillors…have to be absolutely impartial. If the ADP [Alcohol and Drug Partnership—a strategic multi-agency group in each local area] were viewed as a lobbying group it would undermine their credibility and independence.”[L322, Interview 8, Key Informant]
“We changed the tack—instead of fighting [the licensing board], we said ‘let us support you, let us work with you. We understand the anxieties you have around this whole issue [of overprovision].’”[L120, Interview 4, ADP]
“They kind of get used to my face. I go to the board meetings to see how they’re getting on so they start to see me, that might be a good thing or a bad thing—oh no here she comes again, always banging her drum about alcohol. So I’m starting to build up a relationship with them as well. One board member came to me after the last meeting and asked me ‘how did you think that went? Did you think we made the right decision?’ That was quite nice, they are obviously beginning to build up some trust in me…”[L166, Interview number and type withheld]
“We are developing a beautiful working relationship with the licensing board and that’s what we’re looking for, that’s what it needs to be.”[L403, Interview 4, ADP]
4. Discussion
Strengths and Limitations
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Licensing (Scotland) Act 2005 Objectives | Licensing Act 2003 (England and Wales) | Northern Ireland (Previously Proposed) |
---|---|---|
For the purposes of this Act, the licensing objectives are—
| The licensing objectives are—
|
|
Descriptor | Breakdown a |
---|---|
Organisation (number of interviewees)/Role: | Alcohol and Drug Partnership (ADP) (6)/various roles including ADP co-ordinator and more junior officers of the ADP. National Health Service (NHS)/Public Health (5)/public health consultants, trainee consultants, or junior doctors. Key Informants (2): Alcohol Focus Scotland, a third sector organisation working to reduce alcohol-related harm (1); Recognised local licensing expert (1) |
Health Board areas in which interviewees had experience: | Eight of 14 health board areas were covered. |
Licensing Board areas in which interviewees had experience: | Twenty of 40 licensing boards were covered. |
Licensing Board areas policy status: | The extent to which the sample included licensing boards which had declared overprovision (OP) was analysed using data on policies published by 30 April 2014 [44]:
|
Main Questions in Interview Topic Guide |
---|
|
1. Learning, Expertise, Capacity, Persistence | |
1a. Learning about Influencing Licensing | Formal and informal mechanisms of learning for public health (PH) actors—peer support, national guidance. |
1b. Other Expertise | Data analysis, legal and economic expertise—confidence and availability of expertise |
1c. Long term approach, persistence | Timing, preparation, planning for future, taking a long-term view. Reviewing all licensing (L) applications; |
1d. Capacity | Capacity to respond regularly and rapidly; Level of effort/time spent/required. |
2. Working with Others | |
2a. Alliances | PH actors from various organisations working in partnership with public sector colleagues from other organisations on licensing issues |
2b. PH Actors working with Licensing Actors | Perceptions and reports of working with licensing standards officers, L clerks, L boards. Mechanisms for communication with L actors. |
2c. Helping or Influencing | Efforts to influence licensing board (LB) members and how such efforts are framed/perceived—helping versus lobbying/campaigning. Presentation of “recommendations” or “options” to LBs |
2d. Raising awareness | Efforts to inform LB and other stakeholders about alcohol harm, overprovision etc. |
2e. Building relationships | Relationship building with LB and others; time needed to build; more than awareness—“hearts and minds” |
3. Power, Autonomy, Bias | |
3a. Licensing board autonomy & accountability | Independence and control of LBs. Mechanisms to hold LBs accountable for upholding the L Scotland Act or implementation of L objectives. |
3b. Legalistic licensing system | Formal and legal processes and requirements; Disempowerment of LB outsiders; disempowerment of LB—fear of litigation. |
3c. Conflicts of interest (COIs) | Ability of individuals and organisations to act independently and without bias—for PH actors and others. Types of bias—host organisation; personal interests…Issues about representation on forums are not included here, but in 6a, 6a, though COIs of individuals on forums would be included. |
3d. Power and influence of individuals | The influence of individuals on action and progress. Lack of continuity when personnel/LB membership changes. |
4. Evidence | |
4a. Defining overprovision of L premises | Challenges and difficulties in defining overprovision (OP); choices re. geographical unit of analysis; historical practices and understanding of OP |
4b. Hard (imperfect) data | Emphasis on quantitative data, challenges of measuring capacity and provision, relating harm to provision. |
4c. Presentation of evidence | Oral and written presentations; importance of presenter, and clarity and simplicity of data presented. |
4d. Softer data | Importance and power of qualitative evidence and public opinion—anecdote/personal experience; (Methods used to collect data are covered in 6 d) |
4e. Perceptions of data | Ownership of evidence; acceptance of evidence; attitudes towards harder and softer evidence including public views. |
5. Attitudes and Beliefs Regarding Alcohol and Alcohol Licensing | |
5a. Attitudes to alcohol in general | Perceptions of alcohol problems; sense of problems only in other places or groups; |
5b. Role of licensing in relation to PH & other objectives | Importance of mood of L board; focus on short term issues (e.g., disorder) or long term (e.g. health); acceptance of availability as driver of consumption and harm; |
5c. Views on the Effectiveness of the L system to address alcohol-related harm. | Perceived limitations of the L system in improving public health. Return on time invested in taking action on this issue. L as just part of a larger alcohol policy picture. |
5d. Economic arguments | How economic issues influence licensing decisions; lack of data/method to compare risks/benefits of new L applications; beliefs in economics being more important than PH |
6. Public and Stakeholder Involvement | |
6a. Forum as Public Involvement mechanism | Representativeness of members; appointment of members. |
6b. Functioning of forums | Effective operation; representation of stakeholder views to the LB: conflicts within forums |
6c. LB statutory consultation | Breadth of formal consultation; scope; standards; impact |
6d. PH-led consultation/research into public views | Methods used; questions asked; groups and numbers involved; impact |
6e. PH-led public engagement/empowerment | Engagement; awareness raising; support; empowerment; campaigning. Public power. |
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Fitzgerald, N.; Nicholls, J.; Winterbottom, J.; Katikireddi, S.V. Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence. Int. J. Environ. Res. Public Health 2017, 14, 221. https://doi.org/10.3390/ijerph14030221
Fitzgerald N, Nicholls J, Winterbottom J, Katikireddi SV. Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence. International Journal of Environmental Research and Public Health. 2017; 14(3):221. https://doi.org/10.3390/ijerph14030221
Chicago/Turabian StyleFitzgerald, Niamh, James Nicholls, Jo Winterbottom, and Srinivasa Vittal Katikireddi. 2017. "Implementing a Public Health Objective for Alcohol Premises Licensing in Scotland: A Qualitative Study of Strategies, Values, and Perceptions of Evidence" International Journal of Environmental Research and Public Health 14, no. 3: 221. https://doi.org/10.3390/ijerph14030221