Half-measures over price in fight against drink culture

Paul Southern remembers his days as a young doctor when, nine times out of 10, the patients he saw fitted neatly into one easily defined category.

In fact up until a few years ago, the consultant hepatologist would still have described alcohol-related liver condition as the middle-aged white man's disease. Today, things are different. The patients he sees are now often in their 30s, some even younger, many of them are women and the effects of the recession, which pushed many people over the brink, are still being keenly felt.

"There has been a complete explosion of cases," says Mr Southern, who first worked on the transplant team at St James's Hospital in Leeds before moving to Bradford, where he is now the lead on alcohol for the city's Teaching Hospitals NHS Foundation Trust. "In the last year we have treated more people in their 30s than ever before and one young girl who died was only in her 20s. No-one ever gets used to breaking that kind of news to a family, but we all have to admit heavy drinking is not a problem which affects one specific age group or gender. Now it's something which can affect anyone.

"The people we see have not just been sipping on mum's Babycham, they have a long and hardened history of drinking which often begins before they are even in their teens. We are talking about people who think nothing of drinking a three-litre bottle of cider in a night. That's 21 units in one sitting, and the pattern continues until they are dependent on the stuff.

"The patients we see now tend to fall into one of three categories. Some pick up the habit watching their parents drink – we often have families visiting the bedside who are drunk themselves – others are from this new generation of drinkers and a new group we have seen recently are victims of the recession. When times are hard, alcohol can be seen as a cushion and we have definitely seen an increase in people who turned to drink because of money and job worries and simply weren't able to stop.

"Whatever the reason behind why they drink, one of the things which makes it easy for them to continue is the cheapness and ready availability of alcohol. In many supermarkets and off-licences a large bottle of cider costs less than 4, it's something even limited pocket money can buy."

The need to address the cost of alcohol is an argument which has been circulating round the House of Commons for some time. Amid increasing reports of alcohol-fuelled anti-social behaviour and horror stories of the strain binge drinking is putting on the NHS, countless reports have been commissioned and the Government has been under pressure to act.

Yesterday, the proposals were finally unveiled, but they stopped short of the much-touted ban on the sale of alcohol below cost price. Instead shops and bars will be prohibited from selling drink for less than the duty and VAT paid on them.

It means that while a can of weak lager will now cost at least 38p and a litre of vodka at least 10.71, the original promises have been so watered down that many fear it will do little to reduce alcohol-related crime and disorder, which costs the taxpayer 13bn a year. As the various interested parties digested the detail of the plans, the reception of everyone from medical experts to brewers was at best described as lukewarm.

"It's an acknowledgement that price has an impact on consumption," says Mr Southern. "But I would like to see it go further and I think it must if we are going to see any real effect. Ideally, the cheapest bottle of wine on the supermarket shelf should be 5 and spirits need to retail for around 20. I know it sounds like a lot and it would inevitably have an impact on moderate drinkers, who perhaps only buy one bottle of wine a week.

"It's a difficult balance to strike, but we are faced with such a big change in the demographic of drinking. If we are to stop the ticking timebomb, something needs to be done."

As part of his remit, Mr Southern and his team help prepare patients for liver transplants. Many have been drinking for years and, with a shortage of organs, it is a job fraught with tough choices and sometimes, inevitable disappointment.

"Those eligible for a transplant go through a rigorous assessment process, are subjected to random alcohol tests and by the time of their operation have to be abstinent for at least six months. If they fail a test during that time – and that does happen – there are no second chances. It can sound quite harsh, but there is a shortage of organ donations and it simply doesn't make sense to allow someone who is still drinking to undergo a transplant when there are other deserving cases on the waiting list."

The concerns raised by those who work on the frontline of alcohol abuse, fits with research first published in 2008 by the University of Sheffield. The independent study concluded that while increasing the price of alcohol would reduce consumption only a significant rise would have a major impact on the harm done to individuals and the rest of society.

"For minimum pricing to be really effective, the price per unit of alcohol needs to be at least 45p," says Dr Robin Purshouse, whose team explored 18 different pricing policies. "At that point after a decade there would be almost 3,000 fewer deaths every year and 40,000 fewer hospital admissions. These proposals set the price per unit at around 20p, which inevitably has a much less impact, perhaps 2,500 less admissions to hospitals."

The university has recently won a grant from the Medical Research Council for a further three-year study into Britain's drinking culture, but Dr Purshouse also adds that some of the worst offenders will remain under the radar as a result of these proposals.

"Strong white cider is often cited as one of the real problem areas. However, these price increases are calculated on the amount of duty currently paid on various alcoholic drinks.

"Traditionally the duty on cider has been much lower than on say spirits or beer, so in fact drinkers may not notice much of a difference at all."

Home Office Minister James Brokenshire said the move was an important first step towards banning below-cost sales of alcohol, but it is understood that defining the cost price as anything other than duty plus VAT would create serious legal difficulties with European competition laws.

"Today's decision will mean pubs will continue to close as they are undercut by supermarkets selling canned beer at pocket-money prices," says Mike Benner, chief executive for the Campaign for Real Ale.

"The plans are a betrayal by the Government of their previous promise and a blow to pub- goers. It appears all too ready to impose higher costs and regulations on well-run community pubs, but is prepared to turn a blind eye to the irresponsible attitude towards alcohol expressed by the supermarkets."

The social cost of britain's booze binge

Alcohol is a factor in one in three sexual offences, a third of all burglaries and half of all street crimes. Around 40 per cent of violent offences are committed when offenders are under the influence of alcohol.

An estimated one in six Accident and Emergency admissions are for alcohol related injuries or problems. This figure has been estimated to rise to 80 per cent at peak times on Friday and Saturday nights.

While there has been much debate over the current guidelines, binge drinking for men is classified as more than eight units – about three pints of strong beer and for women it is more than six units, the equivalent of two large glasses of wine.

The General Lifestyle Survey in 2008 showed that 21 per cent of men and 14 per cent of women drank more than double their recommended units on at least one day in the previous week.

More than 10,000 young people every year end up in hospital due to drinking, as a result of acute alcohol poisoning or an alcohol-related accident.

A study by the Advertising Standards Authority in 2005, revealed that only four per cent of 17 to 21-year-olds have never tried alcohol.

Industry estimates that absenteeism from work as a result of alcohol costs the British economy more than 3.6bn a year.