How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings

Abstract

Background In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health. Objective This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches. Participants Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches. Results Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both. Conclusions In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation. Study registration The study is registered with the Research Registry as researchregistry6162. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.

Factors influencing public health engagement in alcohol licensing in England and Scotland including legal and structural differences: comparative interview analysis

“…57 Qualitative data from the same study suggested that public health input was largely valued and was slowly reorienting the licensing system in some areas, especially in Scotland. 58,59 It is likely that any public health impact is limited in its effects by limitations in the licensing system more generally, which cannot reduce availability or effectively address remote alcohol sales, though large-scale studies have found some effects. 60,61 Either way, by engaging in licensing, PHTs can gather intelligence to better understand and communicate the limitations that exist from a public health perspective.…”

Mechanisms of impact of alcohol availability interventions from the perspective of 63 diverse alcohol licensing stakeholders: a qualitative interview study

“…PHTs and other stakeholders in licensing must articulate evidence-based arguments when making licensing policies and decisions (O’Donnell et al., 2022 ). Our findings should help them to be clearer about their rationale, and help them to consider how/why specific policies or decisions will have impact.…”

“…Separate topic guides were developed for each of the five stakeholder groups, as this was part of a larger study which also explored interviewee roles, responsibilities and purpose in the licensing system (findings have been published separately, alongside a detailed description of the role and remit of key stakeholder groups in the licensing system, for which there are differences in Scotland and England (Fitzgerald et al., 2023 b; O’Donnell et al., 2022 )) Each topic guide was based on alcohol licensing literature and team discussion, including open-ended questions ( Supplementary Table 1 ) to elicit views on the ways in which temporal and spatial availability interventions impact on a range of alcohol-related harms. In total, 29 interviewees were based in England and 24 were based in Scotland.…”

Public health engagement in alcohol licensing in England and Scotland: the ExILEnS mixed-method, natural experiment evaluation

“…Separate topic guides were developed for the five stakeholder groups [public health, licensing managers/officers, elected members, police (licensing) officers and licensing lawyers/clerks] based on existing alcohol licensing literature and research team discussion. The topic guides (summarised in O'Donnell et al 5 ) included a focus on interviewee roles, responsibilities and purpose in the licensing system, public health approaches to engaging in licensing, and interviewee views on such approaches and the ways in which temporal and spatial availability impact on alcohol harms. Interviews lasted between 32 and 156 minutes (median = 72 minutes) and were audio-recorded.…”