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

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Background

Alcohol consumption in the UK remains high when compared to levels of consumption elsewhere in the world. 1 There is consistent evidence to suggest an association between increased availability of alcohol and higher rates of alcohol consumption, and associated harms;2 this includes physical availability, which relates to alcohol outlet density,3,4 and temporal availability, which related to hours of sale. 5,6 Restricting alcohol availability is therefore a plausible means of reducing harm. 2 However, achieving a reduction in harms through restrictions in availability remains challenging due to high baseline availability levels and the limitations of local regulatory and legislative measures. 7

Many countries use some form of premises licensing system to regulate alcohol availability, by granting a licence to premises to permit and put conditions on the sale of alcohol. Scotland and England/Wales have independent systems which both assign responsibility for licensing to local authorities. 8 The systems are governed by Scottish and English laws respectively, which set statutory objectives for licensing focused on preventing harm to children, crime and disorder and public nuisance, securing public safety, and in Scotland only, ‘protecting and improving public health’. In both systems, local public health stakeholders have a statutory role and attempt to influence alcohol premises licensing using a variety of approaches and degrees of effort. These include, for example, engaging local authority stakeholders on licensing policy or seeking to influence decisions on applications. 9–15

The absence of a health-focused objective for licensing in England (unlike in Scotland) is seen by many English public health teams (PHTs) as hindering their efforts to influence licensing,14,16,17 and is often perceived as diminishing the legitimacy of public health stakeholders in relation to other statutory bodies. This also makes it more likely that the admissibility of health evidence will be challenged in licensing decisions, where a case can be made that such data are irrelevant to the other objectives. Nevertheless, even without a public health objective, many PHTs in England have sought to work closely with other licensing stakeholders, such as the police, to try to boost their influence on both decisions and policy. 13,14 In Scotland, however, licensing stakeholders also report difficulties applying the public health objective, especially when objecting to individual applications. 9,18 We are unaware of any comparative studies that have examined how legal or structural differences between these two licensing systems (other than the extra objective in Scotland) might affect public health practices. The explicit inclusion of public health improvement, as a decision criterion in licensing, is relatively unique globally – though some licensing jurisdictions (including most Australian states and territories) have a requirement to consider ‘harm minimisation’, which may include public health. 19,20 We are not aware of any study outside of the UK focused on how public health stakeholders engage with alcohol premises licensing.

As part of the exploring the impact of alcohol premises licensing in England and Scotland (ExILEnS) study,21 we previously compared public health practices in engaging with the licensing system in England and Scotland. We conducted structured interviews and documentation analysis to capture the nature and intensity (level or degree of engagement or leadership) of relevant public health activity in 39 local government areas in England and Scotland from 2012 to 2019. We developed and systematically applied a measure of PHIAL (the Public Health engagement In Alcohol Licensing measure)22 to the data, to generate a quantitative measure of activity under each of 19 different activity types in 6 categories for each 6-month period in each of the 39 areas. These measurements enabled comparison of PHT activity in Scotland and England over the whole data set, and we have previously reported seven differences across both type and level of activity:22 (1) generally higher levels of activity in Scotland especially from 2012 to 2014; (2) a step-change increase in activity in English PHTs from 2014 onwards; (3) higher levels of activity in Scotland around efforts to input to local licensing policies; (4) greater levels of involvement of senior leaders (e.g. Directors of Public Heath) in Scotland; (5) greater diversity of approaches around responding to licence applications in England, with English PHTs being more likely to have sought to influence licence applications pre-submission, attempted to shape submitted applications, or been involved in licence reviews (a process by which a licence can be suspended or revoked); (6) more frequent involvement of PHTs in Scotland in making or leading objections to licence applications; and (7) more activity in Scotland around initiatives to involve communities in efforts to influence licensing. 22 This previous paper was focused on outlining the development of the PHIAL Measure, and while the seven differences are clear in the PHIAL scores that we report there, it was beyond the purpose of that paper to seek to describe or explain those differences.

In this paper, we therefore draw in greater depth on qualitative data from the structured interviews and on additional in-depth interviews to more fully describe and explain the seven differences, from the perspective of public health stakeholders. To orientate the reader, we firstly provide a comparative description of the two licensing systems including legislation and related structures in Scotland and England before outlining our methods in detail and then covering each of the seven differences in turn. Our key research question therefore is:

• What factors, including legal and structural differences, may explain previously identified differences in public health engagement in alcohol licensing in Scotland and England, from the perspective of public health stakeholders?

Licensing systems in Scotland and England

Scotland and England are both part of the UK of Great Britain and Northern Ireland. Scotland has devolved authority to make decisions over certain matters, including alcohol licensing. In both nations, local licensing committees make the final decision on new or amended licences, guided by the licensing objectives (see below). Various stakeholders (known as ‘Responsible Authorities’ in England or ‘Statutory Consultees’ in Scotland) are routinely informed of licence applications. In response, these stakeholders can seek to influence licensing decisions, for example, by formally suggesting amendments to applications (making a ‘representation’) or by formally opposing the granting of a licence (making an ‘objection’).

Normally, outside of specific areas (see below and Table 1) the licence will be granted unless a convincing case is made, with supporting evidence, that the proposed licence would undermine one or more of the licensing objectives. Scotland and England have their own distinct licensing legislation, local government structures and alcohol policies. Notably, in Scotland, all applications for new premises licences or major variations to existing licences are considered by a meeting of the Licensing Board who may choose to accept or reject the application. In England, the Licensing Committee only meets to consider an application if a representation or objection against the licence has been submitted; otherwise it is granted without a meeting. Legislation heralding major reforms to the licensing system in each nation came into effect in 2005 for England and Wales23 and 2009 for Scotland,24 later supplemented and amended by further guidance and legislation.

Table 1 outlines key differences and similarities between the two systems.

Methods

This paper reports novel qualitative data seeking to explain quantitative findings from the larger ExILEnS study described above. The interviews analysed in greater depth for this paper were with individuals sampled from the 39 PHTs who took part in the overall study. We, therefore, firstly describe how these 39 PHTs were sampled and recruited for the overall study, and then outline how and with whom the interviews were conducted.

Findings

Participants described in detail how they and their colleagues had sought to influence alcohol licensing from 2012 to 2019, and the rationale for the approaches taken. Further detail and available explanatory data, relating to the seven identified differences in activity between English and Scottish PHTs, are outlined below.

1. Earlier initiation of PHT involvement in alcohol licensing in Scotland

Scottish PHTs more often described their involvement in alcohol licensing arising from early in the study period, often as early as 2012, or in some cases earlier. Three potential reasons for this emerged from the data: prior work preceding when Scottish health boards were made SCs in 2011; input to SLPs which became due for renewal in all Scottish Licensing Boards in 2013 (though a few PHTs inputted to SLPs in 2009); and support activity from AFS. Activity levels in English PHTs increased in 2014, most likely due to support activity from PHE.

Firstly, in Scotland, some public health actors had been involved in health input to licensing even prior to the point at which health was made a SC.

He [an Alcohol and Drug Partnership (ADP) colleague] had been here twelve years … would have been involved in writing the ADP strategy and this is where you see the first mentioning of alcohol licensing for us as an ADP. There is a wee bit of mention about the Licensing Forum in the involvement in licensing here … [shows local ADP strategy document for 2009-2019] … so licensing was already a priority for the ADP in 2009.

(PHT, Area 32, Scotland)

Secondly, the timing of the issuing of SLP was a reason for PHT activity in Scotland occurring as early as 2012 – because each licensing board in Scotland had to review their SLP by 2013, consultation and development work started in 2012. Scottish PHTs were often actively involved in supporting this process through provision of data and analysis, or were involved in responding to or facilitating public consultations around draft revised SLPs. Thus, there was increased relevant activity for most PHTs in the year or months leading up to the publishing of SLPs.

… from the start [2013], I have also been heavily involved in producing data to support the development of policy.

(PHT, Area 37, Scotland)

Thirdly, the early involvement of Scottish PHTs in licensing may reflect the timing of support activity by AFS who produced a widely disseminated report in 2011 called ‘Rethinking Alcohol Licensing’ (MacNaughton and Gillan, 2011), followed by regional events for public health and licensing practitioners. 10 AFS also organised an annual National Licensing Conference which first included health stakeholders in September 2011. 15,45

AFS had, they had a specific day where they brought people from licensing across Scotland together, to shape our response to the new national guidance that comes out to licensing boards in Scotland … that was a really good practice because it was a full on day where everybody got to contribute … I think that really strengthened all of our approaches.

(PHT, Area 35, Scotland)

1. Step-change increase in activity in England from 2014

In contrast, participating PHTs in England were generally slower to get actively involved in engaging with alcohol premises licensing and were only designated as Responsible Authorities in 2012. This explains some of the lower activity in the early years of our data collection period. The distinct rise in activity levels identified from 2014 onwards appears likely to be attributable to national and regional support activities, and to the participation by two PHTs in a Home Office initiative known as ‘local alcohol action areas’ (LAAAs).

The year 2014 was the start of a ‘big push’ from PHE national and regional teams around getting local PHTs engaged in licensing that included training sessions, briefing notes, case studies and a national ‘Licensing and Public Health’ network. 46 Around the same time, regional bodies such as Balance Northeast, DrinkWise and Safe Sociable London partnership, alongside the Local Government Association, were also proactively supporting English PHTs on licensing matters. 47,48 One PHT described a learning phase as they started to work on this agenda and the contribution of PHE to the feeling that they could ‘do more’ (PHT in London/South East) on this – in this area they brought in a regular process of reviewing licence applications towards the end of 2014.

The UK Home Office’s LAAA programme was set up in England/Wales to tackle alcohol harms,49,50 and was launched in February 2014 in 20 areas. Two of the 20 participated in this study, though 7 other of our study areas took part in a second phase from January 2017. LAAAs required local licensing authorities, health bodies, the police, businesses and other organisations to work together, with the key aim of ‘reducing alcohol-related crime and disorder, and reducing the negative health impacts caused by alcohol’, underpinned by a ‘goal of promoting diverse and vibrant night-time economies’. 49 One area describes how their participation in the LAAA enabled them to make progress on data collection around licensed premises sales of alcohol, and in developing their SLP.

… this [mapping licensed premises] is generally done once a year. It has proven quite difficult … it was a lot easier in 2014 because basically we said ‘government have introduced an initiative … [PHT area] has been declared as a Local Alcohol Action Area. We’re looking at trying to reduce alcohol related crime disorder and the impact that it has on our NHS, do you mind if I just have a look at the alcohol that you sell?’ ‘Yes’ – it was fine, absolutely fine.

(PHT, Area 38, England)

1. More active efforts to input to local SLPs in Scotland

Public health teams in both England and Scotland described the importance of their work in inputting to SLPs. Many PHTs also saw this as an opportunity to maximise impact in the limited time and capacity they had to spend on responding to licensing applications. In England, some PHTs viewed their SLPs as the best way to influence conditions on new licences and in a few cases, occasional (temporary) licences. In Scotland, this was driven by a belief that their input to SLPs may be more important than making objections to licences, when seeking to address harms from alcohol. Attempts to object to individual premises/applications were limited by difficulties establishing a causal link between granting one specific licence application and adverse impact on the licensing objectives. 18 It was felt easier to make the case at area level for policy.

I believe [influencing policy] to be the most important thing. I think what you do with your letters [of objection] along the way is tinkering around the edges. The most important thing is getting the policy right in the first place, because if the policy is right, the Board should be making the decisions with Public Health in the front of their mind anyway, so you shouldn’t need to object, because the policy should be robust enough in terms of overprovision.

(PHT, Area 37, Scotland)

Scottish PHTs tended to be active from earlier in the period 2012 to 2019 as on this specific type of engagement, as well as having a higher level of activity on average throughout the period. 22 All Scottish PHTs recruited as active areas consistently inputted to SLPs, whereas some PHTs in England did not engage with policy at all. Of those that did, input was sometimes fairly short-lived.

One reason for more sustained activity in Scotland is that SLPs were renewed at least twice (2013 and 2017) under regulations in Scotland, whereas there may have been only one review that fell into our time frame in many English PHTs. Secondly, Scottish areas were more likely to get involved in policy as they were more generally active at an earlier stage on licensing, as outlined above. Some of our PHTs in England reflected on the fact that it took them some time to realise the importance of the SLP in terms of potential public health impact – ‘it didn’t factor as being as significant as it could be’ (PHT, Area 27, England). So even when there were two SLPs renewals in an area our time frame of interest, the PHT may not have been involved in the first one.

Finally, it appears to be more common in Scottish PHTs for them to start work to prepare for the next round of review of the local SLP from well in advance – working with other agencies and licensing colleagues, and gathering diverse data to support the mandatory overprovision assessment to be included in Scottish SLPs.

1. Greater involvement of senior leaders in Scotland

Many senior public health staff in Scotland were active in reviewing applications, giving presentations to the Licensing Board, signing off on applicant letters and engaging in consultations for the development of SLPs. In England too, DPHs were often ‘the one who has gone to the Licensing Committee and presented our cases’ (PHT, Area 16, England).

Greater involvement of senior leadership in Scotland compared to England appear to reflect the volume and diversity of senior staff involvement in Scotland, rather than lower DPH activity in England compared to Scotland. In England, PHTs were based in local government, often alongside the licensing team, whereas in Scotland health input to licensing was external to the licensing team and involved input from diverse organisations. Thus, a single Licensing Board in Scotland might have health input from the local NHS Board and its DPH, as well as from the local Health and Social Care partnership, and a senior professional there and/or potentially from a senior colleague acting for the ADP.

… there was some strong feelings in the Public Health Department [the NHS department that covered multiple licensing board areas] that really it should be the Director of Public Health that should sign off [letters of representation or objections]. So, for some of the other areas that maybe [this DPH] was involved in, she would act as a guide almost, sort of give some advice and guidance in terms of where … they feel that Public Health would put an objection in and that letter would then be signed off by the Director [of Public Health].

(PHT, Area 31, Scotland)

1. Greater diversity of activity around responding to licence applications in England

In both nations, there was a statutory requirement that licensing teams notify PHTs about applications for new premises licences or major variations to existing licences. Most of the more active PHTs in both nations had established routine processes for logging, monitoring and reviewing these applications. These processes helped PHTs to decide whether or not and how to respond to applications. Decisions on how to respond to applications were weighed up differently by PHTs in both nations, explained in part by the structure of the systems in place, and the philosophy of the PHTs.

In England, most PHTs chose to negotiate with applicants or their solicitors rather than have applications proceed to being considered at a licensing committee meeting, and in a few cases, made themselves available to work with potential applicants before they even submitted an application. There were two main reasons why several English PHTs used this approach. First, PHTs considered attending committee meetings to be time-consuming and resource-intensive for them and for applicants, creating an incentive to avoid them. If they or other RA did not lodge a representation/objection for new licenses or major variations, no committee meeting was required as the licence would be automatically granted. Many applicants reportedly preferred engaging with PHTs to come to an agreement about licensing conditions on their applications, to avoid an objection from public health and therefore a committee meeting. Second, there was no guarantee that a PHT’s representation would be successful at a committee meeting and many PHTs reported feeling low in confidence about attending a committee meeting due to their lack of experience, or not having strong enough evidence to support their representation. Thus, most English PHTs found they were more likely to be successful in influencing licensing conditions on individual applications rather than objecting to applications.

I kind of see it as a bit of a failure if we end up at a hearing because that means that we’ve not been able to reach a decent compromise, we haven’t been able to communicate decently … I’ve withdrawn several reps because I’ve got what I’ve requested or a version of what I’ve requested that I believe to be fair enough … prework is probably more important than getting people to hearings. [A hearing is] very costly for everybody involved and doesn’t necessarily end the way we want it to either.

(PHT, Area 30, England)

as soon as there’s a whiff of a hearing then your ability to have a constructive relationship with the premises is gone really because suddenly you are in a very confrontational situation. Whereas if you can do it on the basis that ‘we could take you to a hearing but we want to help you not go there’ then they realise you’re kind of on their side and will work with you.

(PHT, Area 24, England)

In Scotland, there was less incentive for PHTs or applicants to make a deal to avoid a Licensing Board meeting, as such meetings went ahead regardless of whether the PHT made a representation or objection; however, applicants could avoid attending a meeting if their application was unopposed (see below). More salient though were Scottish PHTs’ strong objections to engaging with applicants or their representatives directly outside of Licensing Board meetings on grounds of a perceived conflict of interests between industry actors and public health actors. If PHTs had queries about an application, they preferred to seek answers via the local licensing team.

… from my point of view, it’s not that we haven’t bothered to [engage with applicants], I would have it as a policy that we don’t engage with the applicant directly. I think that is too controversial and that it opens it up to a more personal interaction [with industry] whereas I would, if I were to have any questions I would direct them to the Licensing Board.

(PHT, Area 32, Scotland)

Other Scottish PHTs viewed formally submitting representations to the Licensing Board as the only way of ensuring that applicants would adhere to any conditions requested. This view was borne out of past experiences, with one PHT, for example, noting:

I think our fear is, that verbal approach does not necessarily mean [a condition on a licence] will be adopted. So we would like to see something formal, to know that there is no opportunity for them to wiggle out. Because sometimes, just even at a Licensing Board, somebody saying verbally ‘I agree, I will not stock high end alcohol products’ and the Board say ‘oh that is really commendable, well done’. If it’s not a condition, they do not need to abide by it. So we’ve been caught like that before.

(PHT, Area 32, Scotland)

However, when interviewed again 8 months later, they reported some changes to their approach, in that the licensing team would negotiate with applicants or their solicitors prior to licensing board meetings if there were minor changes that the PHT wanted applicants to make. If applicants agreed and these changes were confirmed before the Licensing Board meeting, the PHT would then withdraw their representation or objection – similar to the practice that was more common in England except that the negotiation was not done directly by the PHT. This change was instigated by the local area Licensing Board, in a bid to simplify the application process and reduce costs for applicants. This new way of working was welcomed by the PHT, who noted the process had been ‘evolving in a good way’ (PHT, Area 32, Scotland).

1. Scottish PHTs were more commonly involved in making or leading representations or objections to licence applications

The presence of the public health objective in Scotland appeared to give more confidence to Scottish PHTs about submitting representations independently of other Statutory Consultees. In England, some PHTs felt that they needed to work with the police or other Responsible Authorities because they perceived public health data were not taken seriously, or that it did not always fit exactly under the four other licensing objectives, so they were more likely to support representations or objections made by others, including ‘the police, the licensing authority or others – we’ve found it helps to influence the outcome more’ (PHT, North of England).

Finally, some Scottish PHTs held a belief that they could not collaborate with the police when deciding whether or not to object to an application, because that would constitute a form of ‘collusion’, not permitted by law. Though this was a misperception arising from a requirement in criminal law for witnesses not to collaborate, which does not have any legal parallel in licensing, it arose as a key reason why some Scottish PHTs worked on representations independently of other SCs. This fear about the legality of working together also extended to data sharing in relation to overprovision assessments in at least one case.

We wouldn’t be able to put something [a joint response to an application with other SCs] in. I believe that would be, I’m trying to think of the way the Act is worded. It’s something, it is worded about, I’m sure the word collusion is used there. So, I think it would be absolutely fine for us to talk to one another and share views and opinions. I don’t think, there would never be a time where you would put in a joint response.

(PHT, Area 31, Scotland)

In contrast, many English PHTs consulted with other RAs about the approach they were going to take regarding an application, with some even sharing information and data so that they could submit the same representation/objection:

… we’ve got that team approach of all the Responsible Authorities working together. And what we do is that we pool our information. So, we receive an application, and we share our views on what we think the approach should be to deal with that application, and then we look at how we can gather the evidence together that we’ve got within individual service areas and organisations, to support us taking any action. And then we’ll do a review of what we think the best action is for us to take … that is how we maximise the achievement of the licensing objectives … present a united front when meeting with applicants, that we are consistent in our views in what we’re saying to applicants …

(PHT, Area 38, England)

1. Scottish PHTs more commonly sought to involve the public in alcohol licensing

All six active PHTs in Scotland sought to involve the public in licensing either occasionally or consistently throughout the period 2012–9, whereas just 3 of the 14 such areas in England did so. This can be explained in part by the existence of local Licensing Forums in Scotland (see Table 1), on which members of the local community and specifically local young people can sit. These Forums were routinely attended by PHTs and sometimes PHTs took a more active role – organising or chairing the Forum on behalf of the Licensing Board.

I tend to lead the licensing forum, even though I’m not in the position of Chair … I do quite a bit of feedback nationally and locally, bringing in some of the national data … and evaluation that’s been done [and] giving them an update on the alcohol profile. But I work very closely with whoever’s in the Chair position on the licensing forum, I’ll sit down with them, we’ll create the agenda together so I do tend to be a bit of the driving force for the forum and, I think that otherwise that may have crumbled, as I think has happened in other areas where the forums are not as strong.

[PHT, Area 34, Scotland]

Over and above this, some areas used time-limited funding to boost their engagement with local communities, perhaps because this issue had started to receive attention in reports and events in the sector. 51,52

… we had an ADP underspend in 2015 and we employed a Health Improvement Practitioner for a year to come in and look at community response to licensing … I got him to do some awareness raising … and got some, an understanding, some training opportunities and understanding about how they [the local community] could basically react if, should an application come up in their area.

(PHT, Area 31, Scotland)

This more intense public involvement was rarely sustained, due to time constraints and limited capacity and resources; however, some PHTs had established links to community groups and were invited along to group meetings. They used these links to provide education about alcohol harms and alcohol licensing, or raise awareness of the SLP, often using the AFS toolkit to do so.

[Colleague] actually attends the meetings [of a local community group], but I got in touch with them to say ‘there is an application for a premises in your area, if [you] want to make a comment’, because they would not be notified [of the application otherwise] … Because we have such a big alcohol problem in [that area].

(PHT, Area 32, Scotland)

One PHT who worked closely with their local Licensing Team was approached by a group who identified drugs and alcohol as an area of concern for their community:

… I steered them [community group] towards licensing, because of their involvement in the community and just because people don’t automatically think about the impact that licensing can have. They found that really helpful … They agreed that actually, they would want to be more involved and understand licensing a bit better and then going forward, be able to put in representations, if there was something happening in their community … we’ll also use Alcohol Focus Scotland’s toolkit for community members.

(PHT, Area 34, Scotland)

When the time came to review the local SLP, Licensing Boards/Committees are required to consult the public. Some PHTs got involved in supporting these consultations, whereas others preferred to engage through existing mechanisms for community engagement such as Community Councils or the Licensing Forums.

In England, just a few PHTs proactively involved the public specifically on licensing matters. Others described interacting with the public more generally on alcohol matters, such as to inform an alcohol ‘Inquiry’ or alcohol strategy for the local area, but alcohol licensing was not raised as a major focus of such discussions.

It is something we have been considering, but we haven’t done anything directly with the public from a Public Health perspective. We have consultation engagement with public and wider stakeholders from the perspective of developing the alcohol strategy in the past and moving forward with the new one, but licensing is only a small part of it and I think it probably, to be honest, gets missed in terms of discussion.

(PHT, Area 16, England)

One English PHT who, through conducting the alcohol enquiry for their area, recognised the need for the public to be trained on alcohol licensing, and decided to develop a toolkit which was informed by the one developed by AFS for this purpose:

… this was more asking them what they think the issues are around alcohol and one of their recommendations was to do with a toolkit about licensing which is why we’re now doing the toolkit.

(PHT, Area 27, England)

Discussion

This paper explores in-depth differences in the timing and nature of PHT practice between Scotland and England and what factors might explain such differences. Differences in the timing of legislative changes, giving public health a statutory role, may have led to earlier involvement of PHTs in Scotland, but the role of AFS in raising the profile of licensing as an issue for public health at that time was also important. The timing of an increase in activity on licensing by English PHTs could also be traced to national support, in this case, from PHE, working alongside or together with local groups such as Balance North East, DrinkWise NorthWest and the Safer Sociable London Partnership, as well as the Local Government Association. AFS support is likely also to explain greater involvement of PHTs in Scotland in working with communities on licensing. This is the first study to find evidence of the importance and impact of AFS and PHE support in generating PHT engagement on licensing matters. Our previous work showed that there was also some reduction of PHT activity in England in 2017–9, which was not the case in Scotland, coinciding with a time of a lower national profile for this work from PHE. 22

Legal differences in the timing of renewal of SLP, with them occurring more frequently in Scotland during our data collection period (2012–9) and at the same time for all Licensing Boards, may have provided more opportunities for Scottish PHTs to influence policy and a clear timetable/impetus for organisations providing them with strategic support. The structure of local public health bodies in Scotland also meant that there were often more people, organisations and more complex arrangements and relationships amongst those seeking to support a public health perspective in the local alcohol premises licensing regime. This may also have helped to ensure a higher level of public health activity on licensing issues in Scotland than in England.

Previous studies have discussed the use of the public health objective for licensing in Scotland,9 and limitations on PHT engagement that might arise as a result of its lack in England. 16,17 The legitimacy given to public health through this objective may have partly explained why PHTs in Scotland were more active in making representations or objections to licence applications without needing to involve other statutory stakeholders such as the police. Similarly, the lack of a public health (PH) objective may have made English PHTs less confident about doing so and nudged them more towards negotiating conditions on licences with applicants rather than objecting outright. We discuss the potential value of a public health objective in detail separately;53 however, our findings suggest that the public health objective does not fully explain the differences in practice observed, and that previously little discussed legal and structural factors may also be important. For example, we identified a surprising (mistaken) belief amongst some experienced PHT colleagues in Scotland, that working with other Statutory Consultees to share data and co-ordinate a joint response to a licence application would constitute illegal ‘collusion’. There is no basis for this belief in civil licensing law, and it suggests a need for clear guidance to be issued, perhaps by licensing teams or AFS.

Public health teams in England were more likely than their counterparts in Scotland to negotiate with applicants or their solicitors to avoid new licence applications having to go to a licensing committee ‘hearing’. By avoiding having to attend a hearing, this put less strain on PHTs in terms of time and resources available for alcohol licensing. This practice in England has been found previously,13 but this is the first study highlighting that this incentive to avoid a meeting does not exist in the same way in Scotland. All new licence applications are considered at Licensing Board meetings in Scotland, and this is one reason why Scottish PHTs did not tend to negotiate on applications. Another is that Scottish PHTs did not feel it was appropriate for them to liaise directly with licence applicants; they seemed to be more sensitive to likely conflicting interests between public health and licence applicants. This may reflect the national alcohol policy context in Scotland which takes a strong public health approach54 Thirdly, PHTs in Scotland tended to be focused mainly on containing availability by avoiding new premises opening, rather than shaping how premises operated11 and so negotiation does not make the same sense in this context. An emphasis on responsible retailing is a more traditional focus of licensing,43 and may have been more common amongst PHTs in England at least partly because they are based within local government, and often working directly alongside the licensing team. 11

These findings demonstrate that relatively minor features of the workings of a licensing system may have important implications for how it operates in practice and in particular for opportunities for public health influence. Public health involvement in alcohol licensing systems is underexplored internationally, though many Australian states and territories include ‘harm minimisation’ as an ‘object’ (or purpose) of liquor licensing. 19 In a comparison of licensing systems between England and Australia, Foster et al. (2017) discuss the details of this harm minimisation requirement but make no reference to the involvement of PHTs in Australian licensing. 55 Licensing legislation in Ireland gives a role for the Health Service Executive (which runs publicly funded health services there),56 but we could not identify any research exploring how this role is fulfilled.

The importance of differences, in public health approaches in terms of reducing harm, is largely unknown. The quantitative analyses in the ExILEnS study found no association between the extent of PHT efforts (measured over 7 years) and health and crime outcomes. 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. In addition, the operation of the public health objective in Scotland relies on public health data and input.

Further research could helpfully focus on whether the differences in PHT practices identified make a difference to their success in influencing licensing policies and decisions and examine the impact of individual activities. The ways in which temporary increases in availability are handled by the two licensing systems remain underexplored and may be an important driver of additional availability. 62 These include both one-off applications from unlicensed venues and requests for occasional expansions in opening hours from licensed venues. Recent changes in licensing legislation in Northern Ireland, permitting many more of the latter, highlight the importance of better understanding how public health and public health engagement in licensing may be affected. It would also be beneficial to better understand where the erroneous belief about collusion with other stakeholders came from in Scotland and how it may change practice once PHTs are aware that there is no legal barrier to full collaboration with the police. Finally, it would be helpful to understand more about the influence of support from national organisations in the two nations with differing constraints on resources and advocacy. This is of additional interest since PHE’s team covering alcohol availability is now part of the Office for Health Improvement and Disparities, which is part of the Department of Health and Social Care in the UK Government, rather than an arms-length body.

Conclusions

While the alcohol premises licensing systems in England and Scotland are similar on the surface, there are important differences between them that influence how PHTs seek to engage with licensing matters. These differences include, but also go beyond, the presence or absence of a public health objective in licensing legislation, and include procedures for handling applications, public health organisational arrangements, the timing of renewals of local SLP and the handling of licensing for one-off events. Our findings suggest that seemingly small differences in the set-up of the licensing system may have an important influence on how PHTs engage in this arena. This is likely to be of interest to those considering the design and implementation of licensing regulations in similar permit-based systems worldwide. Some differences in practice also arose from differing public health views on the appropriateness of liaising with industry actors, beliefs about the legality and necessity of collaborating with other stakeholders, and the value (or futility), from a public health perspective, of trying to influence retail practices in licensed venues. Finally, the data strongly suggest that the support of national bodies such as AFS and PHE (as was) was important in boosting public health interest in alcohol licensing in the period 2012–9.

Additional information

List of abbreviations

AFS

Alcohol Focus Scotland

CIA

cumulative impact assessment

CIP

cumulative impact policy

CIZ

cumulative impact zone

EMRO

early morning alcohol restriction order

ExILEnS

exploring the impact of alcohol premises licensing in England and Scotland

LNL

late night levy

LAAA

local alcohol action area

PHE

Public Health England

PHT

Public Health Team

RA

responsible authority

SC

statutory consultee

SLP

statement of licensing policy

References

1. Ritchie H, Roser M. Alcohol Consumption vs GDP Per Capita. Our World in Data; 2018.
2. Martineau F, Tyner E, Lorenc T, Petticrew M, Lock K. Population-level interventions to reduce alcohol-related harm: an overview of systematic reviews. Prev Med 2013;57:278-96. https://doi.org/10.1016/j.ypmed.2013.06.019.
3. Hobday M, Chikritzhs T, Liang W, Meuleners L. The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010. Addiction 2015;110:1901-9. https://doi.org/10.1111/add.13063.
4. Popova S, Giesbrecht N, Bekmuradov D, Patra J. Hours and days of sale and density of alcohol outlets: impacts on alcohol consumption and damage: a systematic review. Alcohol Alcohol 2009;44:500-16. https://doi.org/10.1093/alcalc/agp054.
5. Sanchez-Ramirez DC, Voaklander D. The impact of policies regulating alcohol trading hours and days on specific alcohol-related harms: a systematic review. Inj Prev 2018;24:94-100. https://doi.org/10.1136/injuryprev-2016-042285.
6. Hahn R, Kuzara JL, Elder R, Brewer R, Chattopadhyay S, Fielding J, et al. Task Force on Community Preventive Services . Effectiveness of policies restricting hours of alcohol sales in preventing excessive alcohol consumption and related harms. Am J Prev Med 2010;39:590-604. https://doi.org/10.1016/j.amepre.2010.09.016.
7. Holmes J, Guo Y, Maheswaran R, Nicholls J, Meier PS, Brennan A. The impact of spatial and temporal availability of alcohol on its consumption and related harms: a critical review in the context of UK licensing policies. Drug Alcohol Rev 2014;33:515-25. https://doi.org/10.1111/dar.12191.
8. Foster J, Charalambides L. The Licensing Act (2003): Its Uses and Abuses 10 Years On. London: Institute of Alcohol Studies; 2016.
9. 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. Int J Environ Res Public Health 2017;14. https://doi.org/10.3390/ijerph14030221.
10. Fitzgerald N, Cairney P. National objectives, local policymaking: public health efforts to translate national legislation into local policy in Scottish alcohol licensing. Evid Policy 2022;18:670-90.
11. O’Donnell R, Mohan A, Purves R, Maani N, Egan M, Fitzgerald N. Navigating different public health roles in alcohol premises licensing: a multi-stakeholder interview study. Lancet 2021;398. https://doi.org/10.1016/S0140-6736(21)02557-5.
12. Egan M, Brennan A, Buykx P, De Vocht F, Gavens L, Grace D, et al. Local policies to tackle a national problem: comparative qualitative case studies of an English local authority alcohol availability intervention. Health Place 2016;41:11-8. https://doi.org/10.1016/j.healthplace.2016.06.007.
13. Reynolds J, McGrath M, Engen J, Pashmi G, Andrews M, Lim J, et al. Processes, practices and influence: a mixed methods study of public health contributions to alcohol licensing in local government. BMC Public Health 2018;18. https://doi.org/10.1186/s12889-018-6306-8.
14. Somerville L. Public Health Involvement in Alcohol Licensing Decisions: Policy, Partnerships and Professional Ideology. PhD Thesis 2018.
15. Mahon L, Nicholls J. Using Licensing to Protect Public Health: From Evidence to Practice. Glasgow/London: Alcohol Focus Scotland and Alcohol Research UK; 2014.
16. Reynolds J, McGrath M, Engen J, Pashmi G, Andrews M, Sharpe C, et al. ‘A true partner around the table?’ Perceptions of how to strengthen public health’s contributions to the alcohol licensing process. J Public Health 2019;41:e1-8. https://doi.org/10.1093/pubmed/fdy093.
17. Martineau FP, Graff H, Mitchell C, Lock K. Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government. J Public Health (Oxf) 2014;36:435-42. https://doi.org/10.1093/pubmed/fdt079.
18. MacGregor A, Sharp C, Mabelis J, Corbett J. An Evaluation of the Implementation Of, and Compliance With, the Objectives of the Licensing (Scotland) Act 2005: Final Report 2013.
19. Davoren S, O’Brien P. Stemming the Tide of Alcohol: Liquor Licensing and the Public Interest. Canberra: Foundation for Alcohol Research and Education in collaboration with University of Melbourne; 2014.
20. Fitzgerald N, Winterbottom J, Nicholls J. Democracy and power in alcohol premises licensing: a qualitative interview study of the Scottish public health objective. Drug Alcohol Rev 2018;37:607-15. https://doi.org/10.1111/dar.12819.
21. Fitzgerald N, Egan M, de Vocht F, Angus C, Nicholls J, Shortt N, et al. Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): protocol for a mixed methods natural experiment evaluation. BMC Med Res Methodol 2018;18. https://doi.org/10.1186/s12874-018-0573-z.
22. Fitzgerald N, Mohan A, Maani N, Purves R, de Vocht F, Angus C, et al. Measuring how public health stakeholders seek to influence alcohol premises licensing in England and Scotland: the Public Health engagement In Alcohol Licensing (PHIAL) Measure. J Stud Alcohol Drugs 2023;84:318-29. https://doi.org/10.15288/JSAD.22-00020.
23. UK Parliament . Licensing Act 2003 2003. www.legislation.gov.uk/ukpga/2003/17/contents (accessed 8 January 2024).
24. Scottish Parliament . Licensing (Scotland) Act 2005 2005. www.legislation.gov.uk/asp/2005/16 (accessed 8 January 2024).
25. UK Parliament . Police Reform and Social Responsibility Act 2011 2011. www.legislation.gov.uk/ukpga/2011/13/contents/enacted (accessed 7 January 2022).
26. UK Parliament . Policing and Crime Act 2017 2017. www.legislation.gov.uk/ukpga/2017/3/contents/enacted (accessed 7 January 2022).
27. Scottish Parliament . Alcohol Etc. (Scotland) Act 2010 2010. www.legislation.gov.uk/asp/2010/18/contents (accessed 8 January 2024).
28. Scottish Parliament . Air Weapons and Licensing (Scotland) Act 2015 2015. www.legislation.gov.uk/asp/2015/10/contents/enacted (accessed 8 January 2024).
29. Scottish Parliament . Alcohol (Minimum Pricing) (Scotland) Act 2012 2012. www.legislation.gov.uk/asp/2012/4/contents/enacted (accessed 8 January 2024).
30. Scottish Parliament . Criminal Justice and Licensing (Scotland) Act 2010 2010. www.legislation.gov.uk/asp/2010/13/contents (accessed 8 January 2024).
31. Home Office . Revised Guidance Issued Under Section 182 of the Licensing Act 2003 2018. https://assets.publishing.service.gov.uk/media/6579dec8095987000d95e063/Revised_guidance_issued_under_section_182_of_the_Licensing_Act_2003_-_December_2023.pdf (accessed 8 January 2024).
32. Select Committee on the Licensing Act 2003 . The Licensing Act 2003: Post-Legislative Scrutiny (Report of Session 2016 -17, HL Paper 146) n.d. https://publications.parliament.uk/pa/ld201617/ldselect/ldlicact/146/146.pdf (accessed 8 January 2024).
33. Mcgill E, Egan M, Fitzgerald N. Briefing Paper: The Late Night Levy. Stirling, Scotland: University of Stirling; 2021.
34. Woodhouse J. Briefing Paper Number 7100: The Late Night Levy. London: House of Commons Library; 2019.
35. City of Glasgow Licensing Board . Licensing (Scotland) Act 2005 Guidance on Applying for an Occasional License n.d.
36. Nicholson G. Review of Liquor Licensing in Scotland. Edinburgh: The Scottish Government; 2003.
37. UK Parliament . Health and Social Care Act 2012 2012. www.legislation.gov.uk/ukpga/2012/7/contents (accessed 8 January 2024).
38. Martin McColl Limited Against West Dunbartonshire Licensing Board 2017. www.scotcourts.gov.uk/search-judgments/judgment?id=b08631a7-8980-69d2-b500-ff0000d74aa7 (accessed 8 January 2024).
39. Martin McColl Limited Versus Aberdeen City Licensing Board 2015. https://licensinglaws.files.wordpress.com/2015/09/mccoll-v-aberdeen-2015.pdf (accessed 8 January 2024).
40. MRS CAROL CALDERWOOD V. RENFREWSHIRE COUNCIL 2004.
41. Woodhouse J. Briefing Paper 07269: Alcohol Licensing: Cumulative Impact Assessments. London: House of Commons Library; 2019.
42. Alcohol Focus Scotland . Review of Statements of Licensing Policy 2018–2023 2020. www.alcohol-focus-scotland.org.uk/media/440017/afs-review-of-statements-of-licensing-policy-2018-2023.pdf (accessed 8 January 2024).
43. Nicholls J. Public Health and Alcohol Licensing in the UK: Challenges, Opportunities, and Implications for Policy and Practice. Contemp Drug Probl 2015;42:87-105. https://doi.org/10.1177/0091450915579875.
44. Bothwell E. Lambeth Council EMRO Rejected. Morning Advert. William Reed Ltd; 2014.
45. Alcohol Focus Scotland 2011. https://argyll-bute.gov.uk/moderngov/documents/s56530/Licensing Conference 2011.pdf (accessed 19 February 2022).
46. Public Health England, Local Government Association . Public Health and the Licensing Act 2003 – Guidance Note on Effective Participation by Public Health Teams About Public Health England About the Local Government Association 2014.
47. Andrews M, Pashmi G, Smolar M. Public Health and Licensing Guidance. A Simple Guide for Responding to Applications as a Responsible Authority. London: Safe Sociable London Partnership/Public Health England; 2014.
48. Local Government Association and Alcohol Research UK . Public Health and Alcohol Licensing in England 2013.
49. Home Office . Local Alcohol Action Areas 2014.
50. Home Office . Local Alcohol Action Areas Will Tackle Alcohol Related Harms. GOV.UK 2017. www.gov.uk/government/news/local-alcohol-action-areas-will-tackle-alcohol-related-harms (accessed 30 April 2018).
51. Iconic Consulting . Strengthening the Community Voice in Licensing Decisions in Glasgow – Feasibility Study 2014.
52. Alcohol Focus Scotland . Alcohol Licensing in Your Community: How You Can Get Involved 2016.
53. Nicholls J, O’Donnell R, Mahon L, Fitzgerald N. ExILEnS Consortium . ‘Give us the real tools to do our jobs’: views of UK stakeholders on the role of a public health objective for alcohol licensing. Public Health 2022;211:122-7. https://doi.org/10.1016/J.PUHE.2022.07.006.
54. Scottish Government . Alcohol Framework 2018: Preventing Harm 2018. www.gov.scot/publications/alcohol-framework-2018-preventing-harm-next-steps-changing-relationship-alcohol/ (accessed 8 January 2024).
55. Foster J, Harrison A, Brown K, Manton E, Wilkinson C, Ferguson A. Anytime, Anyplace, Anywhere? Addressing Physical Availability of Alcohol in Australia and the UK. London: Institute of Alcohol Studies; 2017.
56. Tracey S. A Community Guide to Alcohol Licensing in Ireland. Letterkenny: Alcohol Forum; 2017.
57. de Vocht F, McQuire C, Ferraro C, Williams P, Henney M, Angus C, et al. Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: a comparative timeseries study between 2012 and 2019. Lancet Reg Health Eur 2022;20. https://doi.org/10.1016/J.LANEPE.2022.100450.
58. O’Donnell R, Mohan A, Purves R, Maani N, Egan M, Fitzgerald N, et al. How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings. Public Health Res 2022. https://doi.org/10.3310/XCUW1239.
59. Fitzgerald N, Egan M, O’Donnell R, Nicholls J, Mahon L, de Vocht F, et al. Public health engagement in alcohol licensing in England and Scotland: a mixed-method, natural experiment evaluation (ExILEnS). Public Health Res 2022.
60. de Vocht F, Heron J, Angus C, Brennan A, Mooney J, Lock K, et al. Measurable effects of local alcohol licensing policies on population health in England. J Epidemiol Community Health 2015;70:231-7. https://doi.org/10.1136/jech-2015-206040.
61. de Vocht F, Heron J, Campbell R, Egan M, Mooney JD, Angus C, et al. Testing the impact of local alcohol licencing policies on reported crime rates in England. J Epidemiol Community Health 2016;71:137-45. https://doi.org/10.1136/jech-2016-207753.
62. Zahnow R, Miller P, Coomber K, de Andrade D, Ferris J. Lessons from Queensland’s last-drinks legislation: the use of extended trading permits. Drug Alcohol Rev 2018;37:537-45. https://doi.org/10.1111/dar.12701.