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

Abstract

Background: Greater availability of alcohol is associated with higher consumption and harms. The legal systems by which premises are licensed to sell alcohol in England and Scotland differ in several ways. The ExILEnS (Exploring the Impact of alcohol Licensing in England and Scotland) study measured public health team (PHT) activity regarding alcohol licensing from 2012-2019 and identified seven differences between England and Scotland in the timing and type of activities undertaken. Objective: To qualitatively describe the seven previously identified differences between Scotland and England in public health approaches to alcohol licensing, and to examine, from the perspective of public health professionals, what factors may explain these differences. Methods: Ninety-four interviews were conducted with 52 professionals from 14 English and 6 Scottish PHTs selected for diversity who had been actively engaging with alcohol licensing. Interviews focused primarily on the nature of their engagement (n=66) and their rationale for the approaches taken (n=28). Interview data were analysed thematically using NVivo. Findings were constructed by discussion across the research team, to describe and explain the differences in practice found. Findings: Diverse legal, practical and other factors appeared to explain the seven differences. (1) Earlier engagement in licensing by Scottish PHTs in 2012/13 may have arisen from differences in the timing of legislative changes giving public health a statutory role and support from Alcohol Focus Scotland. (2) Public Health England provided significant support from 2014 in England, contributing to an increase in activity from that point there. (3) Renewals of statements of licensing policy (SLPs) were required more frequently in Scotland and at the same time for all Licensing Boards, probably explaining greater focus on policy in Scotland. (4) Organizational structures in Scotland, with public health stakeholders spread across several organizations, likely explained greater involvement of senior leaders there. (5) Without a public health objective for licensing, English PHTs felt less confident about making objections to licence applications without other stakeholders such as the police, and instead commonly negotiated conditions on licences with applicants. In contrast, Scottish PHTs felt any direct contact with applicants was inappropriate due to conflicts of interest. (6) With the public health objective in Scotland, PHTs there were more active in making independent objections to licence applications. Further in Scotland, licensing committee meetings are held to consider all new applications regardless of whether objections have been submitted; unlike in England where there was a greater incentive to resolve objections, because then a meeting was not required. (7) Finally Scottish PHTs involved the public more in licensing, partly because of statutory licensing forums there. Conclusion: The alcohol premises licensing systems in England and Scotland differ in important ways including and beyond the lack of a public health objective for licensing in England. These and other differences, including support of national and local bodies, have shaped opportunities for, and the nature of, public health engagement. Further research could examine the relative success of the approaches taken by PHTs and how temporary increases in availability are handled in the two licensing systems.