The effect of the new “24 hour alcohol licensing law” on the incidence of facial trauma in London

doi:10.1016/j.bjoms.2008.01.018

British Journal of Oral and Maxillofacial Surgery

Volume 46, Issue 6, September 2008, Pages 460-463

https://doi.org/10.1016/j.bjoms.2008.01.018 Get rights and content

Abstract

On 24 November 2005 the new 2003 Licensing Act was implemented. It permits licensed premises to close at different times under English and Welsh law, rather than at 2300h as under the previous law. The aim of this study was to assess whether head and neck trauma secondary to alcohol-associated assaults had increased, decreased, or stayed the same since the introduction of the act. Data were collected from the Accident and Emergency Department, University College Hospital, attendance databases for two six-month periods: 24 November 2004 to 30 April 2005, and 24 November 2005 to 30 April 2006. There were 1102 attendances for head and neck trauma secondary to alcohol-associated assaults during the six months before the introduction of the 2003 Licensing Act and 730 such attendances during the similar period after the introduction of the law, with fewer cases in each corresponding month during the later period. There were more cases at weekends than on weekdays during both periods. There were fewer cases but more at weekends in 2005–6 than in 2004–5 (423, 58% compared with 584, 53%, respectively). Neither rainfall nor temperature had any influence on the results.

The 2003 licensing Act seems to have reduced the number of attendances at the A&E department for head and neck trauma secondary to alcohol associated assaults.

Introduction

On 24 November 2005 the Licensing Act 2003 was implemented, which permitted 24-hour drinking under English and Welsh law. Previously public houses had had to close at 2300h. The new law aimed to prevent those who had been drinking alcohol from leaving public houses and clubs at the same time, which has been thought to cause much antisocial behaviour and associated disorder in our towns and cities. It also aimed to slow the rate at which alcohol was drunk, with the idea of reducing the incidence of alcohol related assaults. It allowed Britain's pubs, clubs, bars, supermarkets, and service stations to apply for licenses for the new longer opening hours.

The Licensing Act 2003 was the result of many years consultation with police, local authorities, industrialists, other interested groups, and the public. It also gave powers to the police and other responsible authorities to act where there continued to be problems associated with badly-run premises.

Critics of the new law feared that the extension of the licensing hours would bring noise and disturbance to quiet residential areas 24 hours a day. The government and supporters of the new law thought that it would reduce drink related crime and antisocial behaviour. They said that the changes would reduce the problem of brawling after drinking, associated with many people leaving different venues at the same fixed closing time. Head and neck trauma is important in this context, as the head and neck are the anatomical targets for blows given in violence.

According to the Office of National Statistics, 37% of men aged 16–24 consume the equivalent of more than 8 units of alcohol in a typical session, with 23% of women consuming at least six. This exceeds the government's guidelines on safe daily drinking. The United Kingdom government recommends that men drink no more than 32 units of alcohol a week, and women no more than 24 units.

Hutchison et al. in 1998 reported that the commonest sites for assaults were the street, followed by public drinking establishments.¹ They also reported that alcohol consumption was associated with 90% of facial injuries that occurred in bars and 45% that occurred on the street.

A poll by the British Broadcasting Corporation (BBC) in January 2005 showed that almost two thirds of Britons thought that extended opening hours would increase antisocial behaviour and make the country a worse place in which to live (BBC website).

University College Hospital (UCH) accident and emergency (A&E) department is just a short walk away from the heart of London's social scene, with probably one of the highest concentrations of drinking establishments in the United Kingdom. This makes UCH the ideal hospital from which to assess the effects of these changes to the law on alcohol-related trauma.

Key performance indicators suggest that 34% of maxillofacial trauma treated at UCH is from the London borough of Camden, 26% is from Islington, 8% from Westminster, 25% from the rest of London, and the remaining 5% from the rest of England and Wales.

The aim of this study was to assess whether head and neck trauma secondary to alcohol-associated assaults had increased, decreased, or stayed the same during the five months after the introduction of the Licensing Act 2003 compared with the same period the year before. The reason that head and neck trauma is important in this context is that the head and neck is the obvious anatomical target for violent blows.

Data were obtained from the A&E database at UCH, which were recorded initially by the receptionist when the patient attended for treatment.

The data about all maxillofacial injuries, head injuries, road traffic crashes, lacerations, and dentoalveolar trauma were recorded from 24 November 2004 to 30 April 2005 (using a system called PAS) and from 24 November 2005 to 30 April 2006 (using a system called EPR), which generated 2334 and 2518 cases, respectively. Alcohol-related injuries are recorded as such on the A&E database.

The data were then sorted and the following cases were removed as they were not relevant to our study: non-alcohol-related road traffic crashes, dental infections, non-alcohol-related-dizziness, collapse and epileptic fits, faints, and injuries at work, educational establishments, home, falls from a height, and deliberate self-harm.

This produced 1102 relevant cases for Nov 2004 to April 2005, and 730 for Nov 2005 to April 2006.

These data were analysed by creating two-way contingency tables and using chi square tests where appropriate. The assumptions underlying the chi square tests were satisfied in each instance. A result was considered significant if the probability was less than 0.05 (Fig. 1).

Section snippets

Results

There were 1102 A&E patients with alcohol-related trauma of the head and neck between 24 November 2004 and 30 April 2005 compared with only 730 during the period 24 November 2005 to 30 April 2006; the total number of cases in the 2005–6 period was less (66%) than that in the earlier period, being a reduction of 34% (95% confidence interval (CI) 31% to 37%).

The sex distributions of patients were similar during the two periods (Table 1). Three-quarters during the period November 2004-April 2005

Discussion

It seems that since the introduction of the 2003 Licensing Act on 24 November 2005, which permitted variable closing times of drinking establishments, head and neck trauma resulting from alcohol-associated assaults has decreased by 34%.

To our knowledge this is the first such study in the UK that has examined the effects of the new extended-opening licensing laws on the NHS. On first assessment the law seems to have indeed been a great success. This is in contrast to a study done in Edinburgh in

References (5)

I.L. Hutchison et al.
The BAOMS United Kingdom survey of facial injuries part 1: aetiology and the association with alcohol consumption. British Association of Oral and Maxillofacial Surgeons
Br J Oral Maxillofac Surg
(1998)
M. Douglas
Restriction of the hours of sale of alcohol in a small community: a beneficial impact
Aust N Z J Public Health
(1998)

There are more references available in the full text version of this article.

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Nonetheless, changes in the Licensing Act 2003, which staggered opening hours, presents a more mixed picture. On the whole, a small body of research reports that the Act did not increase total violence, but shifted it later into the night,112,113 while for most hospitals, admissions relating to alcohol increased.114–118 Nonetheless, since the mid-20th century, licensing in England has been increasingly viewed as an administrative process in a system primarily defined by market demand.102
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Les plaies sont une des urgences faciales les plus fréquentes. Elles touchent souvent les jeunes. Nous avons étudié les caractéristiques épidémiologiques des plaies faciales prises en charge dans notre centre.
Cette étude prospective a été menée de juin 2008 à juin 2009 dans le service d’accueil des urgences. Elle a inclus tous les patients ayant au moins une plaie faciale. Les paramètres analysés concernaient les caractéristiques du patient, du traumatisme et des plaies.
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