2021-03-31-accounts

(>MCA Medical Council on Alcohol | EDUCATION | JOURNAL | POLICY | SUPPORT I Annual Report 2020-2021

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CONTENTS

COMMITTEE & OFFICERS LIST	2
REPORTS
CHAIRMAN’S REPORT	3
MEDICAL DIRECTOR’S REPORT	4
EDUCATION COMMITTEE CHAIR’S REPORT	5
JOURNAL COMMITTEE CHAIR’S REPORT	6
MCA LEGACY ESSAY PRIZE COMPETITION
2020-2021 WINNING ESSAY	7
2020 AGM
MINUTES OF THE AGM	14
COMMITTEE MEMBERSHIPS	18
REGIONAL ADVISORS	20

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ANNUAL REPORT 2020-2021

PATRONS

The Lord Turnberg of Cheadle, MD, FRCP Sir Miles Irving, MD, ChM, MSc, FRCS Sir Graeme Catto, MD, FRCP Sir Kenneth Calman, KCB, DL, FRSE Professor Sir Michael Marmot, MB BS, MPH, PhD, FRCP, FFPHM, FMedSci OFFICERS President: Professor Sir Ian Gilmore, MD, PRCP Vice President: Dr Bruce Ritson OBE, MD, FRCPsych, FRCP(Ed) DISTINGUISHED FELLOWS Dr Brian Hore, BSc, MB BS, MPhil, FRCP, FRCPsych (deceased July 2020) Dr Peter Brunt, CVO, OBE, MD, FRCP, FRCP(Ed), FRCS(Ed) EXECUTIVE COMMITTEE Officers Chairman: Professor Colin Drummond, MBChB, MD, FRCP, FRCPsych, FFPH, FRCGP (Hon) Education Committee Chair: Dr Iain Smith, BSc(Hons), MD, MBChB, FRCPsych, FRCPE Journal Committee Chair: Dr Peter Rice, MBChB, FRCPsych Members Prof Jonathan Chick, MA, MPhil, DSc, FRCP(Ed), FRCPsych Dr Michael Dougan, MBChB, LLB, D.A. (UK), FFARCSI, CCGPT (from November 2020) Dr Clare Gerada, MBE, FRCP, FRCGP, MRCPsych Dr Eilish Gilvarry, FRPsych, MRCGP, DCH, FRCPI Dr Anne McCune, MD, FRCP Dr Zulfiquar Mirza, MBCHB, DCH, DRCOG, MRCO, FRCP, FFAEM, Tox FRCEM Dr Marsha Morgan, MBChB, FRCP Dr Andrew Thillainayagam, MD, MBChB, FRCP Prof Robin Touquet RD, FRCEM Dr Alasdair Young, MBChB, MRCPsych HONORARY TREASURER Mr Graham Warner, MBA, FCA MEDICAL DIRECTOR Dr Dominique Florin, MA, MB BS, MRCGP, MD, FFPH

ADMINISTRATIVE STAFF

Executive Assistant & Office Manager Administrative Officer

Ms Ria Pearson Ms Clare Farrow, BA (Hons)

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CHAIRMAN’S REPORT

In keeping with the theme of my last annual report, 2021 has continued through uncharted territory as a consequence of the Covid-19 pandemic. While clinical work in the addictions field has largely resumed after the national lockdown, we are now facing increased demand for alcohol treatment, partly due to an increase in harmful drinking and interruptions to service delivery over the last 18 months. We have a lot of catching up to do against a background, in England at least, of continuing cuts to the provision of alcohol services. The dismantling of Public Health England, which oversees the addiction treatment system in England, could not have come at a more inopportune time. This, combined with increased pressures on cash-strapped local authorities due to the pandemic and serial central government cuts to public health, the future of alcohol treatment services in England does not look particularly rosy. However, it was encouraging to see the emphasis on improving addiction treatment services in Dame Carol Black’s recent report to government in England. One can only hope that this, together with new national alcohol treatment guidelines which are due for publication, will provide the needed impetus for service improvement.

Against that less than optimistic background, I am pleased to report that the MCA has continued to make progress, and I must thank Dr Dominique Florin, Ria Pearson and Clare Farrow for their forbearance and hard work during this challenging time. Our committees have continued to meet remotely, and continue to deliver an outstanding service to the organisation. Thanks are due to Drs Peter Rice and Iain Smith for their hard work in chairing the Journal and Education committees, and all the committee members who give their time so generously.

Our journal, Alcohol and Alcoholism, continues to be a leading academic journal in the field, and enormous thanks are due to the chief editors, Profs Jonathan Chick and Lorenzo Leggio, for their tireless work and dedication to the journal’s success. We continue to enjoy a strong partnership with our publishers, Oxford University Press, and I would like to personally thank Paul Kidd who has made that relationship effective and positive. We wish him well with his future career as he leaves OUP for new pastures.

The education committee continues to provide excellent service and we are delighted with the number and quality of entries for the annual essay competition and the biennial NAAD competition. New initiatives are coming on stream, including a new Quality Improvement Prize aimed at trainee doctors, which aims to improve engagement with the next generation of medical professionals, as well as raise awareness of the MCA’s work and the importance of alcohol care in medical practice.

This year’s MCA annual symposium will be held exclusively online in view of the ongoing uncertainty around in-person events. We have an excellent line-up of speakers, and I look forward to welcoming Dr Peter Rice as our Max Glatt memorial lecturer. Peter has made many contributions to the alcohol field, not least his highly effective advisory and advocacy work on alcohol policy in Scotland.

Thanks are also due to our treasurer, Graham Warner, for his expertise and steady handling of our finances, and to Ed Shooter at Charles Stanley for managing our investments so expertly in challenging financial times. Our finances are as a consequence, in better shape than we had feared.

On a more sombre note, I must sadly inform you of the passing of our good friend and colleague, Professor Robin Touquet, who died on 16th July 2021. Robin was a long-standing and loyal supporter of the MCA and a fearless advocate for improving the care of people with alcohol problems, particularly in emergency departments. His no-nonsense approach, his amusing turn of phrase, and his willingness to speak up for people without an effective voice, were an inspiration to all who worked with him. He will be greatly missed, and our thoughts and good wishes go to Liz Touquet and his family.

I look forward to seeing MCA members and delegates at our 2021 symposium and AGM, and I hope that we are able to welcome you to an in-person meeting, and to our new premises in St Andrew’s Place, when conditions allow.

Professor Colin Drummond, MBChB, MD, FRCP, FRCPsych, FFPH, FRCGP(Hon) Chairman

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MEDICAL DIRECTOR’S REPORT

The whole of the period covered by this report has taken place during the Covid-19 pandemic and the current situation in the UK and more widely remains uncertain.

The MCA office closed of course in March 2020, mid-move to new RCP premises. The MCA team successfully migrated to working from home and this remained the case throughout the next 12 months, though recently we have begun to once again work from our new offices.

The MCA has continued its work with the aim of reducing alcohol-related health harm, primarily through educational means. We work with health professionals in the alcohol and health harm arena including of course students, promoting education for this group; our Journal is highly regarded in the field; we support organisations which support health professionals themselves in difficulty with alcohol; and we remain committed to achieving evidence-based policy change through our links with the Alcohol Health Alliance and other organisations.

Among other regular educational projects are our student competitions. This year’s excellent winning essay on Alcohol and Covid is published in this report. Perhaps because of the pandemic, we had a record number of entries and the judges were so impressed that there were five prizes awarded rather than the usual three. The biennial NAAD competition for an alcohol and health- related screen saver for students is still being judged, again with a high number of entries. The MCA is committed to developing new up to date digital alternatives to the much-loved Alcohol and Health handbook. This is proceeding in collaboration with the Society for the Study of Addiction with the aim of producing a range of webbased resources. We have also developed a new Quality Improvement prize aimed at post graduate doctors in training, which will be launched later this year. This is a professional group with which we would like to increase engagement.

Our excellent relationship with Oxford University Press, our Journal co-owners, and the dedication of the Chief Editors, are key to the on-going success of Alcohol and Alcoholism. The Journal is of course a major source of income for the MCA and at bi-annual Journal Committee meetings ways of continuing the Journal’s success are discussed, including Special Issues on topics of particular importance, the challenges posed by the growth in open access publishing and maximising marketing opportunities. Fortunately, a feared possible decrease in income due to Covid has thus far not materialised. We must thank Paul Kidd, the senior publisher at OUP with whom we have worked for many years, who has recently announced his departure.

The planned 2020 MCA Symposium on Interventions and Recovery and Max Glatt lecture was cancelled due to Covid. In its place we held a webinar on Alcohol and Covid, immediately after our online AGM. This was a new departure for the MCA in response to circumstances but in the event it proved unexpectedly successful with a much higher attendance than normally achieved at our Symposia. Speakers included Peter Rice, Katherine Severi and Chris Daly and the event was chaired by MCA President Sir Ian Gilmore. The MCA team met the digital challenges and a good level of discussion was achieved. A recording of the webinar is available on the MCA website and has been viewed by many more than were able to attend on the day. The event was free to attend and to view on the website but was run at a minimal cost to the MCA. Very fortunately the Symposium programme planned for 2020 has been moved to 2021, together with the Max Glatt memorial lecture by Peter Rice. This will be a digital event but we hope to be back in person in 2022.

Our work is dependent on the time and energy of our Committee members and of course chairs Colin Drummond, Iain Smith and Peter Rice, our treasurer Graham Warner, our Journal Editors Jonathan Chick and Lorenzo Leggio and our Regional Advisors. Meetings on Zoom are of course the new normal, and as we slowly get back to the office, the increased engagement that this period has generated means that we will probably continue to use a hybrid model for meetings. The MCA office team comprised of Ria Pearson and Clare Farrow has risen to the challenges of the past year, keeping the MCA going in these new circumstances.

Dr Dominique Florin, MB BS, MA, MD, MRCGP, FFPH MCA Medical Director

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EDUCATION COMMITTEE CHAIR’S REPORT

This is my report as Chair of the MCA Education Committee for 2020-2021. I continue to be supported by an excellent committee who assist the MCA in its goal of supporting alcohol education at all stages of the medical career.

The year of April 2020 through to March 2021 has been the most challenging of times. This more or less coincided with the period of lockdown due to COVID-19 and we had to move all of our activity online during this year. (The last committee we had in person was late February 2020 with growing awareness of the threat of the pandemic.) We have all quickly learned how to deal with virtual meetings. Much praise to the MCA staff in keeping the show on the road.

Our 2020 symposium had to be postponed but is now going ahead entirely online and unchanged, in November 2021. The programme for our now 2021 annual academic meeting, including a Max Glatt lecture from Dr Peter Rice, was in place in record time last year and we are lucky that all speakers were able to commit to speak a year later than was originally intended. The theme for the meeting is alcohol dependency treatment including biological and psychosocial approaches. This seems timely with Public Health England scheduled to complete its Alcohol Treatment Guideline in late 2021 or early 2022. Also there is a current need to help rebuild and redesign alcohol services to meet continuing and new challenges in the field of alcohol and addiction medicine

At relatively short notice in 2020 we were able to hold a brief online webinar on alcohol and COVID-19. This sat alongside our AGM and Regional Advisors Meeting. All meetings were conducted online. The webinar had a record attendance for an MCA academic meeting and reached a new audience. It was free of charge and showed the potential to boost numbers with such a platform. We will watch closely to see if we have large numbers again this November with a fee being charged to allow us to utilise the services of an online conference organiser, namely RCP. Already we are wondering about hybrid formats for future conferences to maximise our audiences.

Our Legacy essay competition during this year for undergraduates,2020-2021, was on the topic of alcohol and COVID-19. We had a record number of entries and our three judges had their work cut out in marking these essays. The quality was high and as usual we reproduce the winning essay within this Annual Report. The top five entrants - we had three students in joint third place - will receive their prizes at the annual meeting.

Also in 2021 we are running the biannual NAAD competition. Again, we have had a very high number of entries for the design of an alcohol educational screen saver for University and College use and the winners should be known by the annual meeting.

A perennial remit is to keep our network of Regional Advisors active and engaged with the University Medical Schools in their area. We updated the RAs at our 2020 meeting on changes we are making to our educational material to bring it into line with new alcohol guidelines and to meet the increasing demand for electronic versions of our material. Our goals include developing a series of case-based discussions that dovetail with the material already available on other sites such as the Factsheets on the SSA site. With this in mind we began discussion with the SSA on how this might be taken forward and we have entered into a fruitful collaboration with the SSA.

We are hoping now to have two Regional Advisor meetings each year and to hold these online and separate from the busy annual meeting. Our next meeting is scheduled for 26 November 2021.

It has been a difficult year for the MCA. We look forward to helping to reinvigorate the work of the MCA which remains as relevant now as it did at its inception, given the importance of alcohol as a cause of myriad and highly prevalent forms of illness. Our 2021 symposium will be timely as the need for effective alcohol treatment systems is currently a hot topic as the restrictions of the pandemic have receded due to widespread vaccination. The rise in alcohol deaths in 2020 is a marker of the relevance of our work.

Dr Iain D.Smith, BSc(Hons), MD, MBChB, FRCPsych, FRCPE Education Committee Chair

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JOURNAL COMMITTEE CHAIR’S REPORT

The MCA’s partnership with Oxford University Press to publish the journal Alcohol and Alcoholism continues.

The Journal’s impact factor remains in a similar range to the last few years and in line with similar journals. Article submissions, readership and subscriptions continue to be dominated by the UK and USA although there is a wide range of international submissions and readership. Professors Chick and Leggio, the journal Editors, continue to work tirelessly to assess papers, identify reviewers and ensure timely response to authors, whose feedback shows a highly positive view of the journal. Our Editors are both active in the International Society of Addiction Journal Editors.

OUP have undertaken a number of projects to increase the journal’s reach with collections of papers on specific topics and this has had a positive effect on article readership.

The Journal’s relationship with the European Society for Biochemical Research on Alcoholism (ESBRA) continues, and Professor Sebastian Mueller, ESBRA President’s contribution to the work of the journal is much appreciated. The Journal’s publication of papers from the ESBRA Young Investigator Awards was a highlight of 2021.

The publishing and marketing skills of Oxford University Press are invaluable and the MCA’s partnership with OUP remains strong. Thanks to Paul Kidd and his OUP colleagues for their commitment to the Journal and to the MCA staff for their continued support and hard work.

Dr Peter Rice, MBChB, FRCPsych Journal Chair

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(>MCA Medical Council on Alcohol | EDUCATION | JOURNAL | | SUPPORT I 2021 MCA Legacy Essay Competition

2021 WINNING ESSAY

Miriam Gill, University of Aberdeen

Covid-19 - It’s enough to drive you to drink

Introduction

COVID-19, a novel virus that has been dominating the world stage, has claimed almost two million lives in just over a year from when it was first identified[¹] . The UK, despite its surrounding barrier of water, has been hard hit by the pandemic and as a result, has seen devastating numbers of deaths and strict lockdown measures imposed on its people. On the 23rd of March 2020, the UK Prime Minister instructed everyone to stay at home. Shops and venues that did not sell essential items – such as food and medicine – were closed. These ‘lockdown’ measures were rolled out across the UK and implemented for a number of months. As each nation moves between its own levels of lockdown and vaccination programmes are implemented, it is becoming more evident what the individual effects of the restrictions have been to many people. With the majority of the population confined to the four walls of their homes, the pandemic has been enough to drive some individuals to drink.

This essay will look at the relationship between COVID-19 and alcohol. Importantly, the changes in alcohol consumption during the pandemic, the related health harm that follows, and whether that contributes to an increased risk of contracting the virus and potentially falling victim to it. We will also look at the best ways to address problem drinking during the COVID-19 pandemic.

Alcohol Sale and Consumption

Perhaps one of the most keenly felt restrictions was the closure of restaurants and pubs. This meant that for some months following the announcement, sales of on-trade alcohol decreased until the restrictions eased later in the year. However, it is important to note that some licensed on-trade establishments could remain open and receive sales through means of take-away services².

Lockdown saw changes to people’s behaviour, and it was hypothesised that these changes in behaviour could be reflected in changes in alcohol consumption. In Scotland, a paper published by Public Health Scotland investigated the impact of the national lockdown and the COVID-19 pandemic on alcohol use across England, Wales, and Scotland. The paper used an earlier study that compared the sales of on- and off- trade premises during the pandemic to the same weeks in the two years previous (2017-2019). Another study surveyed the British public through behavioural questionnaires and diaries that would highlight drinking habits. Drawing from these earlier studies, the paper by Public Health Scotland found that alcohol sales across England, Wales and Scotland had decreased by 6%. There was an increase in off-trade sales, but it was not sufficient to replace the loss of sales from on-trade premises. It was also concluded that the number of drinking days had on average increased during the restrictions, however, the change was not significant³.

A study by Alcohol Change UK surveyed 1555 people, two weeks after initial lockdown measures were imposed, and found that more than a third of participants had either stopped drinking completely or reduced how often they drank. However, there were around a fifth of participants that had been drinking more frequently and were also drinking more per drinking day since the beginning of lockdown. This suggested a new sub-group of drinkers that were potentially developing harmful alcohol consumption habits⁴.

This harmful pattern was further commented on by a survey carried out by the St Mary’s Hospital Alcohol clinic on patients with pre-existing alcohol use disorders. The survey found that of the participants who had increased their alcohol consumption during lockdown (24% of participants), there had been a mean weekly consumption of 82.5 units. The weekly recommended intake is no more than 14 units. These participants also had a 57.6% mean increase in AUDIT

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score. Overall, these studies suggest that despite there being as many people reducing their alcohol intake as increasing it, those increasing their consumption are doing so by a significant and harmful amount⁵.

Demographics of Consumption and Service Use

When identifying the individuals who may be most at risk of drinking harmfully, NHS data found that the age group with the highest proportion of people drinking over the weekly recommended units were aged between 55 and 64. This applied to both men and women⁶. The Alcohol Health Alliance Commission stated that in Scotland, the most disadvantaged and poorest groups are 6 times more likely to be admitted to hospital for alcohol-related conditions than the least disadvantaged⁷.

Strict lockdown measures forced many people into social isolation and gave rise to fears over job security and financial stability. Stress and anxiety have been well recognised as a factor that can lead to increased alcohol consumption⁵. A study by Alcohol Focus Scotland found that a fifth of those surveyed cited stress as a motive to drink⁸. Furthermore, 51% of respondents who had been consuming more alcohol than usual said it was a way to manage anxiety and stress. Increased anxiety and stress have been recognised as a significant result of the COVID-19 pandemic⁸.

Moreover, access to help with excessive drinking was curtailed during the pandemic. Services including supervised consumption, detoxification, and blood-borne virus (BBV) screening and treatment were either completely stopped or significantly reduced⁹. Many alcohol clinics were moved online which were less effective at preventing relapse⁵. A study from one alcohol clinic in London found that the patients who received face-to-face contact with an alcohol nurse were more likely to abstain from alcohol and less likely to relapse during lockdown compared to those patients who did not⁵.

Similarly in Scotland, Alcohol Brief Interventions (ABIs), a service used to help support those with alcohol issues, were curtailed. ABIs are brief discussions within Primary Care, A&E and maternity settings aimed at helping individuals decrease their alcohol consumption to within safe standards. As face-to-face contact was severely limited during the pandemic, carrying out ABIs proved difficult as staff were redeployed to care for COVID-19 patients[10] .

The restrictions also limited activities that may have been used to cope with isolation and anxiety – including churches and community-run organisations that provided places for people to connect. Alcoholics Anonymous (AA) is a community-run organisation that seeks out to help those with alcohol use issues to recover and continue their sobriety. Prior to the pandemic, around five thousand AA meetings were being held across Great Britain every week. However, because of government restrictions, most groups have had to go online. AA also runs a telephone helpline and over the course of the pandemic, calls to this line have risen by 22%[11] .

Impact of Alcohol Consumption

Both the long- and short-term effects of excessive alcohol consumption have been widely reported. The immediate effects of heavy drinking commonly present as acute drunkenness or alcohol poisoning while the longer-term consequences have a much more gradual progression and can damage major organs such as the liver and brain. Extended periods of excessive alcohol consumption most commonly manifesting as alcohol-related liver disease[12] .

During the pandemic, it has been difficult to source data on the number of hospital admissions relating to alcohol. However, according to the Lancet, there has been an increase in the number of people presenting and being admitted to hospital with alcohol-related liver damage[4] . An article from Frontline Gastroenterology commented on an increase in patients being admitted to tertiary care units with alcohol-related liver disease. These patients were noted to be sicker and requiring more intensive observation and care in High Dependency and Intensive Care Units. This may be partly due to a delay in presenting at hospital, perhaps because the individuals had been asked to shield or were fearful of contracting the virus in hospital[13] .

Alcohol consumption on its own can cause serious injury to the body but what is particularly striking, especially in the context of COVID-19, is the effect of alcohol on the immune system. It has been suggested that alcohol consumption can change the actions of cells involved in the immune response to infection[14] . For example, specific cells that are responsible for destroying invading pathogens (macrophages, neutrophils, and monocytes) can be inhibited by exposure to alcohol[15] . Chronic alcohol consumption has also been linked to promoting strong pro-inflammatory

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reactions that have been shown to contribute to disease processes in the lungs. Simultaneous to provoking these strong inflammatory responses, alcohol impairs the generation of anti-inflammatory cytokines[16] . Cytokines are signalling molecules and are responsible for coordinating the body’s immune response[15] . This chaotic storm of inflammatory molecules can result in respiratory failure, through severe oxidative stress, and multi-organ failure[16] . Heavy alcohol use is a recognised risk factor for acute respiratory distress syndrome (ARDS), which is a severe complication of COVID-19[17] .

Additionally, chronic alcohol consumption has an adverse effect on the cells that respond to specific pathogens (T-cells) and the cells that are responsible for long term immunity (B-cells)[15] . As a result, this makes those suffering with chronic alcoholism more susceptible to infection[14] . It also raises the question of what the effect of long-term alcohol use may be on an individual’s response to vaccination[18] . This is important as the UK looks to vaccinate its population over the coming months against COVID-19.

During the pandemic, there were rumours that alcohol consumption could be beneficial in the prevention of contracting COVID-19. However, the evidence that has been presented challenges this and can conclude that alcohol consumption is a serious risk factor to contracting both bacterial and viral lung infections – importantly COVID-19[16] .

Furthermore, aside from the serious harm alcohol can do to our bodies, it can also severely affect behaviour and impair judgment. This is significant as social distancing is considered key to preventing the spread of COVID-19 and is harder to enforce in large groups of intoxicated people[19] . Because of this, the sale of alcohol has become more restricted in Scotland. It is presently illegal to drink alcohol outdoors anywhere in Scotland – recognition that consumption of alcohol reduces compliance with social distancing rules[20] .

Alcohol and Domestic Violence

In addition to the effects that alcohol has on the body, there have also been reports of other negative consequences of alcohol consumption. With on-licence premises closed, it can be speculated that given the increase in off-licence sales, the majority of alcohol consumption takes place at home. This is particularly problematic as it becomes more difficult to police what goes on behind closed doors. There has been research to suggest that there is a strong relationship between alcohol and violence, but it is unlikely that alcohol is a root cause, rather an exacerbating factor[21] .

More data from a report by Alcohol Change UK found that in around two-thirds of police callouts to domestic incidents, at least one of the two individuals concerned was considered to be under the influence of alcohol. This report also analysed Strathclyde police data from Scotland which investigated domestic incident callouts during events where alcohol is often involved e.g. New Year and contentious football games. The police data identified ‘spikes’ in callouts on expected dates of higher alcohol consumption. This is significant as there have been increases in alcohol consumption in certain groups of the population during the pandemic[22] .

An ONS report looking at domestic abuse-related offences in England and Wales was published in November 2020 and compared current police data to that from 2018-2019. The data showed a 7% increase in domestic abuse-related offences from the same period in 2019: March – June. However, it is unclear if this is an effect of the pandemic as the figures have been steadily rising year by year. The report commented on a general increase in demand for support services for victims of domestic abuse during the pandemic. However, it alluded to the idea that this is not because of an increase in victims but potentially because the abuse experienced has become more severe. This is then compounded by the greater difficulty in accessing coping mechanisms that may have been available before e.g. the ability to leave the house or access to counselling[23] .

Mitigation

In order to help mitigate some of these consequences, it is important to look at what may be the best ways to address problem drinking. A global strategy released by the WHO, in order to reduce harmful alcohol usage, set out effective intervention measures to reduce national alcohol consumption[24] . Alcohol taxation is one effective measure as it not only generates revenue for the government but also makes alcohol more expensive. Scotland went further with its alcohol pricing by introducing minimum unit pricing (MUP) in 2018. It is worth mentioning that minimum unit pricing is not a tax but a measure to ensure alcohol is priced at a level whereby it might reduce the volume consumed. The policy

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set a base price for alcohol at a minimum of fifty pence per unit[25] . When analysing the effects of MUP, Public Health Scotland commented on a decrease in alcohol consumption and a net decrease in alcohol sales in off-license premises compared to England and Wales[26] . Although there is no definitive evidence that would indicate the effect of MUP during the COVID-19 pandemic, it has had an impact on decreasing alcohol sales which cannot be seen in the rest of the UK.

Another intervention measure recommended by the WHO is a complete ban on alcohol advertisement[24] . In a time where the majority of the population is at home, television and media advertisement could not be more accessible, a complete ban on alcohol advertisement, particularly on these media, would be recommended. However, in its place it would be beneficial to have more advertisement or TV programmes on healthy eating, how to look after mental health, awareness on how much alcohol is too much, and how to begin to reduce intake if it is concerning.

The other intervention measures recommended by WHO surround restrictions on the days and hours of sale and the numbers of outlets selling alcohol[24] . Scotland has already imposed restricted hours to buy alcohol which would be recommended for the rest of the UK[27] . Earlier in this essay, we discussed how the supermarkets were responsible for the majority of off-license sales. Given that other off-license shops were allowed to remain open, perhaps there could be tighter restrictions on supermarket alcohol sales. This could be a complete ban on the sale of alcohol or stricter measures on the amount of alcohol individuals can buy. At the beginning of lockdown, many supermarkets chose to put a limit on how many toilet rolls or hand sanitizers people could buy. The same could be done for alcohol e.g. a limit on the amount of bottles or a limit on the volume.

In South Africa, there was a complete ban on alcohol sales beginning in April of last year. A study looking at the impact of the ban found a sharp reduction in patients admitted to hospital because of assault, accidents and sexual assault compared to before the lockdown. It also found another significant reduction in the number of unnatural deaths during that time. The paper commented that restricting alcohol completely has had a great effect in reducing alcohol consumption[28] . However, historically, a complete prohibition on alcohol has proved to be damaging to industries and can be a factor in driving alcohol sales underground and into illegal markets[29] . It is difficult to say whether it would work to impose such a ban in the UK but much tighter restrictions to accessibility would be a start. Another consideration may be to put more pressure on alcohol companies to produce products with lower alcohol content which might have a positive impact on changing the way society chooses to drink.

These are important methods of prevention on a national level. However, when looking at the main reasons people started or continued to drink during lockdown, these were attributed to loneliness, stress, and anxiety[5] . Looking at social isolation in particular, it is challenging to think of ways that are safe for people to interact with each other. During lockdown, many communities that came together and organised outdoor activities at a two-metre distance e.g. bingo or dancing and exercising in the street. This should be encouraged in communities and support should be provided where necessary because of the benefit these activities have had on mental health. Examples might include support for volunteers who wish to start up such activities or, arranging road closures for certain periods of the day so people can take part in activities and stay safe.

Alcohol services should also be recognised as essential, and services should remain open with face-to-face contact as far as possible. These include alcohol clinics, where face-to-face contact was seen to have a positive effect on individuals abstaining from alcohol[5] . The government may also have to consider more money being invested in alcohol and mental health support as a consequence of the pandemic and the cuts that had been made prior to the beginning of the pandemic.

Conclusion

In this essay, we have discussed what the effects of the COVID-19 pandemic have been on the alcohol consumption of the people of the UK. It is evident that since the closure of on-licence premises, sales of off-license alcohol have increased. Despite as many people reducing their alcohol intake during lockdown as those who have increased it, those who have increased their intake have done so to a greater degree. This is important when trying to predict the health-related consequences increased intake will have and how it may affect the likelihood of an individual contracting COVID-19 – and therefore, how it might add to the strain on the NHS. Many of the national alcohol services were halted or moved online during lockdown. Because of this, it has become clear that there has not been sufficient support given

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to those struggling with alcohol use disorders, those at risk of developing one, and those who are a victim of those affected. As the UK continues to battle COVID-19, it is necessary to reflect on what services will need to be protected in future lockdowns and what measures will need to be introduced to prevent individuals from slipping through the cracks.

References

1. WHO Coronavirus (COVID-19) Dashboard [Internet]. World Health Organisation; 2021. Available from: https://www.covid19.who.int/ [Accessed 14/03/21]

2. Retail sales, Great Britain: March 2020 [Internet]. Office for National Statistics; 2020. Available from: https:// www.ons.gov.uk/businessindustryandtrade/retailindustry/bulletins/retailsales/march2020 [Accessed 14/03/21]

3. Alcohol sales and consumption in Scotland during the early stages of the COVID-19 pandemic – briefing paper [Internet]. Public Health Scotland; 2021. Available from: https://www.publichealthscotland.scot/ downloads/alcohol-sales-and-consumption-in-scotland-during-the-early-stages-of-the-covid-19pandemic-briefing-paper/ [Accessed 19/03/21]

4. The Lancet Gastroenterology & Hepatology. Drinking alone: COVID-19, lockdown and, alcohol-related harm. The Lancet. 2020; 5(7):625. Available from: doi:10.1016/S2468-1253(20)30159-X [Accessed 14/03/21]

5. Kim JU, Majid A, Judge R, Crook P, Nathwani R, Selvapatt N, Lovendoski J, Manousou P, Thursz M, Dhar A, Lewis H, Vergis N, Lemoine M. Effect of COVID-19 lockdown on alcohol consumption in patients with pre-existing alcohol use disorder. The Lancet. 2020; 5(10):886-887. Available from: doi:10.1016/S24681253(20)30251-X [Accessed 14/03/21]

6. National Statistics. Statistics on Alcohol, England 2020 [Internet]. NHS Digital. Available from: https://www. digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2020 [Accessed 14/03/21]

7. The Report of the Commission on Alcohol Harm. ‘It’s everywhere’ – alcohol’s public face and private harm [Internet]. Alcohol Health Alliance UK; 2020. Available from: https://www.ahauk.org/resource/commissionon-alcohol-harm-report/ [Accessed 14/03/21]

8. Survey shows Scots lockdown drinking rise caused by stress [Internet]. Alcohol Focus Scotland; 2020. Available from: https://www.alcohol-focus-scotland.org.uk/news/survey-shows-scots-lockdown-drinkingrise-caused-by-stress/ [Accessed 14/03/21]

9. Public Health England. COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol [Internet]. Department of Health and Social Care; 2020. Available from: https://www.gov. uk/government/publications/covid-19-guidance-for-commissioners-and-providers-of-services-for-peoplewho-use-drugs-or-alcohol/covid-19-guidance-for-commissioners-and-providers-of-services-for-peoplewho-use-drugs-or-alcohol [Accessed 14/03/21]

10. Alcohol Brief Interventions: An Official Statistics publication for Scotland [Internet]. Public Health Scotland; 2020. Available from: https://www.beta.isdscotland.org/find-publications-and-data/lifestyle-andbehaviours/substance-use/alcohol-brief-interventions/ [Accessed 14/03/21]

11. Alcoholics Anonymous goes online during Covid-19 pandemic [Internet]. Alcoholics Anonymous; 2020. Available from: https://www.alcoholics-anonymous.org.uk/Media/News-&-Articles/Alcoholics-Anonymousgoes-online-during-Covid~19-pandemic [Accessed 14/03/21]

12. Alcohol related hospital statistics: A National Statistics publication for Scotland [Internet]. Public Health Scotland; 2020. Available from: https://www.beta.isdscotland.org/find-publications-and-data/lifestyle-andbehaviours/substance-use/alcohol-related-hospital-statistics/ Accessed 14/03/21]

13. Cargill Z, Kattiparambil S, Hansi N, Barnabas A, Shawcross DL, Williams R, Agarwal K. Severe alcohol-related liver disease admissions post-COVID-19 lockdown: canary in the coal mine? Frontline Gastroenterology; 2020. Available from: doi: 10.1136/flgastro-2020-101693 [Accessed 14/03/21]

14. Szabo G, Saha B. Alcohol’s Effect on Host Defense. Alcohol Research. 2015;37(2):159-170 Available from: https://www.pubmed.ncbi.nlm.nih.gov/ PMID: 26695755 [Accessed 25/03/21]

15. Szabo G. Alcohol’s contribution to compromised immunity. Alcohol Health Research World. 1997;21(1):30-41. Available from: https://www.pubmed.ncbi.nlm.nih.gov/ PMID: 15706761 [Accessed 25/03/21]

16. Testino G. Are Patients with Alcohol Use Disorders at Increased Risk for Covid-19 Infection? Alcohol and Alcoholism. 2020;55(4):344-346. Available from: doi:10.1093/alcalc/agaa037 [Accessed 14/03/21]

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1. Fact sheet - Alcohol and COVID-19 [Internet]. World Health Organisation; 2020. Available from: https://www. euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2020/fact-sheet-alcohol-andcovid-19-what-you-need-to-know-2020 [Accessed 23/03/21]

2. Pasala S, Barr T, Messaoudi I. Impact of Alcohol Abuse on the Adaptive Immune System. Alcohol Res. 2015;37(2):185-97. Available from: https://www.pubmed.ncbi.nlm.nih.gov/ PMID: 26695744

3. Kuthiah N. Dear Editor: Covid-19 and alcohol – a dangerous cocktail. BMJ; 2020; 369 :m1987. Available from: doi:10.1136/bmj.m1987 [Accessed 14/03/21]

4. BBC News Scotland. Covid in Scotland: The six new lockdown rules. [Internet]. BBC News; 2020. Available from: https://www.bbc.co.uk/news/uk-scotland-55649853 [Accessed 14/03/21]

5. Foster J. Alcohol, domestic abuse and sexual assault [Internet]. Institute of Alcohol Studies; 2014. Available from: https://www.ias.org.uk/uploads/IAS%20report%20Alcohol%20domestic%20abuse%20and%20 sexual%20assault.pdf [Accessed 18/03/21]

6. Gilchrist L, Ireland L, Forsyth A, Laxton T, Godwin J. Roles of Alcohol in Intimate Partner Abuse [Internet]. Alcohol Change UK; 2014. Available from: https://www.alcoholchange.org.uk/publication/roles-of-alcoholin-intimate-partner-abuse [Accessed 18/03/21]

7. Office for National Statistics. Domestic abuse during the coronavirus (COVID-19) pandemic, England and Wales: November 2020 [Internet]. Office for National Statistics; 2020 Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/ domesticabuseduringthecoronaviruscovid19pandemicenglandandwales/november2020 [Accessed 18/03/21]

8. World Health Organisation. Global strategy to reduce the harmful use of alcohol. WHO Press; 2010. ISBN 9789241599931 Available from: https://www.who.int/publications/i/item/9789241599931 [Accessed 19/03/21]

9. Alcohol and Drugs: Minimum Unit Pricing. The Scottish Government [Internet]. Available from: https://www. gov.scot/policies/alcohol-and-drugs/minimum-unit-pricing/#:~:text=Minimum%20unit%20pricing%20 set%20a,higher%20the%20minimum%20unit%20price [Accessed 19/03/21]

10. Statistical analysis of off-trade alcohol sales in the year following MUP published [Internet]. Public Health Scotland; 2020. Available from: https://www.publichealthscotland.scot/news/2020/june/statistical-analysisof-off-trade-alcohol-sales-in-the-year-following-mup-published/ [Accessed 19/03/21]

11. Licensing (Scotland) Act 2005 [Internet]. Legislation.gov.uk. Available from: https://www.legislation.gov.uk/ asp/2005/16/contents [Accessed 25/03/21]

12. Reuter H, Jenkins LS, De Jong M, Reid S, Vonk M. Prohibiting alcohol sales during the coronavirus disease 2019 pandemic has positive effects on health services in South Africa. Afr J Prim Health Care Fam Med. 2020;12(1):e1-e4. Available from: doi:10.4102/phcfm.v12i1.2528 [Accessed 19/03/21]

13. Blocker JS Jr. Did prohibition really work? Alcohol prohibition as a public health innovation. Am J Public Health. 2006;96(2):233-243. Available from: doi:10.2105/AJPH.2005.065409 [Accessed 19/03/21]

.

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("MCA Medical Council on Alcohol | EDUCATION | JOURNAL | POLICY | SUPPORT | 2020 Annual General Meeting

MINUTES OF THE ANNUAL GENERAL MEETING

11 November 2020 on Zoom

ITEM 1 WELCOME

Professor Sir Ian Gilmore, President of the MCA, took the Chair and welcomed all members to the meeting. He introduced the Medical Director; Dr Dominique Florin and the Treasurer, Mr Graham Warner.

ITEM 2 APOLOGIES

9 apologies were received, including Prof Colin Drummond.

ITEM 3 MINUTES OF ANNUAL GENERAL MEETING, HELD ON 13 November 2019

Members attending the meeting agreed that the AGM minutes from 2019 were a true record of proceedings. Their adoption was proposed by Dr Bruce Ritson and seconded by Dr Peter Rice.

ITEM 4 TREASURER’S REPORT

Professor Sir Ian Gilmore introduced the Treasurer, Mr Warner to the members. Mr Warner gave an overview of the finances for the 2019-20 period:

There was a significant decline in total funds, from £758,000 to £642,000. The primary cause was COVID-19 and its adverse effect on MCA’s investment portfolio valuation. Some recovery in valuations has since taken place. Excluding that, MCA had a good year financially from its other activities. After a wobble a few years ago, when a distributor went bankrupt, Journal profit share has recovered and remains strong. Journal profit share increased to £112,000. A very successful Symposium resulted in a surplus of £6,500. Total expenditure for the year increased slightly to £197,000. MCA remains in a healthy position despite the reduction in net funds over the year.

Looking forward to the current year, a surplus of around £18,000 before investment gains or losses was being forecast. This was primarily due to a legacy of £13,000 received from the estate of Douglas Norgan, with the possibility of a further smaller amount to come. Journal profitshare for calendar 2020 was likely to be the same as the previous year, although OUP have advised of the possibility of a decline in 2021.

Dividend income from the investment portfolio in recent years has been in the range of £23,000-£26,000. However, as a result of COVID-19, dividends have been cut, deferred or stopped completely and MCA’s income this year is likely to be £18,000-£20,000. The office move and related rent increase, has been deferred because of COVID-19 until at least January 2021.

Although the drop in the portfolio valuation in March was stomach churning, that is now recovering and overall MCA remains in a healthy financial position.

ITEM 5 REAPPOINTMENT OF GOLDWYNS, AS REVIEWING ACCOUNTANTS

The reappointment of Messrs Goldwyns for 2020/21 was proposed by Dr Iain Smith and seconded by Dr Chris Daly. Approve and accept 2019-20 accounts was proposed by Dr Peter Rice and seconded by Prof Jonathan Chick.

ITEM 6 MEDICAL DIRECTOR’S REPORT

Dr Florin said a special thank you to Mr Warner for his support through the year and his hard work. The MCA were midmove as lockdown started, Dr Florin showed the members pictures of the old and new office, the MCA have contin-

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ued working from home. Symposium is a key note event in MCA calendar, this time last year at the BMA saw a record income £6000 with Prof Nick Sheron giving Max Glatt lecture, high number of delegates and loyal sponsors. Dr Florin expressed thanks to Prof Colin Drummond for talks earlier in the year and decision to run AGM and webinar online. Fortunately, we have contacted all speakers and they have all agreed to present next year, with Dr Peter Rice as Max Glatt lecturer. The event is booked at the BMA 17th November 2021. Journal is a significant source of income for the MCA and is what we do, co-owned with Mr Paul Kidd and OUP who are experts at spotting icebergs ahead and we also have committed editors Prof Jonathan Chick and Prof Lorenzo Leggio. Prof Phillipe De-Witte retired last year, who was ESBRA editor. MCA have worked hard to keep ESBRA relationship, with Prof Sebastien Mueller ESBRA president attending our last Journal Committee meeting in September. Submissions have been up, going forward looking at papers on Meta-Analysis, review papers and RCT’s alcohol and health field. Income has consistently increased, apart from a blip in 2016 however, as Mr Warner warned COVID-19 could affect this.

Another metric we follow is impact factor, which usually sits between 2-3, been a bit lower this year but hopefully will increase, we talk a lot about the impact factor. This is because it will attract better quality papers and be bought by academic consortia. Moving on to educational activities, MCA have been working with medical students we are now looking for post graduate quality improvement prize, Dr Florin has spoken to Jane Huge at the RCP to discuss further. Digital case-based discussions are something else the MCA are looking into, have had talks with the SSA. Students competition on Recovery, prize winning essay published in the Annual report. 2021 competition ‘COVID-19, enough to drive you to drink’ opens 1st January 2021. NAAD competition also in 2021, this is usually more visual rather than an essay. This will be to design a screen saver for student unions ‘Alcohol from freshers to finals and beyond’. Dr Florin Thanked Committee chairs, Prof Gilmore who stepped today, RA’s, Mr Warner our treasurer, editors and team at MCA office Ria Pearson and Clare Farrow, who have kept the show in the road despite obstacles.

Prof Sir Ian Gilmore thanked Dr Florin for all her hard work.

ITEM 7 CHAIRMAN’S REPORT

Prof Colin Drummond is still unwell and Prof Sir Ian Gilmore would like to send his best wishes for a speedy recovery. Prof Drummond’s report is in the papers that were distributed.

ITEM 8 ELECTION OF OFFICERS

Dr Eilish Gilvarry and Dr Anne McCune – standing for re-election. Proposed by Dr Bruce Ritson and seconded by Dr Alisdair Young.

Professor Robin Touquet - retiring. Prof Gilmore thanked Prof Touquet for his long-standing service and support for the MCA and alcohol field in general.

Election of Dr Michael Dougan for the Executive Committee. Proposed by Dr Iain Smith and Seconded by Prof Jonathan Chick.

ITEM 9 BRIAN HORE

Following Dr Brian Hore’s death, Prof Gilmore highlighted his outstanding contribution to the MCA and the alcohol field as a whole. Prof Gilmore advised he could do no better than to refer members to the obituary Dr Bruce Ritson published in Alcohol and Alcoholism.

ITEM 10 STUDENT ESSAY COMPETITION PRIZE

Three winners were announced; 1st Prize: Saranya Baleswaran, 2nd Prize: Shreyas Moodalbyle 3rd Prize: Gemma Swann

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Prof Gilmore asked if any were present virtually. Dr Florin advised that Shreyas Moodalbyle and Gemma Swan were in attendance, just not 1st prize winner Saranya Baleswaran. Prof Gilmore congratulated the winners on their achievement.

ITEM 11 ANY OTHER BUSINESS

No other business.

Prof Gilmore thanked all who presented and Dr Florin advised that after AGM, people will be able to start joining the Alcohol and Covid webinar.

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(>MCA Medical Council on Alcohol | EDUCATION | JOURNAL | I SUPPORT | MCA Committee Memberships

MCA COMMITTEES

EDUCATION COMMITTEE

Dr I Smith BSc(Hons), MD, MBChB, FRCPsych, FRCPE (Chair) Dr C Daly MBChB, MSc, FRCPsych Dr J Hyatt-Williams MB MRCS, FRCA Mr A Jugdoyal RGN, RMN Dr D Kirkham MBChB, MRCP Dr J Lisle MSc, MBBS, FFPH Dr MY Morgan MBChB, FRCP Dr A Thillainayagam MD, MBChB, FRCP Dr M Wrigley MBBS, FRCA (from November 2020)

JOURNAL COMMITTEE

Dr P Rice MBChB, FRCPsych (Chair) Professor J Chick MA, MPhil, DSc, FRCP(Ed), FRCPsych (Joint Chief Editor of Journal) Professor L Leggio MD, PhD, MSc (Joint Chief Editor of Journal) Dr I Guerrini MD, PhD Dr MY Morgan MBChB, FRCP Dr A Thomson BSc, MBChB, PhD, FRCP (Ed). FRCP

Page 19

<>MCA Medical Council on Alcohol | EDUCATION | JOURNAL | POLICY | SUPPORT | Regional Advisors

REGIONAL ADVISORS

AREA COVERED	NAME	ADDRESS	CONTACT DETAILS
BIRMINGHAM: ASTON UNIVERSITY	-
BIRMINGHAM	Dr NC Fisher, MD, FRCP	Department of Gastroenterology, Dudley Group of Hospitals, Rus- sells Hall Hospital, Pensnett Road, Dudley DY1 2HQ	Email: neil.fsher@dgoh. nhs.uk Tel: [phone]
BRIGHTON & SUSSEX	Dr Chris Sargeant	Senior Clinical Lecturer, Institute of Postgraduate Medicine, Brigh- ton and Sussex Medical School, Room 342, Mayfeld House, Uni- versityof Brighton BN1 9PH	Email: C.Sargeant@ brighton.ac.uk Tel: [phone]
	Dr Sarah Flowers	Pavilions, Richmond House Rich- mond Road, BN2 3RL	Email: SFlowers@pavilions. org.uk Tel: [phone]
BRISTOL	Dr A McCune, BSc, MD, MB BS, FRCP	Consultant Dept of Hepatology, Level 10 A919, Queens Building, Bristol Royal Infrmary, Marlbor- ough Street,Bristol BS2 8HW	Email: anne.mccune@ uhbristol.nhs.uk Tel: [phone]
UNIVERSITY OF BUCKINGHAM	-
CAMBRIDGE	Dr J Wood	Box 175, Department of Liaison Psychology, Cambridge University Hospital NHS Foundation Trust, Adenbrookes Hospital, Cam- bridge CB2 0QQ	Email: jonathan.wood@ cpft.nhs.uk
CANTERBURY CHRIST- CHURCH UNIVERSITY	-
ANGLIA RUSKIN UNIVERSITY CHELMSFORD	-
EAST ANGLIA	-
EXETER	Dr B Hudson, MRCP	Consultant Hepatologist, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW	Email: [e-mail]
GUERNSEY	Dr N Wright, BSc, MB- ChB, MRCPsych	Community Drug & Alcohol Team, Oberlands Centre, La Rue de la Corbinerie,St Martins,GY4 6SP	Email: [e-mail] Tel: [phone] ext. 3530 (for PA)
HULL/YORK	Dr JAJ Smithson, MB, FRCP	Consultant Physician & Gastroen- terologist, Hull Royal Infrmary, AnlabyRoad,Hull HU3 2JZ	Email: Jacquelyn. [e-mail] Tel: [phone]
KEELE	Dr A Brind, MD, FRCP	University Hospital of North Midlands, Department of Gastro- enterology, Royal Stoke University Hospital,Stoke on Trent ST4 6QG	Email: Alison.brind@uhnm. nhs.uk Tel: [phone]

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	Dr Derrett Watts, MB- BCh, FRCPsych, DRCOG, MPhil	Consultant Psychiatrist, Substance Misuse, Edward Myers Unit, Harp- lands Hospital, Hilton Road, Harp- felds,Stoke-on-Trent ST4 6TH	Email: DerrettJ.Watts@ combined.nhs.uk Tel: [phone]
	Dr U Thalheimer, MD, PhD, FRCP	Consultant Gastroenterologist and Hepatologist Shrewsbury and Telford Hospital NHS Trust, Mytton Oak Road ShrewsburySY3 8XQ	Email: ulrich.thalheimer@ nhs.net Tel: [phone]
LANCASTER UNIVERSITY	-
LEEDS	Dr Richard Parker, PhD, MRCP	Consultant Hepatologist Leeds Liver Unit St James’s Hospital West Yorkshire LS9 7TF	Email: richardparker@nhs. net
LEICESTER	-
LINCOLN (& NOTTINGHAM)	Dr D P Rhinds, BSc (Hons), BA, MMedSci, MRCPsych	Consultant Psychiatrist in Sub- stance Misuse Nottingham Recovery Network Wellbeing Hub 73 Hounds’ Gate Nottingham NG1 6BB	Email: David.Rhinds@ nottshc.nhs.uk Tel: [phone]
LIVERPOOL	Dr P Richardson	Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Prescot Street L7 8XP	Email: Paul.Richardson@ rlbuht.nhs.uk Tel: [phone]
LONDON: Imperial College London: Charing Cross Hospital, Hammersmith Hospi- tal, St Mary’s Hospital & Chelsea & Westminster Hospital Campuses	Dr A V Thillainayagam, MD, MBChB, FRCP	Gastroenterology & Hepatology Unit, Charing Cross Hospital, Imperial College Healthcare, Hammersmith, London W6 8RF	Email: Andrew.thillainayagam@ nhs.net Tel: [phone]
LONDON: Guy’s, St Thomas’s & King’s College Hospital	-
LONDON: Royal London Hospital & St Barts Hospital	Dr P Kennedy, MB BCh, BAO, BMedSci, MRCP, MD	Barts and The London School of Medicine and Dentistry Queen Mary University of London 4 Newark St London E1 2AT	Email: p.kennedy@qmul. ac.uk Tel: [phone]
LONDON: St George’s Hospital	-
LONDON: University College London	Dr MY Morgan, MBChB, FRCP	Principal Research Associate and Honorary Consultant Physician UCL Institute for Liver & Diges- tive Health, Division of Medicine, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF	Email: Marsha.Morgan@ucl. ac.uk Tel: [phone]

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MANCHESTER	Dr C Daly, MBChB, MSc, FRCPsych	Chapman Barker Unit Prestwich Hospital, Substance Misuse Services, Prestwich Hospi- tal, Bury New Road, Manchester, M25 3BL	Email: chris.daly@gmmh. nhs.uk Tel: [phone]
NEWCASTLE	Dr M Hudson, MD, FRCP	Consultant Gastroenterologist/ Hepatologist, The Freeman Hos- pital, High Heaton, Newcastle-up- on-Tyne NE7 7DN	Email: mark.hudson@nuth. nhs.uk Tel: [phone]
NOTTINGHAM (& LINCOLN)	Dr D P Rhinds, BSc (Hons), BA, MMedSci, MRCPsych	Consultant Psychiatrist in Sub- stance Misuse Nottingham Recovery Network Wellbeing Hub 73 Hounds’ Gate Nottingham NG1 6BB	Email: David.Rhinds@ nottshc.nhs.uk Tel: [phone]
EDGE HILL UNIVERSITY, ORMSKIRK,LANCS	-
OXFORD	Dr A Evans	Consultant Hepatologist, Department of Gastroenterology and Hepatology, Royal Berkshire Hospital,ReadingRG1 5AN	Email: alexevans1@yahoo. com Tel: [phone]
PLYMOUTH/TRURO	-
PRESTON: University of Central Lancashire School of Medicine	-
SHEFFIELD	Dr O Lagundoye, MB BS, MRC Psych	Clinical Director, Substance Mis- use Service, Shefeld Health & Social Care NHS Foundation Trust, Fitzwilliam Centre, Fitzwilliam Street,Shefeld S1 4JB	Email: olawale.lagundoye@ shsc.nhs.uk Tel: [phone]
SOUTHAMPTON	Dr H Gordon, MD, FRCP	Consultant Gastroenterologist The Royal Hampshire County Hospital Mail Point 41, Romsey Road Winchester SPO22 5DG	Email: Harriet.Gordon@ hhft.nhs.uk Tel: [phone]
SUNDERLAND	-
WARWICK	-
ARMED FORCES	Dr C Barker, MRCPsych	Consultant Psychiatrist DCMH Donnington Building V12, Venning Barracks Donnington,Telford,TF2 8JT	Email: DPHCWWM- DCMHDON-Psych-Cons- [e-mail] Tel: [phone]
N. IRELAND: Belfast	Dr J Watson / Dr H Toal (maternity cover)	Malone Place Day Treatment Unit 31 Malone Place Belfast BT12 5FD	Email: Joy.watson@belfasttrust. hscni.net Tel: [phone] / 028 95040338

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N. IRELAND. Londonderry	Dr J Watson	Malone Place Day Treatment Unit 31 Malone Place Belfast BT12 5FD	Email: Joy.watson@belfasttrust. hscni.net Tel: [phone] / 028 95040338
SCOTLAND: Aberdeen	Dr S Anderson	Consultant Psychiatrist in Addic- tions Integrated Alcohol Service - Aberdeen City, Royal Cornhill Hospital,Aberdeen AB25 2ZH	Email: seonaid.anderson@ nhs.net Tel: [phone]
SCOTLAND: Dundee	-
SCOTLAND: Edinburgh	Dr R Lawrence, MBChB, MSc, MPhil, MRCGP, FRCPsych	Consultant Psychiatrist in Addic- tions, Ritson Clinic, Royal Ed- inburgh Hospital, Morningside Terrace,Edinburgh EH10 5HF	Email: rebecca.lawrence@ nhslothian.scot.nhs.uk Tel: [phone]
SCOTLAND: Glasgow / West of Scotland	Dr ID Smith, BSc (Hons), MD, MBChB, FRCPsych, FRCPE	Substance Misuse Service, St Ninians Health Centre Mayfeld Street, Stirling FK7 0BS	Email: [e-mail] Tel: [phone]
SCOTLAND: St Andrews	-
WALES: Cardif	Professor JP Shepherd, CBE, FMedSci	Cardif University, School of Dentistry, Heath Park, Cardif CF14 4XY	Email: shepherdjp@cardif. ac.uk Tel: [phone]
WALES: Swansea	Professor JP Shepherd, CBE, FMedSci	Cardif University, School of Dentistry, Heath Park, Cardif CF14 4XY	Email: shepherdjp@cardif. ac.uk Tel: [phone]

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(

2 St Andrews Place, Regents Park T: 020 7486 3716 Mca London Charity no: 265242 London, NW1 4LB E: [e-mail] @mca_med VAT no: 128992569 W: www.m-c-a.org.uk PATRONS PRESIDENT CHAIRMAN MEDICAL DIRECTOR Lord Turnberg, Sir Graeme Catto, Professor Sir Ian Gilmore Professor Colin Drummond Dr Dominique Florin Sir Miles Irving, Sir Kenneth Calman, Professor Sir Michael Marmot VICE PRESIDENT Dr Bruce Ritson

AN INDEPENDENT CHARITY IN AFFILIATION WITH THE ROYAL COLLEGE OF PHYSICIANS CHARITY NUMBER 265242 | COMPANY NUMBER 952312 (LONDON) | VAT NUMBER 128992569

MCA Medical Council on Alcohol I EDUCATION I JOURNAL I DOLIC'I | SUPPORT I The Medical Council on Alcohol IA company limited by guarantee) Report and Financial Statements Year ended 31 March 2021 Charity number: 265242 Company number: 952312 VAT number: 128992569

TABLE OF CONTENTS REPORT OF THE TRUSTEES & DIREcfoRS OF THE MEDICAL COUNCIL ON ALCOHOL FOR THE YEAR ENDED 31 MARCH 2021 PAGES 3-16 PAGE 3 INTRODUCTION PAGE 3 MEDICAL DIREcfoR'S REPORT PAGE 5 OUR PURPOSE AND ACTIVITIES PAGE 7 ACHIEVEMENTS AND PERFORMANCE PAGE 9 FINANCIAL REVIEW PAGEII STRucfuRE, GOVERNANCE & MANAGEMENT PAGE17 INDEPENDENT EXAMINER'S REPORT TO THE TRUSTEES OF THE MEDICAL COUNCIL ON ALCOHOL FOR THE Y￿R ENDED 31 MARCH 2021 PAGE19 STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 31 MARCH 2021 BALANCE SHEET AS AT 31 MARCH 20201 PAGE 21 NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2021 PAGE 23

REPORT OF THE TRUSTEES & DIRECTORS OF THE MEDICAL COUNCIL ON ALCOHOL FOR THEYEAR ENDED 31 MARCH 2021 The Medical Council on Alcohol is a Registered Charity (Number 265242) and a Company Limited by Guarantee and not having a share capltal (Company Registration Number 952312) as well as being VAT registered (12 8992 569). It is governed by its Memorandum and Articles of Assoclation dated 28 February 1967 under which one third of the Executive Committee is elected or re- elected at each Annual General Meeting. The Executive Committee appolnts the Chalrman and two Vlce-chairmen and is a150 entitled to appolnt new Trustees and determlne the method of their appolntment. The trustees are pleased to present their annual directors, report together with the flnanclal statements of the charlty for the year ended 31 March 2021 whlch are prepared to meet the requirements for a directors, report and accounts for Companles Act purposes. The flnanclal statements comply wlth the Charities Act 2011, the Companles Act 2006, the Memorandum and Articles of Assoclatlon, and Accounting and Reporting by Charltles; Statement of Recom mended Practice appllcable to charltles preparlng thelr accounts in accordance wlth the Flnanclal Reportlng Standard applicable In the UK and Republlc of Ireland (FRS 1021 (Effectlve October 2019). MEDICAL DIRECTOR'S REPORT The whole of the perlod covered by thls report has taken place durlng the Covld 19 pandemlc. Whi 1st the current situation in the UK Is relatlvely posltive, both In respect of case rates and vaccinations, the same cannot be sald regardlng the world-wide situation and the future Is very uncertain. The MCA office is closed with no fixed date for reopenlng. The MCA team successfully mlgrated to working from home and this currently remains the case. The 51tuation was complicated by the fact that the start of the first lockdown coincided with an offlce move to new RCP leased premises. The negotiation of new premises and a new lease was protracted but agreement had been reached however unfortunately the physical move was interrupted by Covid-19. This ha5 caused some complications especially with regard to IT as the MCA offtce Is stil I spllt between two premises. The RCP agreed to keep the old rental rate throughout the past year but this 15 l ikely to increase to the new rate shortly once the move is (hopefully) completed.

Despite the complications described above, the MCA has managed to continue its work with the aim of reducing alcohol-related health harm, primarily through educational means. We continued to work with health professionals in the alcohol and health harm arena Including of course students, promotlng education for this group., our Journal is highly regarded in the field. we support organisations which support health professionals themselves in difficulty Wlth alcohol. and we remain committed to achlevlng evldence-based policy change through our links with the Alcohol Health Alliance and other organlsations. The planned 2020 MCA Symposium on Interventions and Recovery and Max Glatt lecture was cancelled due to Covid, with a view to holding it in better tlmes In 2021. In its place we held a weblnar on Alcohol and Covid, immedlately after our online AGM. Thls was a new departure for the MCA i n response to clrcumstances but In the event, it proved unexpectedly successful with a much higher attendance than normally achieved at our 5ymposla. Speakers included Peter Rlce, Katherlne Severl and Chrls Daly and the event was chaired by MCA Presldent Sir lan Gilmore. The MCA team met the dlgital challenges and a good level of dlscusslon was achleved. A recording of the webinar Is avallable on the MCA website and has been vlewed by many more than were able to attend on the day. The event was free to attend and to vlew on the website but was run at a mlnlmal cost to the MCA. Other regular educatlonal projects Included the an nual student essay competltlon, thls year on the theme of Recovery. A very large number of entries were recelved and the wlnners well deserved thelr prlzes. Handbook sales whlch were already at a fal rly low level, decreased further due to the difficulty of dlstrlbutlon durlng Covld, In any case work has been proceedlng to develop new up to date dlgltal alternatives for thls stream of work. Our excellent relationshlp wlth Oxford Unlverslty Press, our Journal co-owners, and the dedicatlon of the chlef Edltors, are key to the on-golng succes5 of Alcohol and Alcohollsm. The Journal Is our prlncl pal source of Income and over the past year this has resulted In an Income of £166,233 (2020: £163,760). At bi-annual Journal Commlttee meetlngs ways of continulng the Journal's success are discussed, Includlng Special Issues on toplcs of particular importance, the challenges P05ed by the growth in open access publishing and maximislng marketing opportunltles. Fortunately, a feared possible decrease i n i ncome due to Covld-19 has th us far not materlallsed. Our Investment income of course depends on the performance of the flnanclal markets, which have shown the volatlllty expected due to Covid-19. We have benefited from the oversight of our financial advisors Charles Stanley with whom members of the Executive Committee and the Treasurer meet regularly.

Our aim for the next year is to continue our activities to meet our mlsslon of improved outcomes for patients with alcohol related health harm. We alm to do this while staying in budget which requ ires careful scrutiny of all our activities and maxi misation of fundraising opportunitles. The lessons we have learnt from the year past will certainly influence our work going forwards. OUR PURPOSE AND ACTIVITIES Objectives The Council was establlshed In 1967 for "the beneflt of the community to provlde an organisation of registered health care professlonals with a view to the co-ordlnatlon of effort, the better understanding of alcoholism and its prevention and the treatment and after-care of alcoholics Ourpurp05e To ensure that all doctors, medlcal students, nurses and other professlonals allled to mediclne understand the risks to thelr patients from alcohol and act effectlvely to prevent and manage these. To work with health care professionals to increase thelr understandlng of the rlsks assoclated wlth their own alcohol consumptlon and of the measures to address these. To promote sclentlfic advancement In the understandlng, preventlon and management of alcohol-related harm through our Journal and other publlcatlons and actlvltles. To work wlth other organlsatlons on publlc health and policy Interventlons to reduce alcohol- related harm. The vision that shapes our annual actlvltles remains to create a workforce of health profe55lonals educated and supported to reduce health harm from alcohol. Improvlng the competence of health professionals In the alcohol field will improve the quallty of treatment for patients in the UK. The charity also supports healrhcare professionals who have developed problems wlth their own use of alcohol. In shaping our objectlves for the year and plannlng our activities, the trustees have considered the Charity Commlsslon's guldance on public benefit, including the guidance 'public benefit: ru n ning a charity,.

MCA Medical Councll on Alcohol I EDUCATION I JOUR14ALI PVLIL Y I SUPPORT I EducationalAcrivit/es We run a series of educational activities including student competltlons, free leaflets and a yearly symposium. The income from this event15 Intended to ensure that the event itself is cost neutral, although our future strategy 15 to increase sponsorshlp and delegate income to create a small surplus to ald In coverlng the costs of educational activities. Our actlvlties have the benefit of Improvlng the competence of health care professionals, partlcularly at the beginning of their careers, to manage health harm from alcohol In their patients. Membershlp The MCA has a small membership body of 79, all from the healthcare field. The membership fees cover the cost of the thrlce-quarterly newsletter and also allow the MCA to offer reduced rates for members to Its educational event5. MembershSp Increases exposure to the MCA'S actlvltles, wh Ich In tu rn has Increased the competence of health care professlonals. Journal The MCA owns a 50% share wlth Oxford Un5verslty press of the 'Alcohol and Alcohollsrn, Journal. The Income from the Jou rnal contributes toward5 the operatjonal costs of rhe organisatlon. Within the next 3- 5 years It is hoped that the Impact factor wlll contlnue to Increase and that the presence of thejournal in the US and Asla wlll have a positive Influence on income. Thejournal meets the MCA'S vlslon and mission statements by contributing to the academlc endeavours of Improvlng the knowledge and understanding of alcohol-related health harm. This In turn Improves the management of patients with alcohol-related health issues.

ACHIEVEMENTS AND PERFORMANCE Performance Review 2020-2021 To generate a 4% yield on Investments NO We received an approximate 3.5% yield on Investments (£17,689). To hold one AGM as stated In the MCA memorandum. To arrange one symposlum wlth the alm to break even flnancially, and to have a mlnlmum attendance of at least l 00 people. YES The 2020 event was held online. It was well attended and had excellent feedback. It was free to delegates but was very low cost for the MCA. To produce x3 copies of the new51etter 'Alcoholls' YES We produced 3 coples of the Alcohol Is newsletter. To continue to increase the impact factor with the aspi ration of achieving an impact factor of 2.5 3 within a 3- year period NO Annual impact factor wa5 2.078 with a 5- year impact factor of 2.475 (a sllght decrease)

To produce 6 issues of A&AJournal a year, with at least l 00 pages per edition YES To malntaln Ilnks to the AHA (Alcohol and Health Al Ilancel and other organlsatlons on Issues of pol Icy relevance e.g. mlnlmum prlclng YES Supported them flnancially as well as via soclal medla To contlnue to work with the BDDG and SDT to promote both organlsatlons and also slgn post healthcare professlonals suffer5ng from an alcohol problem to these organlsations YES Many Ilnks Includlng commlttee membership and Jolnr marketlng at conferences Thls year the Journal's Impact factor decreased from 2.777 to 2.078. The MCA strengthened its links wlth the AHA by supporting them financially with a £1 500 grant whilst we also highlighted each other's social media campaigns. The MCA also contlnued to work closely with the BDDG (Britlsh Doctors and Dentists Grou p) and the SDT (Slck Doctors Trust). The MCA Weblnar In 2020 was entitled 'Alcohol and Covid, and had over 200 attendees. The plans for the 2021 Symposium are currently under review, given the Covld-19 sltuatlon.

FINANCIAL REVIEW The MCA recorded a net Income for the year of £40,341 (2020- £18.101) before reallsed and unreali5ed investment gains of £184,988 (2020- losses of £134,807) showlng a net increase in funds for the year of £225,329 (2020.. £116,706 decrease>. At the year end the Council had net funds of £867,170 (2020.. £641.841). Income No Symposlum was held was held durlng the year and so MCA received no income from this source. However, this shortfall was more than mitigated by the recelpt of a legacy during the perlod of £16,000. Journal Income showed a small increase over the previous year to £166,233 (2020: £163,760), continulng Its recent run of strong fi nancial returns. No income was recelved from Handbook sale5 during the year. Given the remalnlng coples are somewhat outdated and In poor condltlon, the decislon has been taken not to market them further. Prlmarlly as a result of companles reduclng or eli mlnatlng dlvldends entlrely as they felt the financlal consequences of the CovSd-19 pandemic, dlvldends and interest Income from Investments for the year decllned to £17,689 (2020: £22,026). Expenditure Total expenditure for the year wa5 £166,182 (2020.. £196,699). The signlficant decllne compared to the prevlous year is partly due to no expenditure being incurred In respect of the Symposlum. The overall effect of 'worklng from home, was to reduce MCA'S actlvlties and related expenses, as well as a number of overhead costs. The Intended Increased cost of MCA'S premlses at the RCP did not take effect durlng the year and has been postponed to the 2021 12022 financlal year. Our Membershlp and Symposium Policies The MCA has two prlclng policies, one with regards to its membership and one with regards to its events. Both policies reflect our strategy of belng accessl ble and cost effective to all types of healthcare professlonals especlally as budgets within the NHS are very strict at present, whllst aiming for the MCA to remain financially viable.

Investment Powers and Pollcy The Councll has appointed Charles Stanley and Co. as MCA'S investment managers and members of the Executive Committee and the Treasurer have regular meetlngs With the investment manager to monitor performance. The investment manager is aware of the Council's ethical stance on alcohol-related investments. The value of MCA'S investment portfolio increased significantly as financlal markets recovered following governments measures to protect their economie5 from the effects of Covid - 19. At the ti me of writing this report the portfolio's recovery had been maintalned Into the current financial year. At 31 March 2021 the carrying value of the investment portfolio, whlch excludes dividends recelved and is after charging investment management fees, had Increased in value over the year by £183,531 12020.. decrease of £140,116) to £700,73912020'. £521,262). Reserves Pollcy The Councll's pollcy Is that it wlll at all tlmes seek to retaln sufflclenr cash and easlly Ilquldated Investments to cover at least 9 months e5tlmated future expenditure, whlch in 202012021 was approxlmately £130,000. At the year-end cash at bank and Investments amounted to approxlmately £880,674. All Investment holdlngs are consldered to be capable of belng Ilquldated qulckly should the need arlse. Alms for the Future The councll's continulng alm Is for Its Income and expendlture to be in reasonable balance before any major charltable projects. The Council's intentlon Is to put Income from Its actlvitles towards flnancing such projects, whilst being aware that there may be occaslons when a project s of such Importance that It may be approprlate to support out of the Council's retained funds. We wll I contlnue to strengthen our l ink5 With healthcare professlonals through our membership, educational activities and Journal as well as using soclal medla to ralse the profile of the organlsatlon. Through our collaboration with OUP, we will continue to work to Increase the income generated from the Journal. In parrlcular we are targeting an increase in the impact factor and the reach of the Journal In the USA particularly and other parts of the world. 101 Page

STRUCTURE GOVERNANCE AND MAN GEMENT Governing Document The Medical Council on Alcohol is a company Ilmlted by guarantee governed by its Memorandum and Articles of Association dated 7 967. It is reglstered as a charity with the Charlty Commission. The Councll Is governed by the Executive Committee and its subordinate Committee5: Education, Public Health and Journal. There is a network of Reglonal Advisors associated principally with Medlcal Schools and Universities, and a current membership of 79. Members of the Executlve Committee are Directors under Company Law and Trustees under Charlty Law. Members of the Company guarantee to contribute an amount not exceeding £1 each to the assets of the Company In the event of a windlng-up during their membershlp or wlthln one year of their ceaslng to be a member. The total of such guarantees at 31 March 2021 was £79 (2020.. £88). Appointment of Trusfees Under the company's artlcles, dlrectors of the company are known as members of the Executlve Commlttee. Under the requlrements of the Memorandum and Artlcles of Assoclation the members of the Executlve Committee are elected to serve for a perlod of three years after whlch they must be re-elected at the next Annual General Meetlng. The dlrectors retlre by rotatlon and, Sf ellgi ble, can offer themselves for re-electlon. Most trustees are already famlllar wlth the practlcal work of the Charlty. Addltlonally, new trustee5 are encouraged to attend meetlng sessions to famlllarise themselves with the Charity and the context within whlch It operates. Trustee Induction t7nd Training New trustees are brlefed on thelr legal obligations under charlty and company law, the Charity Commission guldance on public benefit and receive a copy of the Memorandum and Artlcles of Association. New trustees are presented wlth any recent flnancial documents and buslness plans. Organisation The board of trustees, whlch can have up to 30 members, administers the charity. The board normally meets three times a year and there are Sub-committees covering investments and financial strategy which meet twlce a year. A Chairman is appointed by the trustees to manage the day-to-day operations of the charity. To facilitate effective operatlons, the Chairman ha5 delegated authority, within the terms of delegation approved by the trustees. for operatlonal

matters including finance, employment and membership to the Medical Director and other committees (Education & Journal). Related Parties and Co-operation wirh other Organlsatlons The Medical Council on Alcohol has formal Agreements only with the Journal Publlsher (Oxford University Press) and the European Society for Blologlcal Research into Alcohol (a charity with si milar objectives, subject to Belgian National Law, but administered from Vienna). In pursuance of Its charltable objectives The Medical Council on Alcohol co-operates wlth bodies such as the Sick Doctors Trust, the Alcohol Health Alliance and the British Doctors, and Dentists, Group but has no formal relationshlp wlth these bodles. The Medlcal Councll on Alcohol became affiliated to the Royal College of Physlclans In 2006,. thls afflllatlon does not affect the independence of The Medlcal Councll on Alcohol as a Charity. Pay Policy for Senior Staff The dlrectors, who are also the trustees, glve of thelr time freely and no director recelved remuneratlon In the year. Details of directors, expenses are related party transactions and are dlsclosed In note 9 in the accounts. The pay of MCA staff Is reviewed annually In accordance wlth pay scales In other comparable medlcal organlsatlons. Rlsk Management The Councll 15 exposed to operatlonal and flnanclal rlsks as a result of Its operating actlvltles. To mifigate these rlsks a system of internal flnancial controls ha5 been implemented that Is deslgned to provlde reasonable (although not absolute) a55u rance agalnst material misstatement or loss. The trustees have a risk management strategy which comprises.. An annual review of the prlnclpal rlsk and uncertainties that the charity faces., The establls hment of policie5, Systems and procedures to mitigate those risks identifsed in the annual review., The implementation of procedures designed to minimise or manage any potential impact on the charity should those risks materiallse 121 Page

This work has identified that financial sustainability is the major financial risk for the charity. A key element in the management of financial risk is a regular review of the Investment portfolio and active management of debtors and creditors balances to ensure sufficient working capital. The Council is also exposed to market risk as a result of holding investments in equltie5 and bonds. To manage this risk the Council has given clear guideline5 to the investment manager with regards to the investment strategy to be followed and recelves regular reports from the investment manager on the performance of the portfolio. Members of the Executlve Committee and the Treasurer meer regularly wlth the manager to review investment performance. Attention has also been focused on non-flnanclal r15k5 arlslng from fire and health and safety issues. These risks are managed by ensurlng that all offlce machines are PAT tested regularly, havlng set pollcies and procedures in place, malntenance of equlpment, back up of data to an external server and regular staff training. REFEREN EAND ADMINI AILS: Charlty number: 265242 Company number: 952312 VAT number.. 128992569 Reglstered Office.. 2 St Andrews Place, London NWI 4LB OurAdvlsors.' Independent Examlner: Martin Myers, Goldwyns 109 Baker Street, London, Wl U 6RP Bankers.. Natwest PO Box 2021, London, WIA I FH Investment Manager: Charles Stanley 25 Luke Street, London, EC2A 4AR 13 | Page

The directors of the charitable company (the charity) are its trustees for the purpose of charity law. The trustees as at 31 March 2021 were as follows: OFFICERS Presldent Professor Sir lan Gllmore MD. FRCP, DL Vice Presldent Dr Bruce Rltson, OBE, MD. FRCPsych, FRCP (Ed) EXECUTIVE COMMirrEE Offlcers.. Chalrman Prof Colln Drummond MB ChB. MD, FRCP, FRCPsych, FFPH, FRCGP(Hon) Educatlon Commlttee Chalr Dr laln Smlth MB ChB, BSC, FRCPsych Journal Commlttee Chalr MB Ch8, FRCPsych Dr Peter Rlce Members: Prof Jonathan Chlck, MA. MPhll, Dsc, FRCP(Ed), FRCPsych Dr Clalre Gerada, MBE, FRCP, FRCGP, MRCPsych Prof Elllsh Gllvary, FRPsych, MRCGP, DCH, FRCPI Dr Anne Mccune, MD. FRCP Dr Zulfiquar Mlrza, MBCHB, DCH, DRCOG, MRCO, FRCP. FFAEM. Tox FRCEM MB Ch8, FRCP Dr Marsha Morgan, Dr Andrew Thillalnayagam, MD, FRCP Dr AllstaSr Young MB ChB, MRCPsych Dr Mlchael Dougan (from March 20211 MB, ChB, LLB, DA. (UK), FFARCSI. CCGPT 141 Page

In attendance.. Honorary Treasurer,. Mr Graham Warner MBA, FCA Medical Director: Dr Dorninique Florln MA. MB BS, MRCGP, MD, FFPHM Executlve Asslstant: Mrs Rla Pearson Admin Asslstant: M5 Clare Farrow BA(Hon51, AISTD Board Reslgnatlons IAGM 2020) Prof Robln Touquet, R.D., FRCEM 0Sstlngulshed Fellows Professor Peter Brunt CVO, OBE, MD, FRCP, FRCPIEdl,FRCSIEd) Dr Brlan Hore (passed away 26thJuly 2020). BSC, MB BS, MPhll, FRCP, FRCPsych

Inancial statements Tru5tee5' responsibilities in relation to the f The trustees (who are also directors of The Medical Council on Alcohol for the purposes of Company Law) are responsible for preparing the Trustees, Report and the financial statements in accordance with applicable law and Unlted Klngdom Accountlng Standards (United Kingdom Generally Accepted Accounting Practice). Company law requires the trustees to prepare financlal statements for each flnanclal year. Under Company Law, the trustees must not approve the Financial Statement unless they are satisfied that they give a true and falr vlew of the state of affalrs of the charitable company and of the Incoming resources and application of resources, including the income and expenditure, of the charitable company for the year. In preparing these financial statements, the trustees are requi red to.. Select sultable accountl ng pollcles and then apply them consistently., Observe the methods and prlnclples in the Charities SORP (FRS 102). Make judgments and estlmates that are reasonable and prudent: State whether appllcable UK Accountlng Standards have been followed, subject to any materlal departures disclosed and explalned In the fl nanclal statements., Prepare the flnanclal statements on the golng concern basls unless It Is Inapproprlate to presume that the charltable company wlll contl nue In operatlon. The trustee5 are responslble for keeplng proper accounting records that dlsclose wlth reasonable accuracy at any time the flnanclal posltlon of the charltable com pany and enable them to ensure that the financial statements comply wlth the Companles Act 2006. They are also responslble for safeguarding the assets of the charltable company and hence for taklng reasonable steps for the preventlon and detectlon of fraud and other Irregularltles. The trustees are responslble for the malntenance and Integrlty of the corporate and flnanclal Informatlon included on the charitable company's website. Legislation in the United Klngdom governi ng the preparatlon and dlssem Inatlon of flnanclal statements may differ from leglslatlon In otherjurisdlctlons. On behalf of the board: Dr Dominiq ue Flori n Med ical Director Date.. 23¥d June 2021 QJLI 161 Page

INDEPENDENT EXAMINER'S REPORT TO THE TRUSTEES OF THE MEDICAL COUNCIL ON ALCOHOL FOR THE YEAR ENDED 31 MARCH 2021 I report to the charity trustees on my examination of the accounts of the company for the year ended 31 March 2021 which are set out on pages 18 to 34. Respons/b/llt/es and Basis of Report As the charlty trustee5 of the company land also Its dlrectors for the purposes of company law) you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 ('the 2006 Act,). Havlng satlsfled myself that the accounts of the company are not required to be audlted under Part 16 of the 2006 Act and are eligible for Independent examlnatlon. I report In respect of my examlnatlon of your company's accounts as carrled out under section 145 of the Charitles Act 2011 I'the 2011 Act'l. In carrylng out my examinatlon I have followed the Dlrectlons glven by the Charity Comm Isslon under sectlon 145(5llb> of the 201 l Act. Independent Examiner's statement I have completed my examination. I conflrm that no matters have come to my attentlon In connectlon wlth the examination glvlng me cause to belleve that In any materlal respect.. accounting records were not kept In respecr of the company as required by section 386 of the 2006 Act., or 2. the accounts do not accord with those records,. or 3. the accounts do not comply wlth the accounting requlrement5 of sectlon 396 of the 2006 Act other than any requirement that the accounts give a 'true and falr vlew, whlch Is not a matter considered as part of an independent examination., or 4. the accounts have not been prepared in accordance with the methods and princlples of the Statement of Recommended Practlce for accountlng and reportlng by charlties. applicable to charlties preparing their accounts in accordance with the Financial reporting standard applicable in the UK (FRSI 02).

I have no concern5 and have come across no other mattors in connection with the examlnatlon to which attention should be drawn in this report in order to enable a proper understanding of the accounts to be reached MARTIN MYERS, FCA CTA GOLDWYNS Chartered Accountants 109 Baker Street London WIU6RP Date: 23rd June 202 7

STATEMENT OF FINANCIAL ACTIVITIES FOR THE YEAR ENDED 31 MARCH 2021 2021 2020 TOTAL Unrestricted Restricted Total Income From generated funds Voluntary Income: Donatlons and Le Income 17,381 ac 16,000 1,381 1,739 Membership 3,580 3,580 3,870 Investment Income 17,689 17,689 22,026 From charitable actlvities ournal oslum 166233 114 558 163760 Publlcatlon Sales Other Incomlng Resources: 2,022 Sundry Income 1,640 167873 1,640 116 198 696 187165 Total Income 206,523 149,887 56,636 214,800 Expenditure Charltable Actlvltles 114,469 57,833 56,636 140,011 Governance & Adminlstration 51,046 51,046 56,055 Other 667 667 633

Total Expenditure 166,182 109,546 56,636 196,699 Net Incomingl(Outgoing) Resource5 40,341 40,341 18,101 Gains / (Losses) on Investments Reallsed Investment gains 1,457 1,457 5,309 Change In value of the Investment portfollo 183,531 183,531 (140,116) 184988 184988 (134 807) Net surplu5 1 (deflclt) and Net Movement In Fund5 for the year 225,329 225,329 (116,706) Reconcl Ilatlon of Funds Total fund5 Brought Forward 641,841 641,841 758,547 Total funds Carried Fo￿ard 867,170 867,170 641,841 The statement of financial activities includes all gains and losses in the year. All income and expenditure derive from continuing activities. The notes on pages 22 to 34 form part of these financial statements.

BALANCE SHEEf AS AT 31 MARCH 2021 31st March 2021 315t March 2020 Fixed A55ets Listed Investments 700,739 521,262 Total Fixed Assets 700,739 521,262 Current Assets Debtors 12,238 89,911 Cash at Bank & In Hand 179,935 58,053 Total Current Assets 192,173 147,964 Llabillties Credltors due wlthln I 2S,742 27,385 year Net Current Assets 166,431 120,579 Total Assets less Current 867,170 641,841 Llabllltles The funds of the charlty Unrestrlcted funds 776,274 734,476 Restrlcted funds Revaluation Reserve 90,896 192,635) Total Funds 867,170 641,841 For the year ended 31 March 2021 the company was entltled to exemption from audlt under Section 477 of the Companles Act 2006 relating to small companie5 and under the Charities Act 2011

Directors, responsibilitles: The members have not required the company to obtain an audit of its accounts for the year in question in accordance with section 476., The directors acknowledge thelr responslbillties for complying with the requirements of the Act with respect to accounting records and the preparation of accounts Approved by the Executive Committee on 23 June 2027 and signed on its behalf, Professor C Drummond, Mr G Warner. MBA, FCA Chairman, Executlve Commlttee Honorary Treasurer 221 Page

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2021 l . Accounti ng Policie5 The principal accounting policies adopted, judgements and key sources of estimation uncertainty Sn the preparatlon of the financial statements are as follows: a) Basls of Preparation The financlal statements have been prepared in accordance with Accounting and Reportlng by Charitles: Statement of Recommended Practice applicable to charities preparing their accounts In accordance wlth the Financial Reporting Standard applicable In the UK and Republlc of Ireland (FRS 1021 (Effective October 20191 {Charltles SORP (FRS 102)) and the Companies Act 2006. The MCA meets the deflnltlon of a public benefit entity under FRS 102. Assets and Ilabilitles are inltially recognlsed at hlstorical cost or transactlon value unless otherwlse stated In the relevant accounting pollcy note. b) Income Income Is accounted for gross (excludlng Value Added Tax where appllcablel when recelvable, as long as It Is capable of flnancial measurement. Thls Includes donatlons, subscrlptlons, Income from publlcatlons and investment Income. Income recelved In advance of a speclflc event Is deferred untll the crlteria for I ncome measurement are met. c) Interest Recelvable Interest on funds held on deposlt Is Included when recelvable and the amount can be measured reliably by the charity; thls Is normally upon notlflcatlon of the Interest paid or payable by the Bank. d) Fund Accountlng Unrestricted funds are avallable to spend on activities that further any of the purposes of the charity. Designated funds are unrestricted funds of the charity which the trustees have declded at their discretion to set aside to use for a specific purpose. Restricted funds are donations which the donor ha5 specified are to be solely used for partlcular areas of the MCA'S work or for specific projects being u ndertaken by the charity.

e) Expenditure Expenditure Is recognised once there is a legal or constructive obligation to make a payment to a third party, it is probable that settlement will be required and the amount of the obligation can be measured reliably All expenditure is accounted for gross or net of value added tax where applicable, and when Incurred. Rentals paid under operating leases are charged to the income and expendlture account on a straight-line basis over the term of the lease. f) Allocatlon of Support Costs Support costs are those functions that asslst the work of the charity but do not directly u ndertake charitable activities. Seventy flve percent of staff costs, rent/servlce charge, rates, insurance, and office expenses have been allocated to the charitable activities listed In note 7b. g) Operatlng Leases The charlty leases Its premlses from the Royal College of Phy51clans. The lease Is renewed perlodlcally. The current lease explred on 31 st December 2019 and the MCA Is In dlscusslons with the RCP about future arrangements (see note 17). h) Tanglble Flxed Assets Depreclatlon on offlce equi pment is provlded on a stralght-l Ine ba515 at a rate of 20% per annum. Items of expendlture are capitallsed where the purchase prlce exceed5 £1,000. l) Debtors Debtors are recognlsed initially at falr value. Trade and other debtors are recognlsed at the amount due on the day they arise. Prepayments are amounts paid In advance and are stated at the actual amount that has been prepaid. i) Cash at bank and in hand Cash at bank and cash in hand includes cash and deposits in the bank or slmilar accounts. k) Investments The Ilsted investment portfollo Is stated at market value. 241Page

l) Foreign Currencies Tran5actlons In forelgn currencies are translated into sterling at the rate of exchange ruling at the date of execution. Exchange differences are taken to the SOFA. Assets and liabilities in foreign currencies are trans lated into Sterling at the rate of exchange rul ing at the balance sheet date. m) Creditors and Provisions Creditors and provisions are recognised where the charlty has a present obligatlon resultlng from a past event or activltles and the amount due to settle the obligation can be measured or estimated rellably. n) Flnanclal Instruments The MCA only has flnanclal assets and fi nanclal Ilabilitles of a klnd that quallfy as baslc financlal instruments. Baslc flnanclal Instruments are Inltlally recognlsed at transactlon value and subsequently measured at thel r settlement valLJe. o) Penslons The Medical Dlrector of the charlty rece5ves an employer's contrlbution to a NHS pension on a monthly basis. The MCA Is part of the NEST scheme with employer contrlbutlons In Ilne with the government approved percentage. If staff meet the government requlrements for a pension, then the MCA pay Into elther NEST on thelr behalf or Into a prlvate penslon scheme at the same rate as the NEST scheme. p) Golng Concern The Financlal Statements have been prepared on a golng concern basls as the tru5tee5 believe that no material uncertainties exist. The trustees have considered the level of fu nds held and the expected level of Income and expenditure for 72 months from authorising these Flnancial Statements. The budgeted Income and expenditure coupled wlth the level of reserves 15 considered sufficient for the charity to be able to contlnue as a goi ng concern. 2. Legal Status of the Charity The MCA is a company limited by guarantee and has no share capital. In the event of the charity being wound up, the Ilability in respect of the guarantee is limited to £1 per member of the charity. 251 Page

For the purposes of the Companies Act, the persons regarded a5 Directors and the Board of Directors respectively, are the Members of the Executive Committee. 3. Financial Performance of the Charity The statement of financial activities shows the overall Income and expenditure of the charity. 4. Income from Donations and Legacies Donations 2020-2021 2019-2020 GiftAld 1,149 1,512 Member & Product 232 22 donatlons Unrestrlcted Legacle5 16,000 17,381 1.739 The income from donations and legacles was £17,381 12020.. £1,739) of whlch £16,000 was unrestricted12020'. £0) and £1,381 restrlcted (2020: £1,739). The MCA benefits greatly from the Involvement and enthusiastic support of Its many board members, Regional Advisors and volunteers, detalls of whlch are given in our annual report. In accordance with FRS 102 and the Charltles SORP (FRS 102), the economic contribution of these people is not recognised in the accounts. 5. Income from Charltable Actlvltles Unrestricted fund5 Unrestricted funds 2020-2021 2019-2020 Income from Symposlum: 20,687

Gross Income from handbook sales 2,022 Total income from charltable actlvities 22,709 6. Investment Income The MCA'S investment income of £17,689 (2020.. £22,026) arises from dividend5 received during the financial per5od and any i nterest received on the MCA'S bank account. During the flnancial perlod a number of investment holdings were sold resulting in a reallsed galn of £1,45712020 gain.. £5,309). 7. Expendlture 7(a) Breakdown of costs by charitable actlvities (See note 16 for details of Restrlcted Expenditure).. Dlrect Costs Support Total Journal (Inc.Commlttee) 34,851 5,103 39,954 Member 2,000 20,411 22,411 Communlcatlon Educatlon (External Events) 15,308 15,308 Education 5,103 5,103 (Publlcatlons) Education (Other) 2,041 2,041 Educatlon (Symposla) 76 23.473 23,549 Education (Competitions) 1,000 5.103 6,103 37,927 76,542 114,469 271Page

7(b) Analysls of costs by financial activlty 5% 111 15% 5% 2% 23% 5X 25% TOTAL Journal Mernber Educatlon: External Events Educatlon.. Publlcatbons Educ4tlon: Other Educarlon: Symposlum Educatbon Comp Governance & Admln Staff 81.285 14,080 Premlses 704 704 282 704 Other Offlce 6,691 335 335 133 335 102,056 Total 76,542 25,514 7(c) Governance and Admlnlstration costs., 2020-2021 2019-2020 Support Costs 25.514 27,529 Professlonal Fees 19.531 18,336 Executive Committee Costs 2,556 Annual General Meeting 2,649 Investment Management 4,416 4,900 Funding / Subscriptions 1,585 85 TOTAL 51,046 56.055 281Page

1. Net Incomel(expenditure) for the year This Is stated after charging: 2020-2021 2019-2020 Operatlng leases 14,080 14,980 Bank Interest recelvable 140) 1171) Accountancy ser41ces 7,548 7,563
2. Analysis of staff costs, trustee remuneratlon and expenses 2020-2021 2019-2020 Wages and Salarles 72,058 71,670 Social Securlty contributlons 2,307 3,296 Penslon contributions 6,423 5,880 Staff Travel 496 1,255 Recrultment costs 4,608 Average number of employees durlng the year 291 Page

No trustees were paid or received any other benefits from employment with the organisatlon In the year12020: £nlll other than Professor J Chick who received an Honorarium for his editorship of the Journal which totalled £16,000. No charity trustee received payment for professlonal or other services supplied to the charity 12020.. £nil). No payments were made to (2020: £1,562 to 14 member5) Executive Commlttee members in reimbursement of travelling expenses incurred in attending meetings. No employees had remuneration and employee beneftts In excess of £60,000. l O.Staff Numbers The MCA employs 3 part time members of staff. It also employ5 addltional part-time staff when necessary, during peak actlvlty tlmes le.g. Symposium, other events etc). I l .Taxatlon The charlty Is exempt from tax on Income and gains falllng wlthln sectlon 505 of rhe Taxes Act 1988 or sectlon 252 of the Taxation of Chargeable Galns Act 1992 to the extent that these are applled to its charltable objects. 12. Flxed Assets - Llsted Investments 2020-2021 2019-2020 Cost of Investments at start of flnancSal year 586,860 555,179 Additions at cost during the year 57,324 56,072 Dlsposals durlng the year (41,438) 129,700) Reallsed galns on Investments durlng the year 1,457 5,309 Cost of Invesrments at end of financlalyear 604,203 586,860 Unrealised galns (loss) at year end 90,896 192,635) Market Value at end of financlal year 695,099 494,225 Cash held pendlng Investment 5,640 27,037

All investments were Ilsted on a recognised stock exchange. 13.Debtors: Amounts Falllng Due Within One Year 2020-2021 2019-2020 Prepayments & Accrued Income 12.238 12,880 Trade Debtors 77,031 TLO,tJall 14.Credltors'. Amounts Falllng Due Wlthln One Year 2020-2021 2019-2020 Accruals & Deferred Income 13,764 12,824 Trade Creditors 1,369 2,782 Other Credltors 67 VAT payable 10,609 11,712 15.Analysls of Net Assets Be￿rfeen Funds 2020-2021 2019-2020 311Page

Unrestricted Funds, Net Current Assets 776,274 734,476 Unrealised (gai ns)1055 on revaluation of investments 90,896 (92,635) Restricted Funds, Net Current Assets 86",7,:li70, , 15a. Movement In Revaluatlon Reserve 2020-2021 2019-2020 Brought Forward balance at l Aprll (92,635) 47,481 Net movement for the year 183,531 (140,116) .(,g.?,.6aSl' 16. Movement In Funds Unrestrlcted Funds: 2020-2021 2019-2020 At l Aprll 641,841 758,547 Transfer from restrlcted funds Net Movement In funds for year 225,329 (116,706)) Restricted Funds: 2020-2021 2019-2020 At l Aprll 321Page

Income 56,636 79,993 Expendlture 56,636 79,993 Transfer to unrestrlcted funds Restrlcted funds recelved durlng the year and thei r subsequent expendlture was for.. Restricted Funds (in detall) Amount Expendlture GifL4id Donations.. Donatlons by members for members only actlvltles, such as AGM costs £1,381 Members contributlon towards AGM costs (to ald In coverlng costs) Membershlp.. The MCA recelves yearly subscrlptlons to pay for member actlvltles £3,580 AGM costs, newsletter, webslte and member actlvlty costs Journal.. The MCA recelve5 monthly Income from Oxford Unlverslty Press to contrlbute to edltorlal and board expenses £51,675 Edltors, honorarla and board meetlngs £56,636 17. Operatlng Lease Commltments MCA'S lease on premises it occupies at the Royal College of Physlclans expired on 31 December 2019. A lease for new premise5 has been provlslonally agreed with the College at an approximate annual cost of £19,867 lincluding service charge). Finalisation and signature of the new lease, as well as the move to the new premises has been deferred as a result of the Covid-19 pandemic. Pending the resolution of these matters, MCA has continued to pay rent and service charges based on the terms of the previous lease. The combined rent and service charge5 in respect of leased premises Included in these accounts 15 £14,080 (2020.. £14.980).

1. Post Balance Sheet Events There are no post-balance sheet events to report.
2. Related Parties Other than the items shown in Note 9 above, there are no related party transactlons that require dlsclosure. 341 Page

2 St Andrews Place E: [e-mail] Regents Park W: www.m-cLondon a.org.uk NW1 4LB

Messrs Goldwyns 109 Baker Street London W1U 6RP

23[rd] June 2021

Dear Sirs

The following representations are made on the basis of enquiries of management and staff with relevant knowledge and experience such as we consider necessary in connection with your independent examination of the company’s financial statements for the year ended 31 March 2021. These enquiries have included inspection of supporting documentation where appropriate. All representations are made to the best of our knowledge and belief.

General

• 1 We acknowledge that the work performed by you is substantially less in scope than an audit performed in accordance with International Standards on Auditing (UK) and that you do not express an audit opinion.

• 2 We confirm that the company qualifies as small in accordance with the conditions set out in chapter 1 of part 15 of the Companies Act 2006.

• 3 We confirm that the company was entitled to exemption under section 144 of the Charities Act 2011 the requirement to have its financial statements for the financial year ended 31 March 2021 audited. We also confirm that the members have not required the company to obtain an audit of its financial statements for the financial year in accordance with section 476 of the Companies Act 2006.

• 4 We have fulfilled our responsibilities as directors / trustees as set out in the terms of your engagement letter dated 26 April 2019, under the Companies Act 2006 for preparing financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice), for being satisfied that they give a true and fair view and for making accurate representations to you.

An independent charity in affiliation with the Royal College of Physicians

Charity No: Company VAT No: 265242 No:92312 128992569 Regents Park Regents Park Regents Park

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• 5 All the transactions undertaken by the company have been properly reflected and recorded in the accounting records.

• 6 All the accounting records have been made available to you for the purpose of your independent examination. We have provided you with unrestricted access to all appropriate persons within the company, and with all other records and related information requested, including minutes of all management and trustee meetings and correspondence with The Charity Commission.

• 7 The financial statements are free of material misstatements, including omissions.

Assets and liabilities

• 8 The company has satisfactory title to all assets and there are no liens or encumbrances on the company’s assets, except for those that are disclosed in the notes to the financial statements.

• 9 All actual liabilities, contingent liabilities and guarantees given to third parties have been recorded or disclosed as appropriate.

• 10 We have no plans or intentions that may materially alter the carrying value and where relevant the fair value measurements or classification of assets and liabilities reflected in the financial statements.

Accounting estimates

• 11 Significant assumptions used by us in making accounting estimates, including those measured at fair value, are reasonable.

Loans and arrangements

• 12 The company has not granted any advances or credits to, or made guarantees on behalf of, directors / Trustees.

Legal claims

• 13 We are not aware of claims in connection with litigation that have been, or are expected to be, received for disclosure or accounting in the financial statements.

Laws and regulations

• 14 We have disclosed to you all known instances of non-compliance or suspected noncompliance with laws and regulations whose effects should be considered when preparing the financial statements.

Related parties

• 15 Related party relationships and transactions have been appropriately accounted for and disclosed in the financial statements. We have disclosed to you all relevant information concerning such relationships and transactions and are not aware of any other matters

An independent charity in affiliation with the Royal College of Physicians

Charity No: Company VAT No: 265242 No:92312 128992569 Regents Park Regents Park Regents Park

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which require disclosure in order to comply with legislative and accounting standards requirements.

Subsequent events

• 16 All events subsequent to the date of the financial statements which require adjustment or disclosure have been properly accounted for and disclosed.

Going concern

• 17 We believe that the company’s financial statements should be prepared on a going concern basis on the grounds that current and future sources of funding or support will be more than adequate for the company’s needs. We have considered a period of twelve months from the date of approval of the financial statements. We believe that no further disclosures relating to the company’s ability to continue as a going concern need to be made in the financial statements.

Grants and donations

• 18 All grants, donations and other income, the receipt of which is subject to specific terms or conditions, have been notified to you. There have been no breaches of terms or conditions in the application of such income.

Internal Control and Fraud

1. We acknowledge our responsibility for the design, implementation and maintenance of internal control systems to prevent and detect fraud and error. We have disclosed to you the results of our risk assessment that the financial statements may be misstated as a result of fraud.

2. We have disclosed to you all instances of known or suspected fraud affecting the entity involving management, employees who have a significant role in internal control or others that could have a material effect on the financial statements.

3. We have also disclosed to you all information in relation to allegations of fraud or suspected fraud affecting the entity’s financial statements communicated by current or former employees, analysts, regulators or others

Yours faithfully

FOR AND ON BEHALF OF

The Medical Council on Alcohol

DIRECTORS

....………………...............

An independent charity in affiliation with the Royal College of Physicians

Date: 23[rd] June 2021

Company VAT No: No:92312 128992569 Regents Park Regents Park

Charity No: 265242 Regents Park

Regents Park