Reducing towards Alcohol Harms and Health Inequalities.Julia Miller

What is the Healthy Places, Healthy Lives Programme?

• Funded by DH – originally three years, but reduced to one! Partnered by LGID, NST, Marmot

• Started Jan 2010 – end ?• Developing partnerships to reduce health

inequalities• Implementing Marmot principles• 25 sites in England• Initiatives focus on teenage pregnancy, alcohol,

obesity, community aspirations, CVD,diabetes, smoking, domestic abuse and more…

Why Alcohol?

Health

Crime

Employers

Alcohol related hospital admissions (wholly and partially attributable to alcohol)Outpatients, A&E, AmbulanceGP consultations, practice nurse consultationsSpecialist treatment servicesDependency servicesImpact on families

£2.9Offenders under the influenceYoung people committing criminal damageVehicle-related theftsCrime and Anti-Social BehaviourDomestic violence

Fear of crime & impact on environment £8.0

Average employee absence (7.4 days per year)11 million working days annuallySickness absence (17 million annually)Poor and underperforming

£1.7

Not including estimated costs to the economy of alcohol-related deaths and unemployment

Key Features of Healthy Places Healthy Lives

Developing partnerships to address the “wider determinants”

Working on an area of need in an area

Reducing health inequalities – Marmot

Influencing Commissioning

Reducing alcohol harms

Wolverhampton

Lincoln

Great Yarmouth and

Waverney

Trafford

Brighton and Hove

Isle of Wight

Infrastructure

IntelligenceGovernanceSystems & processes

Strategy

Return on Investment

Community Approaches

Service Focused and innovation

interventions

IBA

Lincoln

Training for frontline staff IBA

Supporting the development of work in alcohol and young people

Development of work in A&E – delivery of IBAs & Cardiff Model

Alcohol & Primary Care (DES/LES)

High Impact Users Lincoln Audit

Developing new commissioning models

Work on supporting infrastructure

Strategy

Intelligence

Benefits realisation

Finance and Commissioning

Infrastructure Development

• Cementing partnerships• Think Tanks• Mapping alcohol services• Links to commissioning• Links into other local strategies and Boards e.g. Child Poverty, Community Safety• Local leadership & cementing partnerships• Understanding the wider determinants

Alcohol Strategy: Isle of Wight, Wolverhampton, Brighton, Gt Yarmouth

City-wide Intelligence, Wolverhampton

• Terms of Reference• Multiple stakeholder engagement• Linking data • Analyst expertise • Gaining buy-in across the City• Model to support other strategic work

Benefits realisation, Gt Yarmouth & Waverney, Wolves

• Economic modelling• Benefits realisation• Links to commissioning• Amenable mortality• Convincing commissioners

Cost Effective Interventions

Review of the evidence (eg WHO, NICE)

Review of individual studies

Keep it Safe Wolverhampton

Amenable Mortality

Summary of the evidence of the effectivenessof alcohol interventions

Source: WHO, Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, 2009

Degree of Evidence

Evidence of action that reduces alcohol-related harm

Evidence of action that does not reduce alcohol-related harm

Convincing • Alcohol taxes• Restricting outlet density• Restricting days/hours of sale• Minimum purchase age• Random breath testing• IBA programmes• Treatment for alcohol use disorders

• School-based education & information

Probable • Minimum unit price• Restricting volume of commercial communications• Enforcing restricted sale to intoxicated/ under-age people

• Training of alcohol servers• Consumer labelling and warning messages• Public education campaigns

Limited • Suspending driving licenses• Workplace programmes• Community-based programmes

• Campaigns funded by the alcohol

industry

Outline:• Increased police presence.• Voluntary ‘Street Pastors’ – street patrol

and guidance.• ‘Safe Havens’ – alcohol free drinks,

somewhere to wait, free call to taxi company.

• Temporary medical centre (on the spot first aid) and triage ambulance to relieve A&E pressure.

• Taxi enforcement officers to monitor unlicensed ‘plying for hire’ activities.

• Multi-agency visits to licensed premises to ensure compliance with licensing and safety conditions.

Impact (compared to same period, 2007/08): • 29% reduction in violent crime• 14% reduction in alcohol-related ambulance

call-outs (28% reduction on New Year’s Eve) • 8% reduction in A&E attendances • 125 visits to licensed premises by

enforcement officers (leading to 1 prosecution and 3 license reviews)

• 12 taxi drivers were stopped for ‘plying for hire’, of which, 10 were prosecuted, enforcing the ‘get home safely’ message.

• Fire Officers conducted 38 inspections across 24 premises. 23 required further action, relating to means of escape and insufficient fire risk assessments.

Night Time Economy, ROI example:Keep It Safe, Wolverhampton

Return on Investment: Total budget was £218,786. Cost analysis indicated total savings to the emergency services alone of £235,000. This shows strong ROI before Wider social determinates are factored in.

Service Focused Interventions

Brief Interventions

Cardiff Model

Pharmacy

Brief InterventionsReview

LES & DESAgree local care

pathways

Better engagement with

Primary Care

Review LES & DES

Discussion with local Boards

Implementation of AUDIT C in

vascular checks

A&EReview &

mapping. A&E champion

Training, development and

embedding

Children and Young

People

Training for 1,000 front-line staff on

screening and IBA

Increased referrals and prevention

Cardiff Model

Engage and consult stakeholdersMap Cardiff

requirements – data, pathway and resource

Implement and continue to improve

Identify existing Symphony data fields (free text)

to avoid IT upgrade

System now working, and

police acting on data received

Continual improvement and feedback

Scratch card scores

Scores above 5 could indicate that drinking levels are harmful or hazardous to health

3438 Scratch cards have been given out• 3322 Over the counter by pharmacies• 110 NHS Health checks (Chamber Health)• 3 Emergency Contraception• 3 Other• Details from Arrest Referral not yet available

Community Focus

Sale West Partnership, Trafford

Bilston East, Wolverhampton

Focussing on the wider social determinants

Bilston East, Wolverhampton

Community Workshop

Training for community members

and workers

Halo effect & Mentoring

• How does alcohol effect people?

• Neighbourhood development

• Awareness raising

• Increased knowledge

• Spreading the word

Addressing Marmot Policy Areas

Give every child the best start in life

Enable all children, young people and adults to maximise their capabilities and have control over their lives

Create and develop healthy and sustainable communities and places

Strengthen the role and impact of all health promotion

Maturing Partnerships

Different needs of sites

Health Inequalities

and prevention

New opportunities

and innovation

Financial austerity

Lessons Learned

• Partnerships take a while to mature and bed in with regular meetings between stakeholders

• The financial climate and the changing shift in staff has been problematic in some places

• Some issues need to be solved at a national level eg incentivising the delivery of IBAs

HPHL into 2011

• New sites joining• New Issues to discuss

– Transforming Communities– Social return on investment– Raising Aspirations

• NHS Institute is moving to Social Enterprise Model

• We would welcome discussions with potential new sites!

More information

• Website - www.institute.nhs.uk/commissioning/general/healthy_places_healthy_lives.html

• Flyer - www.institute.nhs.uk/images/documents/Healthy%20Places%20Healthy%20Lives/62934%20NHS%20Healthy%20Places%20A5%20flyer.pdf

• juliamiller@nhs.net HPHL Alcohol Lead 07903 218321