4 th largest seaside town in UK 2 nd most densely populated Most densely populated which is 100% seaside Typical presentation for a town of its

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Alexia Mason
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1 Glyn Halksworth

2 4 th largest seaside town in UK 2 nd most densely populated Most densely populated which is 100% seaside Typical presentation for a town of its scale. Or is it? Tourism and alcohol Regional hub University Thriving NTE

3 1. Nature and scale of issue 2. What we did / are doing in Southend

4 Over 1m adults affected by alcohol misuse in UK, with over 24% of people consuming alcohol in a way which is potentially or actually harmful to their health (Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE CG ) Costs are reckoned at 21bn annually for England broken down as: - NHS costs, at about 3.5 billion per year (at costs) - Alcohol-related crime, at 11 billion per year (at costs) - Lost productivity due to alcohol, at about 7.3 billion per year (at costs, UK estimate) (Govt. Alcohol Strategy) Scarborough et al suggest alcohol-related ill health is as costly to the NHS as smoking: 5.8 bn was spent on poor diet-related ill health, 3.3 bn on alcohol-related ill health, 3.3 bn on smokingrelated ill health, 0.9 bn on physical inactivity-related ill health (Scarborough, P., Bhatnagar, P., Wickramasinghe KK, et al (May 2011)., 'The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to NHS costs'. Journal of Public Health, Oxford, vol 33:4, pp )

7 Acute Chronic Homicide Suicide Other intentional injuries (i.e., interpersonal violence) Domestic violence Sexual assault Unprotected sex Motor vehicle accidents Other accidents Drowning Burns Public disorder Liver cirrhosis and other forms of alcohol-related liver disease Hypertension and haemorrhagic stroke, CV disease Cancers of the mouth, larynx, pharynx, and oesophagus Colorectal cancer and breast cancer Foetal alcohol syndrome (FAS) and foetal alcohol effects Mental illness Alcohol dependence syndrome CV=cardiovascular disease 7

8 For people aged years, the leading risk factor worldwide was alcohol use. 8

Age standardised mortality rate per 100,000 Age standardised mortality rate per 100,000 Deaths from chronic liver disease and liver cirrhosis, 1950 to 2006 Deaths in Scotland are increasing at a

10 Age standardised mortality rate per 100,000 Age standardised mortality rate per 100,000 Deaths from chronic liver disease and liver cirrhosis, 1950 to 2006 Deaths in Scotland are increasing at a greater rate than in England and Wales Other European countries Scotland England and Wales % liver deaths due to alcohol 20% viral Men aged years Women aged years Source: Changing Scotland s relationship with alcohol: a discussion paper on our strategic approach, Scottish Government, Drug & Alcohol Services in Scotland. Report prepared for the Auditor General for Scotland and the Accounts Commission. Audit Scotland. March

11 Cause specific relative risks by alcohol consumption. White I R et al. BMJ 2002;325:191

12 Hart C L et al. BMJ 2010;340:bmj.c

13 Source: The state of the nation facts and figures on England and alcohol, Alcohol Concern, 2013(?)

16 116k adult drinkers in Southend Increasing risk drinking: units weekly for men, units weekly for women. - 22,968 drinkers in Southend Higher risk drinking: 35+ / 50+ units per week. - 8,352 drinkers in Southend Alcohol-related hospital admissions: - 1,670 drinkers in Southend And yet..only about 500 people each year get specialist alcohol treatment

17 In most (all?) areas specialist treatment capacity falls short of estimated need There is likely to be a significant level of treatment initiated in primary and secondary care, much of which is delivered outside of a treatment planned framework with variable outcomes Capturing this treatment within a more outcome focused framework offers significant benefits to service users, practitioners and commissioners Building capacity for the identification and effective treatment of alcohol use disorders in non (addictions) specialist services will allow specialist services to focus on those with more severe and complex levels of need

18 Risk of death (%) The benefits of reducing drinking Lifetime risk of death due to alcohol-related injury Alcohol consumption (g/day) Reductions in high consumers big health benefits Men Women Rehm et al. Addiction 2011;106(Suppl 1):11 19

19 A number of studies have identified low levels of identification and treatment of alcohol use disorders. Alcohol Related Needs Assessment Project (ANARP) found extremely low levels of formal identification, treatment and referral of patients with alcohol use disorders. Lock et al survey of 419 GP principles (one per practice) concluded that GP s remain poorly motivated to engage with the treatment of alcohol problems. The main barriers identified were: Too busy (63%) not adequately trained (57%) and GMS does not encourage work with alcohol problems (47%). The most likely incentives were identified as better access to support services (87%), if interventions were proven to be effective (81%) and if patients requested advice regarding their alcohol use (80%) Ref: 1. Alcohol Needs Assessment Research Project (ANARP) The 2004 national alcohol needs assessment for England Lock C, Wilson G, Kaner Et al. A Survey of General Practitioners Knowledge, Attitudes and Practices Regarding the Prevention and Management of Alcohol-Related Problems: An Update of a World Health Organisation Survey Ten Years on. London: Alcohol Education and Research Council; 2009.

20 Which of the following areas have you been trained in? YES NO No but other practice staff have Screening and Brief Advice 83% 11% 6% Treatment planning for alcohol use disorders Clinical management of alcohol withdrawal The use of medications to support relapse prevention 55% 42% 3% 57% 40% 3% 53% 45% 2% Note: Online survey to all GP s in the UK circulated twice by both the Royal College of General Practitioners and the Substance Misuse in General Practice (SMMGP). The sample is self selecting and too small to be considered representative. It is likely that the positive responses e.g. those who report access to training, may be elevated by the response from members of the SMMGP who are actively involved in treating drug and alcohol problems.

21 Which of the following are currently commissioned in your area YES N0 I am unsure Primary care alcohol liaison nurses 31% 47% 23% Services where patients can self refer for advice regarding their alcohol use GP led alcohol clinics for moderately dependent drinkers 73% 12% 15% 15% 69% 6% Specialist community alcohol team 87% 5% 8%

22 F Specific (isolated phobias) F Generalized anxiety disorder F45 - Somatoform disorders F Panic disorders Other ICD-10 code F42 - Obsessive compulsive disorder F32 - Depressive disorder F Social phobia Z Disappearance and death of a family member F Mixed anxiety and depressive disorder No code provided F99 - Mental disorder, not otherwise classified F50 - Eating disorders F33 - Recurrent depressive disorder F Agoraphobia (with or without history of panic disorder F Post-traumatic stress disorder F31 - Bipolar affective disorder F10 - Mental and behavioural disorders due to the use of alcohol Source: Psychological Therapies, Annual Report on the use of IAPT services - England, HSCIC (2014)

23 Survey of 129 key stakeholders (unpublished)

24 Health intervention is needed for all patients with mild moderate dependence 75% Alcohol services are effective at addressing mental health in my area 52% Those at risk of alcohol related harm remain undetected 91% Alcohol use is not sufficiently prioritised by commissioners in my area 77% Commissioning of alcohol services must increase to extend provision from 6% of alcohol dependent patients to 15% by the end of %

25 There is sufficient investment in alcohol treatment services in my area by commissioners 28% Funding streams for alcohol services (from screening through to medication) are clear in my area 22% Greater investment is needed in community alcohol services to meet current and future treatment needs addressing harmful for alcohol use 98% Funding for treatment needs to be agreed and clear 100%

26 PCTs, alcohol (and drugs!) and block mental health contracts 3 year procurement cycles and the death of innovation Southend s (developing) approach commissioning not procurement ROSC

Addiction and Substance misuse pathways

Addiction and Substance misuse pathways Gordon Morse Chief Medical Officer Turning Point UK Gordon Morse statement of interests Sole employer Turning Point Some unpaid advisory work to the Hepatitis C