The Alcohol Systems Model. System Dynamics Society UK Gathering. Thursday 9 th February, 2012

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1 Department of Health (England) Alcohol Improvement Partnership The Alcohol Systems Model System Dynamics Society UK Gathering Douglas McKelvie Steve Arnold Eric Wolstenholme David Monk Thursday 9 th February, 2012

2 This is the population of England.

3 ABSTAINERS 5.8m DRINKING AT LOWER RISK 24.8m Common view of alcohol problems Binge drinking Dependence/alcoholism This project Broader health problems associated with alcohol CONSUMPTION Increasing Risk (> 2 glasses of wine per day for men, 1.5 for women) Higher Risk (> 3.5 or 2.5 glasses) DRINKING AT INCREASING RISK Dependent Drinking 1.1m 7.6m men who drink more than 3 to 4 units a day (2 glasses of wine) run an increasingly significant risk of illness and death from a Binge Drinking number of conditions, including 7.7m haemorrhagic stroke, some cancers, accidents and hypertension This is the population of England. UK General Lifestyle Survey HIGHER RISK DRINKING 2.9m Sources: General Household Survey 2006 and mid-2006 population estimates (ONS). dependent drinking fig - ANARP 2005 (DH)

5 Department of Health Ready Reckoner (Spreadsheet) user input Hillingdon Select PCT in drop down box below Admissions The Symmetric PCT Increasing Good News: to Project Risk Drinkers 44,751 tackle CONSUMPTION, Brief: as opposed to Hillingdon 5AT Higher Risk Drinkers 10, Dependent 5,867 Binge 21, BINGE DRINKING or DEPENDENT DRINKING, relatively inexpensive To develop treatments a (brief tool advice, similar brief interventions), to Alcohol Health Workers (AHW) Non-dependent drinkers 5000 Visits/admissions averted some of which can be implemented in primary care, can Number of nurses wte A&E hospital 4000 Ready Reckoner extra but cost benefit more of a 2009/ , , , / , , , be effective. 2011/ , , ,000 Alcohol model Health Workers (AHW) with a User Friendly 2000 Dependent drinkers visits/admissions averted Number of nurses wte A&E hospital extra cost benefit 2009/ , , ## As a way 2010/11 of demonstrating why 172 it 60,000 is worthwhile 145,200 to spend money Interface 2011/ , ,200 0 Treatment-dependent on drinkers these Number interventions, 5,867 the Department of Health MET or SBNT counselling packages (UKATT) developed a spreadsheet to be used by local Assumption Increase in treatment: percentage points of prevalence (ppop), or that input extra proposed to treat the Ready extra %popextra treated A&E hospital extra cost benefit 2009/ ,000 61,100 - Past trend commissioners. 2010/ ,500 71,700 - Projection 2011/ ,500 71,700 - Future trend with the selected interventions Reckoner was probably correct IBA - GP screening new registrants input number screened % screened who get BA 20% 16,979 screened A&E hospital extra cost benefit 2009/ ,500 14, / ,500 16, / ,500 18,700

6 Policies increasing increasing increasing Abstainers Lower Risk Increasing Risk Higher Risk reducing reducing reducing

7 Policies increasing increasing increasing Abstainers Lower Risk Increasing Risk Higher Risk reducing reducing reducing Services Services Services

8 Hospital Admissions increasing increasing increasing Abstainers Lower Risk Increasing Risk Higher Risk reducing reducing reducing Services

9 Policies increasing risk - Consumption time lag Hospital Admissions reducing risk + Services Services Services

10 Time Period Covered 20years New services are introduced in 2010 Further changes can be made when the model pauses Note the time delay before some effects register

11 What is the Underlying Flow Rate between Consumption Groups? It cannot be deduced from observing the stocks This simple insight led to the = Department of Health calculating, for the first time, what the underlying rate of movement between = consumption groups actually is.

(screen not shown) Then on the model dashboard, user can switch on these

12 The model works by enabling a user to Introduce a new service capacity, at a point in time Make assumptions about its impact on alcohol consumption (screen not shown) Then on the model dashboard, user can switch on these new service settings, and observe the impact on hospital admissions and total costs

13 Total admissions Total costs Change in admissions (pa) Change in total costs (pa)

16 Impact of Brief Advice Services on Whole Population over Time

17 Model simulates some key dynamics that are harder to show on a spreadsheet time delay between intervention and health improvement Cumulative impact on Population Dynamic view of changing consumption, new data Invest to save, the case is made, but there will be a few years of higher expenditure at a time when costs are tight Available as a runtime tool for commissioners in England (and anyone else interested) Wider public benefits of reductions in alcohol consumption can also be considered (some interest in the model from the criminal justice system) There may be less costly ways of reducing alcohol consumption, e.g. minimum pricing

18 For further information:- Model available at:- (or search for alcohol systems model Department of Health Alcohol Learning Centre England )

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