Ple Alchl Harm Reductin Strategy 2013-2015 Page 1
1. FOREWORD I am delighted t see the publicatin f the Ple Alchl Strategy 2013-15. It cmes at a time when the Gvernment has published its Natinal Strategy and the wrk that we have dne lcally is very much in keeping with the Natinal Strategy. This dcument sets ut ur achievements ver the past tw years and the wrk we want t d ver the next three years. That fact that alchl misuse can harm individuals, their families and the wider cmmunity, in a number f ways e.g. health, crime, is the basis f ur apprach. The Strategy makes clear just hw imprtant it is that each partner plays its part and hw achieving ur gals relies ttally upn partners wrking tgether. At a time when, mre than ever, we need t manage ur resurces carefully, we must fcus n activity that the evidence shws t wrk, but in ding that include peple s views n what wrks best fr them. T d this we will mnitr ur prgrammes and services frm varius viewpints and ensure we respnd apprpriately t these views. I am happy t endrse ur strategy and lk frward t seeing it in actin. Dr David Phillips Directr f Public Health Burnemuth, Drset & Ple Lcal Authrities Page 2
2. Executive Summary Ple In the Ple Alchl Harm Reductin Strategy 2010-2013 we stated that ur relatinship with alchl is cmplex. It still is; encuraging everyne wh drinks in Ple t d s in a safe, sensible and scial way is a big challenge. The NHS recmmends that men shuld nt habitually drink mre than 3-4 units f alchl daily and wmen shuld nt regularly exceed 2-3 units daily. Hwever, ver the years typical glass sizes have grwn and drinks have increased in strength. The ld belief that a glass f wine was abut 1 unit is nw ut f date. We are aware that there are different messages ging ut t the public abut what is safe drinking we will wrk n hw best t get acrss messages and als ask ur residents abut their knwledge f what is safe. We are cncerned in particular with tw main issues; the first is related t peple wh drink and cause harm t thers, while the secnd is related t peple wh drink, ften at hme, abve safe limits. This grup f peple are harming themselves, ften withut knwing it. They are drinking large amunts and feel this is nrmal. Latest estimates frm the Nrth West Public Health Observatry & Natinal Drug Evidence Centre suggests that fr Ple s aged 16+ ppulatins, 20,230 f us d nt drink. 75,044 are classed as lwer risk drinkers, meaning that the remaining 27,335 f the ppulatin aged 16+ are increasing r higher risk drinkers. It is als estimated in Ple that 18,650 f the aged 16+ ppulatin binge drink at least nce a week; and between 2002/03 and 2009/10 alchl attributable admissins in Ple increased by 54%. It wuld be crrect t say that there are peple lcally wh regularly drink at levels that put them at risk f suffering mre than 60 medical cnditins, ranging frm cancer t liver disease and strke. The majrity f these peple will be unaware f the risks they are taking. Hwever, mst f us d drink sensibly and enjy alchl; we d nt want drunken vilence, vandalism and packed emergency departments t be the hallmark f a weekend night ut in Ple. We als acknwledge the assciatin between mental illness and increasing risk f alchl dependence. If yu have a mental health prblem, yu are mre likely t drink at levels that put yur health at risk (Gvernment Alchl Strategy 2012). Fr children, emtinal and mental health prblems are assciated with the misuse f alchl. Whilst we await the Gvernment s new mental health strategy and the implementatin framewrk, we need t ensure that we aim t meet the needs f lcal peple with c-existing mental health and alchl prblems. Prgress has been made since Ple published its first Alchl Harm Reductin Strategy in 2007. The latest strategy aims t build n previus prgress, mirrr the new natinal alchl strategy and priritise identified lcal need. It will frge a clearer understanding f what is acceptable drinking behaviur, in rder t reduce the amunt f harm that alchl causes t individuals, families and ur lcal cmmunity. Page 3
Overall we are lking fr imprvements n the aims belw: these will be cmpared in 2015: A change in behaviur s that peple think it is nt acceptable t drink in ways that culd cause harm t themselves r thers; A reductin in the amunt f alchl-fuelled vilent crime A reductin in the number f adults drinking abve the recmmended guidelines A reductin in the number f peple binge drinking A reductin in the number f alchl-related deaths A sustained reductin in bth the numbers f 11-15 year lds drinking alchl and the amunts cnsumed A reductin in alchl related hspital admissins A reductin in alchl related hspital re-admissins In Nvember 2011, the Brugh f Ple Cmmunities Overview and Scrutiny Cmmittee held an alchl evidence day, t assess the 2010-2013 Alchl Harm Reductin Strategy and the dangers psed by high levels f alchl cnsumptin as part f everyday life. Several key recmmendatins were apprved and have been included within this strategy, these include: Intrducing a Night-time Ecnmy Strategy: Intrducing alchl specific services at Ple hspital Dialgue with the Health & Wellbeing Bard regarding strategy Explratin f minimum pricing f alchl Educatin and treatment fr yung peple and children Nuisance caused by drinking in public places Dmestic abuse Over the next few pages we have utlined the areas f wrk we will cncentrate upn. In Sectin 3 we have set ut what we feel we knw. Sme infrmatin is based upn natinal statistics while ther infrmatin is based upn what we knw lcally. In Sectin 4 we set ut what we have dne ver the past tw years, while Sectin 5 sets ut ur bjectives fr 2013-15. Page 4
2.1 Outcme Measures: Preventin Outcme measure Baseline Outcme target The number f peple aged 1,300 BIT Due t staff 18+, scring 8-19 AUDIT, cmpleted reductin; assisted t mderate their 2011/12 target 69 BIT drinking by successfully per mnth, 828 cmpleting a Brief per year: Interventin Therapy 21 x 69 = 1,449 T be achieved by December 2014 Number f peple aged 18+, scring 8-19 undertaken BIT, presenting SMART 12 mnths hence Ple hspital admissin episdes fr alchlattributable cnditins 2010/11 BIT clients: 1,409 Re-presented SMART in 2011/12: 9 = 0.64% Better than England average (August 2012) Less than 1% re-presentatin Significantly better than England average December 2014 August 2014 Lcal Alchl Prfile data available Treatment: Data cllated frm secndary treatment Outcme measure Baseline Outcme target T be achieved by Prprtin f clients wh N. 196, 75% 77% December 2014 successfully cmpleted Q2 data frm treatment in year t date Natinal Drug Treatment Mnitring System Prprtin f clients waiting 0% 0% December 2014 mre than three weeks t Q2 data frm start treatment Natinal Drug Treatment Mnitring System Enfrcement / crime Outcme measure Baseline Outcme target A reductin in the amunt 2011/12: 431 5% target year alchl related vilent n year: assaults 2012/13: 410 2013/14: 390 2014/15: 371 T be achieved by March 2015 Page 5
Ecnmy Outcme measure Baseline Outcme target T be achieved by A decrease in the prprtin 2011: 22% 15% December 2014 f ff-sales f alchl t persns under the age f 18, thrugh Test Purchasing Operatins Premises (ff sales) failing test purchases shwn t be cmpliant at subsequent check and with apprpriate prcedures in place 2011: 50% 80% December 2014 Prprtin f residents wh perceive drunk r rwdy behaviur t be a prblem n the lcal area 2011 Ple Place survey: 22% (27% 2008 Place survey) T see a reductin n the 22% 2015 Yung Peple: Outcme measure Baseline Outcme target T be achieved by Prprtin f YADAS clients 2011/12: Remain 92% December 2014 successfully exiting alchl 59/64: 92.2% treatment in year Imprvement n Ple Biannual Schl Survey 2011 8-12 year lds: 52% tried alchl nce 12-19 year lds: 28% never used alchl T see an imprvement n the baseline percentages December 2014 Thse wh had drunk alchl, 24% drunk mre than nce Page 6
The ravages f alchl abuse are disrupting sciety and csting huge sums in financial terms frm healthcare and law and rder. N level f alchl intake is safe yet we acknwledge and respect an individual s freedm f chice t enjy alchl in mderatin. T address alchl misuse the Ple Alchl Strategy aims t limit intake f the harmful, hazardus, dependant and binge drinkers amng ur ppulatin. Dr Nick Sharer, April 2012. Cnsultant Physician & Gastrenterlgist Ple Hspital NHS Trust During 2012 and 2013, significant changes are happening in relatin t key partners and partnerships which prvide pprtunities t further strengthen jint wrk t reduce the harm caused by alchl. The key changes are: Electin f the first Drset Plice & Crime Cmmissiner in Nvember 2012 Setting up f a Shadw Health & Well Being Bard in 2012/13 and a statutry Bard fr Burnemuth & Ple in 2013/14 Drset Clinical Cmmissining Grup t take n health cmmissiners respnsibilities and respnsibility fr Public Health t mve Cuncils thrugh a Pan Drset service frm April 2013. All partners will cntinue t wrk jintly thrugh the gvernance f Ple DAAT t develp and implement & mnitr Ple s Alchl Harm Reductin Strategy. Ple s Jint Strategic Needs Assessment & Burnemuth and Ple s Health and Well Being strategy will priritise the reductin f the harm caused by alchl. Jan Thurgd, September 2012. Strategic Directr, Ple Brugh Cuncil Page 7
3. Intrductin: Natinal and lcal scene setting Natinal: The fllwing key natinal facts are taken frm the Office f Natinal Statistics: Alchl-related harm csts the NHS arund 2.7 billin each year. Prfessinal classes are nw the mst frequent drinkers in Britain, 41% f them drinking abve recmmended limits at least nce a week. Liver disease is the nly majr cause f death still increasing year n year in the UK. Twice as many peple nw die frm liver disease as in 1991. In England in 2008 there were 6,769 deaths directly related t alchl. An increase f 24 per cent frm 2001. Of these alchl related deaths, the majrity (4,400) died frm liver disease. Overall, alchl cnsumptin is falling, at the same time alchl-related health prblems are increasing. Data nw suggests that rising numbers f peple are nw drinking at hme and drinking mre. Lcal: Latest synthetic (a statistical methd fr carrying estimates dwn t subppulatins) estimates f ppulatin aged 16+ in Ple (data frm Natinal Drug Evidence Centre and Office Natinal Statistics 2012 ) are: Abstainers: 16% ppulatin 20,230 Estimate f thse wh d nt drink Lwer Risk drinking: 61% ppulatin 75,044 Estimate (nt including abstainers) men wh drink less than 22 units f alchl per week and wmen wh drink less than 15 units: Increasing Risk drinkers: 17% ppulatin 20,476 Estimate (nt including abstainers) men wh drink between 22 and 50 units a week and wmen wh drink between 15 and 35 units a week. Higher Risk drinking: 6% ppulatin 6,859 Estimate (nt including abstainers) men wh drink ver 50 units per week and wmen wh drink mre than 35 units per week And as a separate calculatin Binge drinking: 18.9% drinking ppulatin 18,645 % adults wh cnsume at least twice the daily recmmended amunt f alchl in a single sessin (8 r mre units fr men, 6 r mre units fr wmen Estimatin Alchl use aged 16-24 in Ple (ONS, NDEC data) 2,488 d nt drink 10,171 lwer risk drinkers 2,553 increasing risk drinkers 434 higher risk drinkers 2,487 binge drinkers (these exist amngst abve 3 chrts) Estimatin 11-15 year lds in secndary educatin in Ple (statistics n Alchl: England, 2012) 3,502 drunk alchl at least nce 1,012 drunk alchl in last week Page 8
Ple Ppulatin aged 16+ Synthetic alchl estimates 6,859, 6% 20,476, 17% 20,230, 16% 75,044, 61% Abstainers Lwer risk drinkers Increasing risk drinkers Higher risk drinkers There are peple in Ple wh regularly drink at levels that put them at risk f suffering mre than 60 medical cnditins, ranging frm cancer t liver disease and strke. The majrity f these peple will be unaware f the risks that they are taking. Alchl Attributable Hspital Admissins in Ple: In 2009/10, 6,578 individuals in Ple were admitted t hspital either whlly r partly due t alchl. This was equivalent t 2,762 alchl attributable admissins, nce alchl attributable fractins were applied The 2,762 alchl attributable hspital admissins were made up f 667 whlly due t alchl (alchl specific) and 2,095 partially due t alchl (alchl related) Between 2002/03 and 2009/10 alchl attributable admissins in Ple increased by 54%. Alchl Attributable Hspital Admissins in Ple: DOH: Analysed by Suth West Public Health Observatry Publicatin date: February 2012 Page 9
Lcal Alchl Prfile fr Ple: Latest data available frm Nrth West Public Health Observatry: August 2012 5 YEAR TREND CHARTS Page 10
Lcal Alchl Prfile fr Ple: Latest data available frm Nrth West Public Health Observatry: August 2012 The abve data shws that fr Ple s Lcal Alchl Prfile; althugh alchl attributable hspital admissins are better than the England average fr male and females, the numbers have been steadily rising ver a 5 year perid. Page 11
4. Key Achievements frm previus Ple Alchl Harm Reductin Strategy Health educatin: One f the key initiatives frm the previus strategy was the utcme targets set fr the Brief Interventin Therapy Service prvided by CRI. Identificatin and Brief Advice (IBA) is pprtunistic case finding fllwed by the delivery f simple alchl advice. These are effective interventins directed at patients wh are nt typically cmplaining abut r seeking help fr an alchl prblem In Nvember 2011, the Brugh f Ple Overview and Scrutiny Cmmittee held an alchl evidence day, t assess the 2010-2013 Alchl Harm Reductin Strategy. One f the key recmmendatins was a re-examinatin as t hw yung peple are educated arund alchl Identificatin and Brief Assessment (IBA) has cntinued t be implemented in Ple Hspital. Fr every eight peple wh receive simple alchl advice, ne will reduce their drinking t within lwer-risk levels (Myer et al., 2002) In the 2 year perid April 2009 March 2011: 3937 Adult Brief Interventins were undertaken 161 adults had mre than 1 brief interventin 844 unique adult alchl referrals were made t Ple Treatment System between April 2009 and March 2011. An estimated 470 f the adults wh undertk a brief interventin in the said perid are likely t have reduced their drinking t within lwer-risk levels. All the utcme measure targets set in the previus strategy were met: Increase in the number f peple aged 18+ presenting t A & E and scring 8-19 using AUDIT assisted t mderate their drinking. 1650 Outcme target met. Increase in the number f hazardus and harmful drinkers assisted t mderate their drinking by successfully cmpleting BITS. 2750 Outcme target met. Ple hspital admissins fr alchl related harm. Outcme target Significantly better than England average met. Page 12
Alchl and the Night Time Ecnmy (NTE) In Nvember 2011, the Brugh f Ple Overview and Scrutiny Cmmittee held an alchl evidence day, t assess the 2010-2013 Alchl Harm Reductin Strategy. One f the key recmmendatins was the develpment f a NTE strategy fr Ple and that a strategic directr will be taking the lead fr this piece f wrk. Christmas 2011, a peak time fr vilent disrder related t the night-time ecnmy, Safer Ple ran a successful Operatin Spt which invlved British Transprt Plice drugs dgs in Ashley Crss and n Ple Quay; and high visibility plicing at peak times. This peratin received gd media cverage fr the Partnership. The Tactical Operatinal Grup is nw fcussing n implementing a street pastr scheme with the vluntary sectr, addressing licensing issues at key premises in the twn and the intrductin f a Public Disrder Ntice Diversin Scheme fr alchl related ffending. The fllwing NTE utcme measures set in the previus strategy were met: Prprtin f Ple residents wh perceive drunk r rwdy behaviur t be a prblem in the lcal area. Outcme target 24% met. Actual 22% Increase the number f alchl related ffenders assisted t mderate their drinking by successfully cmpleting Alchl Treatment Orders. Outcme target f 20 met A reductin in the number f alchl related assaults in Ple. Outcme target 2% imprvement met: Latest imprvement 2011: 3.88% The fllwing NTE utcme measures set in the previus strategy are nging: A decrease in the prprtin f ff-sales f alchl t persns under the age f 18, thrugh Test Purchasing Operatins nging Test purchasing failure rate reduced frm running at 24% in December 2011 t 19% end February 2012. Cmpliance rates cntinue t imprve Premises (ff sales) failing test purchases shwn t be cmpliant at subsequent check and with apprpriate prcedures in place Since 2010 there have been 4 premises where repeat sales have been a cncern Page 13
Alchl & Dmestic Abuse (DA) One f the key initiatives in Alchl Treatment services in Ple has been the identificatin and actin n Safeguarding issues such as dmestic abuse Clients that enter the Ple system fr drug r alchl misuse will receive a risk assessment, even if they d nt engage with ur treatment services. This allws fr the identificatin f risks that a client may present t themselves r t ther peple, including identifying if a persn is a victim r perpetratr f dmestic abuse. If a persn is a victim f DA then a check will be made with the Brugh f Ple (BOP) Adult Safeguarding Help Desk r Children and Yung Persn s Safeguarding Help Desk and a discussin as t whether a vulnerable adult r child alert shuld be raised. Even if an alert is nt raised, advice and signpsting t lcal DA services r the plice are given. A representative frm the Ple treatment system attends the Ple MARAC meetings chaired by Drset Plice and intelligence regarding clients (as victims r perpetratrs f DA) in treatment. Infrmatin is shared with ther treatment agencies s that a risk actin plan can be devised and implemented t reduce the risk f further DA t either adults r children. The intrductin f the Cardiff Mdel in Ple Hspital has als increased tactical intelligence between data captured in the Emergency Department and the Plice. The Cardiff Mdel utilises annymised infrmatin btained frm Emergency Department (ED) patients abut the precise lcatin f vilence, weapn use, assailants and day/time f vilence. Evaluatin has shwn that this mdel enhances the effectiveness f targeted plicing and lcal authrity effrt, and significantly reduces serius vilence recrded by the plice and vilence-related hspital admissins. The verall bjective f the Cardiff Mdel is t prevent vilence and reduce the alchl-related burden n emergency services. This apprach has been fund t be effective in clinical trials The fllwing utcme measure set in the previus strategy was maintained: Decrease in the prprtin f alchl flagged dmestic crimes: Outcme target 27-28% maintained Page 14
Alchl and Older Peple The fllwing utcme measures set in the previus strategy were met: Increase in the number f peple aged 60+ assisted t mderate their drinking by successfully cmpleting Brief Interventin Therapies (BITS): Outcme target f 206 significantly exceeded. Maintain the prprtin f alchl client aged ver 60 effectively engaged in Ple secndary addictin treatment services. Outcme target 88% maintained. The rganisatins thrugh a Pan Drset wrking grup and an lder persn fcus grup will fcus n tw areas: Preventin: Braden public and prfessinal knwledge arund alchl misuse and the risks t health as we grw lder Interventin / treatment: Ensure treatment is tailred twards individual need and the stigma f accessing treatment is reduced. Each area will have an actin plan, a timescale and a lead; details f actins will be identified and priritised within the wrking grup. The wrk will require c-rdinatin and cmmitment frm rganisatins and individuals invlved but als input frm ther external agencies s the Pan Drset ppulatin are educated and have an awareness f lder peple and alchl related issues. --------------------------------------------- Alchl Treatment Services With a strng fcus n the recvery mdel; the Ple Treatment System has cncerned itself with the utcme gal f enabling service users t attain addictin free lifestyles thrugh its aftercare prgramme. As well as a therapeutic emphasis n sbriety, clse links are als frged with Jb Centre Plus, Alchlics Annymus and the Ple Service Users Frum. Care pathways and eligibility criteria have been develped adhering t NICE alchl guidelines 24, 100 & 115 The fllwing utcme measures set in the previus strategy were met: Increase in alchl clients effectively engaged (retained 12 wks/discharge success) 87% target met Number f Aftercare clients cmpleting treatment addictin free : latest sample size 2011 significantly exceeded 40% target The fllwing utcme measure set in the previus strategy was maintained: A decrease in waiting times fr alchl treatment: average wait 3 weeks maintained Page 15
Alchl and Yunger Peple YADAS (Yung Peple s Drug & Alchl Service) have undertaken the fllwing alchl initiatives: Yung peple aged 16 25 attending BWISE drink / drive initiative alchl wrkshps. Yung Ambassadrs, frmer clients have becme vlunteers, generating referrals; and becme mentrs t ther yung peple. Friday Night Prjects at Limelight s Yuth Club and Turlin Mr Yuth Club. These clubs pen Friday nights t help reduce/delay yung peple s alchl intake. Grup drug & alchl educatin at St Aldhelm s and Ple High Schl: sessins f alchl and drug educatin Links with Ple Hspital Emergency Department Stands & Events include: Cmmunity Fun Days and Fcus Ftball events, prmting alchl educatin Prmtin f YADAS at the Ple & Burnemuth Cllege, discussing alchl awareness. YADAS awareness talks t Duke f Edinburgh participants including the dangers f alchl use in risk taking behaviur and effects n unbrn children. Outreach includes clse links t Mbile Yuth Prject. The Key Wrker visits selected areas where yuth wrkers have identified an issue and ffers supprt t the staff and t the yung peple n an infrmal educatin basis. Carter Media Prject: a grup have prduced a vide and radi sessin based arund alchl awareness and educatin; this can be utilised by YADAS in future educatin but culd als be sld t ther schls fr educatin sessins in PHSE. Drp in dne at Ple Quay Advice Centre s yung peple can discuss alchl withut having a referral made. The fllwing utcme measures set in the previus strategy were met: Yung peple assisted t mderate their drinking by successfully cmpleting either a BIT r extended brief interventin. Outcme target 100 by 31st March 2012. 122 either successfully cmpleted r still pen mid March 2012. Percentage f yung peple that are re-referred t YADAS within 12 mnths f BIT. 2 re-referrals in 2011. The fllwing utcme measure set in the previus strategy has remained at the baseline level: Presentatins f U 18s at ED fr alchl related issues. Remained at England average Page 16
5. Strategic Objectives fr 2013 2015 a. Preventin Objective: T shift ppulatin levels f alchl cnsumptin dwnwards s that: Fewer Ple residents drink at excessive levels knwn t be harmful Fewer Ple residents drink at levels abve the gvernment recmmended limits Fewer Ple residents binge drink Fewer Ple pregnant wmen drink at all Fewer Ple residents under 18 drink alchl at all Braden public and prfessinal knwledge arund alchl misuse and the risks t health t lder ppulatin. Knwledge Base The Lcal Alchl Prfile fr Ple shws that fr many measures, drinking patterns in Ple reflect the natinal (England) trend, which is a slw, but steady increase. This is a majr cncern because these rates f alchl cnsumptin are causing majr and increasing damage t health the trend is in the wrng directin Lcal data fr mental health diagnses and treatment (NHS Burnemuth and Ple JSNA) shw that alchl-related cnditins are the single mst cmmn diagnsis. Depressin and anxiety directly affect ne in fur f the adult ppulatin during their lifetime, and ne in ten at any ne time. Far t many f us are self-medicating with a drug-alchl-which is bth a depressant and addictive. In lder peple, dementia is the mst cmmn diagnsis, and dementia is strngly linked t lifetime rates f alchl cnsumptin. NICE recmmends the fllwing evidence-based actins t prevent harmful drinking: Licensing: Use f lcal crime and related trauma data t map the extent f alchl-related prblems befre develping r reviewing a licensing plicy. Brief Interventin Therapy: NHS and lcal authrities shuld priritise alchl-use disrder preventin. Extra supprt fr children and yung peple aged 10 t 15 years wh are thught t be at risk frm their use f alchl Screening yung peple aged 16 and 17 fr elevated risk frm alchl Extended brief interventins with yung peple aged 16 and 17 years Screening adults pprtunistically, as a rutine part f NHS treatment. Brief Advice fr adults wh have cme int cntact with the NHS as a result f harmful drinking. What is already being dne lcally? Jint wrk thrugh the Safer Ple Partnership, using lcal health and crime data t identify areas f high alchl-related crime and ill-health, and use licensing and ther measures in mitigatin. Brief Interventin is currently ffered t new registratins in primary care settings. What we intend t d Augment the Brief Interventin Service s as t reach mre f thse in need, and extend the age range dwn t 16. Ensure Identificatin and Brief Advice is carried ut in all primary settings by General Practitiners and Practice Nurses, fr bth new and existing registratins Recgnise and supprt the Gvernment s recmmended minimum unit price Page 17
b. Treatment Objective: T develp recvery rientated alchl treatment pathways, that ensure services are apprpriate, timely and achieve successful utcmes that meet the specific needs f each individual client. Knwledge Base Alchl use disrders: diagnsis, assessment and management f harmful drinking and alchl dependence (NICE clinical guideline 115, 2011) The guideline is supprted by audit supprt, baseline assessment tl, csting reprt, csting template, slide set and sample dsing regimens (CG115 Alchl dependence and harmful alchl use: sample chlrdiazepxide dsing regimens fr use in managing alchl withdrawal) NICE recmmends that clinical guideline 115 shuld be read alngside: Alchl-use disrders: preventing the develpment f hazardus and harmful drinking (NICE public health guidance 24, 2010), and Alchl-use disrders: diagnsis and clinical management f alchl-related physical cmplicatins (NICE clinical guideline 100, 2010). Lcal Rutes: Guidance fr develping alchl treatment pathways Review f the effectiveness f treatment fr alchl prblems Mdels f Care fr Alchl (MOCAM) The Department f Health recmmends that an evidence-based recvery rientated alchl treatment system shuld prvide: Screening f the target ppulatin and actin with hazardus and harmful drinkers Assessment f the needs f individuals with identified alchl prblems Care planning t meet the assessed needs f thse with alchl prblems A range f structured treatment interventins Supprt fr individuals t help maintain the gains they have made frm treatment Management f alchl treatment services What is already being dne lcally? Brief Interventin is currently cmmissined by the NHS, delivered by the Prvider CRI. The less-intensive treatments that extend beynd brief interventins prvide the bridge between the general healthcare brief interventin and the alchl fcused specialist treatment. This currently sits within the nn-statutry team, currently EDAS. Alchl-fcussed Treatment is mstly carried ut in EDAS, althugh PACT, thrugh their new cntract will als be treating nn medical prblematic drinkers. This grup is best described as when treatment has cntinued beynd the less intensive stage. Higher intensity Cgnitive Behaviural Therapy and mtivatinal treatments are carried ut. Cmmunity Alchl Detxificatin (CAD), will be taking place, thrugh PACT. Relapse preventin is nt the dmain purely f aftercare services; It is a therapy and skill that is ever-present in the treatment f alchl misuse. Althugh the amunt f research n aftercare is nt large, the evidence in its favur is impressive. Structured aftercare within the Ple Treatment set-up is currently administered in the nn-statutry team, EDAS. Outcmes frm the service are favurable. What we intend t d Cnslidatin f alchl care pathway, including eligibility criteria fr different strands f alchl interventins Explre need fr a dedicated 18-24 service Ensure all staff and vlunteers have bth the apprpriate qualificatins and are delivering an evidence based treatment Ensure there is a seamless link between hspital liaisn pst(s), cmmunity alchl detxificatin and secndary alchl treatment services, including SMART Achieve high recvery rientated utcmes as prduced by new Natinal Alchl Treatment Mnitring System Ensure apprpriate links fr clients with c-existing alchl and mental health prblems Page 18
c. Enfrcement / crime Objective: T reduce alchl misuse and its impact n alchl related crime and disrder, ensuring the impact f alchl in increasing victim vulnerability is reduced and the impact f alchl n ffending behaviur is reduced Knwledge Base Direct Gv, Crime and Justice, Alchl and Crime Institute f Alchl Studies, Alchl and Crime, July 2010 Alchl Cncern Making Sense f Alchl, Alchl and Crime Licensing Act 2003 Plice Refrm and Scial Respnsibility Bill 2012 - rebalances the licensing act 2003 t help deal with the prblem f late night drinking thrugh the intrductin f a late night levy and early restrictin rders, and reduces the evidential threshld n licensing authrities What is already being dne lcally? Implementatin f a Pan-Drset Reducing Reffending Strategy Implementatin f a virtual Integrated Offender Management Team Sexual Assault Referral Centre Cmmissined a Pan-Drset Independent Sexual Vilence Advisr Service Implementatin f Operatin Prtect, targeting night time ecnmy issues Engagement and attendance by PACT at the dmestic abuse Multi Agency Risk Assessment Cnferences Dmestic Abuse featured within initial alchl assessments carried ut by SMART Onging licensing enfrcement Repeat premises being flagged thrugh the Drset Plice database Implementatin f Fixed Penalty Ntices What we intend t d The cntinuatin f Operatin Prtect, targeting night time ecnmy issues The launch f street pastr scheme acrss the twn The cntinuatin f the Sexual Assault Referral Centre The re-cmmissining f the Pan-Drset Independent Sexual Vilence Advisr service The develpment f a Sexual Vilence Strategy The develpment f a night time ecnmy strategy fr Ple Onging licensing enfrcement via the Ple Safe Partnership Establish an Alchl Cnsumptin Designated Public Places Order fr Ple Twn and Ashley Crss, aimed at reducing the incidence f anti scial behaviur caused by alchl cnsumptin in public places Prgramme f underage test purchasing fr alchl frm retail utlets, t reduce the incidents f alchl sales t children and yung peple The identificatin f Serial Perpetratrs f Vilence (SPOV s) and Dmestic Abuse Serial Perpetratrs (DASP s). These ffenders will be managed by the cmmunity safety partnership peratinal grup, with individual multi agency plans put in place fr each ffender Imprve data cllectin in A&E regarding assaults, including where they are alchl related Investigate the feasibility f extending Fixed Penalty Ntices utside f custdy and int the cmmunity. Page 19
d. Ecnmy Objective: T develp an effective night time ecnmy strategy fr Ple which delivers r enables psitive ecnmic utcmes balanced with reduced alchl harm Knwledge Base Updated Cre Strategy references the imprtance f the evening ecnmy in Ple. It states that develping the evening ecnmy cntributes t a number f strategic bjectives in the Cre Strategy, t revitalise the Twn Centre and t create lcally Distinctive and Self Reliant Places. The evening ecnmy cmplements the daytime ecnmy by ensuring that an apprpriate mix f uses ffers vitality and viability t the Twn and Lcal Centres. It is als a key cmpnent f ur turism ffer. The Cre Strategy sets ut plicy prpsals related t supprting the evening ecnmy, with particular emphasis n supprting turism. The twn centre and Quay are nly part f the picture. Ple has a number f vibrant night spts, mst ntably Ashley Crss which is a largely safe and attractive place fr lcal peple. Hwever, clleagues acrss the Cuncil are receiving increasing numbers f cmplaints and issues being raised related t the strng night time activity in the area. While very lw, the numbers f incidents f crime and anti-scial behaviur in the area have increased ver the past 12 mnths. What is already being dne lcally? Plice and licensing clleagues are wrking clsely t manage and mnitr issues that arise as a result f the night time ecnmy, particularly alchl. The mnthly Safer Ple Partnership Operatinal Grup reviews reprted crime/asb cnnected t licensed premises, including alchl related incidents which result in ambulance r A&E attendance where data is available It is well established that alchl impacts n crime and disrder including dmestic vilence and can have significant negative effects n health. Thrugh new legislatin, lcal health bdies are nw recgnised as respnsible authrities and have the ability t cntribute and effect licensing decisins. Health bdies will be able t cmment n licensing arrangements in relatin t ptential impacts n the health and wellbeing f Ple residents. Lcal public health infrmatin will help supprt the delivery f the utcmes identified in the strategy. What we intend t d There is a need t map mre cmprehensively what the current psitin is. It has been difficult t btain any indicatin f the ecnmic value f the night time ecnmy, number f jbs etc as yet. Prducing such a strategy has been cnsidered a lw pririty due t its lw ecnmic prfile and this needs further cnsideratin. There is a need t draw tgether the evidence and identify the right partners t discuss what srt f strategy will deliver the best utcmes fr Ple, and agree clear utcmes which meet ecnmic and alchl harm reductin utcmes. Page 20
e. Cmmissining & Partnerships Objective: Partnerships need t cmmissin utcmes. Mdels f Care fr Alchl (MOCAM) describe the verall utcmes sught (t the individual, t thers directly affected by their behaviur and t the wider cmmunity) and an imprvement in the health and scial functining f the alchl misuser. Knwledge Base Signs fr Imprvement: Cmmissining interventins t reduce alchl-related harm. 'Signs fr imprvement - cmmissining High Impact Changes: http://www.alchllearningcentre.rg.uk/tpics/brwse/hic/ Department f Health has identified a number f High Impact Changes (listed belw are the nes that have clear evidence t their effectiveness) which have the greatest impact n alchl health cmmissined utcmes and suggests sme recmmended actins fr areas where tackling alchl-related harm has been identified as a pririty: Imprve the effectiveness and capacity f specialist treatment: Ensure the prvisin and uptake f evidence-based specialist treatment fr at least 15% f estimated dependant drinkers in yur area Appint an Alchl Health Wrker (s): Cmmissin an adequate number f Alchl Health Wrkers r Alchl Liaisn Nurses t wrk acrss the acute hspitals Identificatin and Brief Advice (IBA) Prvide mre help t encurage peple t drink less: In primary care: New registrants; Cmmissin identificatin and brief advice as per the Directed Enhanced Service (DES) fr all new registered patients. At risk grups; Cnsider extending cverage thrugh a cntract with primary care t additinal at risk grups such as all men aged 35-54 r thse patients n existing Quality Outcme Framewrk (QOF) registers In hspital settings: Brief Interventin(I BA) in ED and specialist units (e.g. fracture clinics); Cmmissin a specialist alchl nurse linked t every accident and emergency unit where there is apparent need What is already being dne lcally? Wrking in Partnership Alchl related needs is t be included in Jint Strategic Needs Assessment (JSNA). DAAT cntinue t c-rdinate lcal initiatives Develping activities t cntrl the impact f alchl misuse in the cmmunity Partnership wrk in the nging develpment f a Night-time ecnmy strategy is being driven by and utilised alngside existing laws, regulatins and cntrls available t lcal partners. Influence change thrugh advcacy High prfile alchl champins have been identified within Burnemuth & Ple NHS and lcal Authrity Cmmissining rles: including Service user frum. Appintment f hspital liaisn wrker Pst cnfirmed by Ple Hspital IBA Partners are still cmmitted t the cmmissining f IBA What we intend t d Ensure effective use f alchl needs assessment and lcal intelligence in cmmissining alchl services Ensure alchl utcmes are being cmmissined rather than utputs Ensure all cmmissining decisins are based n evidence based practice and data Page 21
f. Yung Peple Objective: Fewer Ple yung peple under 18 years drink alchl at all and a sustained reductin in bth the numbers f 11-15 year lds drinking alchl and the amunt cnsumed Knwledge Base YADAS Data Yung Peple s Needs Analysis 2012 Ple DAAT LAPE (Lcal Alchl Prfile Data) The Gvernment s Alchl Strategy The Ryal Cllege f Psychiatrists (RCPsych) has published new practice standards fr the care f yung peple with substance misuse prblems What is already being dne lcally? YADAS prvides team f prfessinal staff ready t engage with yung peple aged 10 t 19 wh live in Ple and have drug and/r alchl prblems. The YADAS team ffers a full range f treatment ptins, frm 1 t 1 advice, cunselling, grup wrk and detxificatin if needed. The service is set up t ffer appintments in lcatins suitable and cnvenient t the yung persn. This culd be within the schl, hme, yuth club, advice centres r any ther lcatin suitable fr the yung persn. YADAS als ffers the pprtunity t becme invlved in scial activities, educatin packages and aftercare supprt t allw fr the best pssible utcmes fr yur future. What we intend t d Ensure prmpt and effective referral pathways frm Ple A&E t YADAS YADAS nurse t prvide fllw up appintments fr all alchl related A&E admissins Prmte take up and cmpletin f Brief Interventin Therapies training All universal and targeted services Mnitr number f extended BIT interventin against base line figure Maintain NTA targets fr successful cmpletin rates fr YADAS treatment prgrammes and lw re-presentatin rates Achieve imprved resilience and stability fr yung peple fllwing apprpriate treatment Ensure suitable step-dwn and supprt services fr vulnerable yung peple fllwing treatment acrss universal and targeted services Prvide IAG fr wrk, emplyment and training. Increase Emplyability fr yung peple nt in educatin, r emplyment. Prvide suitable accmmdatin fr YP in treatment and after care Page 22
6. Summary / Recmmendatins The actins and utcmes within this strategy have been drawn up carefully by members f Ple Partnership. Annual actins frm the strategy are dcumented in tw separate dcument papers: The Ple Adult Harm Reductin Alchl Actin Plan Children s and Yung Peples Harm Reductin Alchl Actin Plan 7. Glssary / References Substance Misuse Assessment Referral Team (SMART): Single pint f access fr anyne wh is a Ple resident and ver 18 years ld, with a drug r alchl prblem. Referrals can be made be service users, GPs, Ple General Hspital, ther services, prviders and cmmunity agencies. Ple Addictins Cmmunity Team (PACT): A multi-disciplinary team made up f dctrs, scial wrkers, nurses and psychlgists respnsible fr the treatment f individuals experiencing mderate t severe substance misuse prblems. Ple Drug and Alchl Actin Team (DAAT): A lcal multi-agency c-rdinating grup cmmitted t wrking in partnership t tackle drugs and alchl by prmting educatin and treatment thrugh care and aftercare. YADAS: Yung Adults Drug and Alchl Service prviding supprt, infrmatin and treatment fr yung peple aged 10-19 Ple Opinin Panel: A representative grup f lcal residents wh participate in tw surveys per year t help the Cuncil keep in tuch with the views f lcal peple Ple Partnership: The Lcal Strategic Partnership fr Ple which made up f many rganisatins aiming t achieve lng-term imprvements t the quality f life fr Ple peple. Its rle is t establish what is imprtant t Ple peple in the lng-term, t identify what wuld imprve their quality f life, t develp an actin plan fr imprvements (the Cmmunity Strategy) and t ensure that these actins take place and mnitr and reprt prgress. Ple Safe Scheme: A partnership plan between agencies and the licensing industry with the aim f reducing crime and disrder t ensure Ple is a safe place t enjy an evening ut. Safer Ple Partnership: A partnership f lcal rganisatins dedicated t tackling crime and substance misuse within the Brugh NTA: The Natinal Treatment Agency is a special health authrity, created by the Gvernment in 2001 t imprve the availability, capacity and effectiveness f treatment fr drug and alchl misuse in England. The functin f the NTA will cntinue in Public Health England frm 2013. NTE: The Night-time Ecnmy BIT: Brief Interventin. An alchl brief Interventin is pprtunistic case finding fllwed by the delivery f simple alchl advice: these are effective interventins directed at patients drinking at increasing r higherrisk levels wh are nt typically cmplaining abut r seeking help fr an alchl prblem AUDIT: Alchl Use Disrders Identificatin Test. A test t determine levels f alchl risk and dependence CRI: Crime Reductin Initiative; the team wh currently deliver alchl brief interventins in Ple. Key Cntact Numbers: Alchlic Annymus 01202 296000 Alchl Services Directry 020 7403 0888 Crime Reductin Initiative (CRI) 01202 318410 Children & Yung Peple s Scial Care 01202 735046 Essential Drug & Alchl Service (EDAS) 01202 733322 Envirnmental & Cnsumer Prtectin Services 01202 261700 Husing and Cmmunity Services 01202 633804 NHS Burnemuth and Ple 01202 541400 NHS Direct 0845 4647 Ple Addictin Cmmunity Team (PACT) 01202 633875 Ple Drug & Alchl Actin Team (DAAT) 01202 261016 Ple Plice 01202 222222 Ple Safe Tgether Partnership 01202 223331 Ple Service User Frum 07779 880221 Substance Misuse Treatment & Referral Team (SMART) 01202 735777 Yung Adults Drug & Alchl Service (YADAS) 01202 741414 Natinal Treatment Agency www.nta.nhs.uk Page 23