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
Alcohol related hospital admissions
(wholly and partially attributable to alcohol)
Outpatients, A&E, Ambulance
GP consultations, practice nurse consultations
Specialist treatment services
Dependency services
Impact on families
£2.9
Crime
Employers
Offenders under the influence
Young people committing criminal damage
Vehicle-related thefts
Crime and Anti-Social Behaviour
Domestic violence
Fear of crime & impact on environment £8.0
Average employee absence (7.4 days per year)
11 million working days annually
Sickness 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
Wolverhampton
Isle of
Wight
Reducing
alcohol
harms
Great
Yarmouth and
Waverney
Brighton
and Hove
Trafford
Intelligence
Strategy
Infrastructure
Return on
Investment
IBA
Service
Focused and
innovation
interventions
Governance
Systems &
processes
Community
Approaches
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
Alcohol Strategy:
Isle of Wight,
Wolverhampton,
Brighton, Gt
Yarmouth
• 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
City-wide
Intelligence,
Wolverhampton
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Benefits realisation,
Gt Yarmouth &
Waverney, Wolves
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Terms of Reference
Multiple stakeholder engagement
Linking data
Analyst expertise
Gaining buy-in across the City
Model to support other strategic work
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 effectiveness
of alcohol interventions
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
Source: WHO, Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm, 2009
Night Time Economy, ROI example:
Keep It Safe, Wolverhampton
Outline:
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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):
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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.
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 Interventions
Review
LES & DES
Agree local care
pathways
Better
engagement with
Primary Care
Review LES
& DES
Discussion with
local Boards
Implementation
of AUDIT C in
vascular checks
A&E
Review &
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
stakeholders
Map Cardiff
requirements – data,
pathway and resource
Implement and continue
to improve
Identify existing
Symphony data
fields (free text)
to avoid IT
upgrade
Continual improvement and feedback
System now
working, and
police acting on
data received
Scratch card scores
3438 Scratch cards have been given out
80%
70%
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68%
60%
50%
3322 Over the counter by pharmacies
110 NHS Health checks (Chamber Health)
3 Emergency Contraception
3 Other
Details from Arrest Referral not yet available
40%
30%
24%
20%
10%
3%
3%
1%
1%
9
10
11
12
0%
<5
5-8
Scores above 5 could indicate that drinking levels
are harmful or hazardous to health
Community Focus
Sale West Partnership, Trafford
Bilston East, Wolverhampton
Focussing on the wider social determinants
Bilston East, Wolverhampton
Community Workshop
• How does alcohol
effect people?
• Neighbourhood
Training for
development
community members
and workers
• Awareness raising
Halo effect &
Mentoring
• 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
Health
Inequalities
and
prevention
New
opportunities
and
innovation
Different
needs of sites
Financial
austerity
Maturing
Partnerships
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/he
althy_places_healthy_lives.html
• Flyer www.institute.nhs.uk/images/documents/Health
y%20Places%20Healthy%20Lives/62934%20NHS
%20Healthy%20Places%20A5%20flyer.pdf
• juliamiller@nhs.net HPHL Alcohol Lead 07903
218321