Salford’s Alcohol
Strategy
2008 – 2011
1
CONTENTS
Page
1
Foreword
3
2
Introduction
4
3
Executive Summary
6
4
Alcohol-related harm
10
5
Policy drivers
14
6
Partnership arrangements
19
7
Strategic Objective 1: Ensure that those who drink
alcohol in Salford are able to do so safely and
responsibly
21
Strategic Objective 2: Reduce the impact of alcohol
on ill health and life expectancy
27
Strategic Objective 3: Reduce alcohol-related crime
and anti social behaviour
35
Strategic Objective 4: Reduce the harm caused to
children and young people by alcohol use
40
11
Action Plans
47
12
References
69
8
9
10
APPENDIX 1
Changes suggested in response to the
consultation on Salford’s Draft Alcohol
Strategy
72
APPENDIX 2
Membership of partnership groups
81
APPENDIX 3
Alcohol Clinical Pathway
82
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Salford’s Alcohol Strategy 2008-2011
1.
Foreword
We are pleased to introduce Salford’s Alcohol strategy which sets out how we
plan to tackle alcohol misuse in the City over the next three years.
Since the middle of the last century, levels of alcohol consumption have risen.
Alcohol has become more affordable, more freely available and has been
marketed more attractively.
Our relationship with alcohol is a complex one. Alcohol is a widely used and
socially acceptable drug, which plays a central role in many social activities.
However alcohol is the third biggest contributor to ill health in developed
countries and is also a major contributor to crime, disorder and anti-social
behaviour. Children and young people are at particular risk of the negative
effects of alcohol misuse, either through their own alcohol consumption, or
through use of alcohol by those who care for and support them.
We want to ensure that Salford residents understand the risks and
consequences of alcohol misuse and that they know how to reduce these
risks by drinking within the Government’s recommended limits. We want to
establish a culture of drinking where safe and sensible alcohol consumption is
seen as part of a healthy lifestyle, but where people do not drink in order to
get drunk.
Changing drinking culture will require sustained effort from all partners across
the City. This strategy aims to build on the partnership work that has already
been undertaken to reduce alcohol-related harm, in order to establish a new
culture of responsible drinking in the City.
Mike Burrows
Chief Executive, Salford PCT
Councillor David Lancaster
Deputy Leader of the Council
Lead Member Crime & Disorder
Eileen Fairhurst
Chairman, Salford PCT
Councillor Keith Mann
Lead Member Environment
Councillor John Warmisham
Lead Member Children’s Services
Councillor Maureen Lea
Lead Member Community Services &
Health
3
2.
Introduction
Alcohol is a drug which is consumed by the majority of the population in
England. Whilst many do so with few negative consequences, for an
increasing number of people alcohol consumption results in poor health,
social and family problems, and crime and anti-social behaviour.
Alcohol misuse is a complex issue. Alcohol use, within the Department of
Health’s recommended limits, is unlikely to cause harm. However when these
limits are exceeded significant problems can be caused, both to the drinker
themselves and to those around them. In Salford approximately 60,000 adults
drink in excess of the Government’s daily recommended limits. In some cases
this results in hospital admissions, family problems, committing or being a
victim of crime, or even death.
The context in which drinking takes place is also complex, and is changing.
Over the last 20 years alcohol consumption has increased, with more women
and children drinking, and more alcohol being purchased from off-licenses
and supermarkets for consumption at home. Public opinion surveys suggest
that the acceptability of drunkenness in English drinking culture is increasingly
a cause for concern. However national surveys also show a lack of awareness
of sensible drinking guidelines and the harm that drinking in excess of these
limits can cause.
This strategy focuses on carefully managing this complexity to ensure that
those who do drink do so without causing harm to themselves or others, and
that those who experience negative consequences receive appropriate
support. As levels of hazardous and harmful alcohol consumption are higher
in the North West region than any other in England (Department of Health
2005), developing and sustaining a concerted local effort to tackle alcohol
issues is a priority.
Aims and Objectives
The aim of this strategy is to reduce the harm caused by alcohol, including
harm associated with crime, health, the economy and family and social
networks.
Its objectives are:
1) To ensure that those who drink alcohol in Salford are able to do so
safely and responsibly
2) To reduce the impact of alcohol on ill-health and life expectancy
3) To reduce alcohol-related crime and anti-social behaviour
4) To reduce the harm caused to children and young people by alcohol
use
4
Notes on how this strategy has been compiled
Four key strategic objectives have been identified which must be achieved if
we are to achieve our aim of reducing alcohol-related harm. All of these
strategic objectives are of an equal level of priority. For each of these
objectives a number of sub-objectives, key actions and performance
indicators have been identified through which we will monitor progress.
Where the term young people has been used in this strategy this refers to
those under the age of 18, unless otherwise stated.
In order to develop the first draft a range of local agencies and partners were
consulted including: Greater Manchester Police, Salford Primary Care Trust,
Children’s Services, Salford Royal Foundation Trust, Salford Probation,
Salford Drug and Alcohol Services, SMART (Young People’s Drug and
Alcohol Service), Community, Health and Social Care, Environmental
Services and Elected Members.
During February 2008 the draft strategy was sent to a wide range of partners
and members of the public for consultation. Over 250 people received a copy
of the strategy, and face to face consultations were undertaken with young
people and alcohol service users. The draft strategy was also available on the
City Council and DAAT websites.
18 written consultation responses were received. Additional feedback was
received through meetings and face to face consultations. A summary of
these responses and an explanation of how they have been incorporated into
the final version of the Strategy can be found in Appendix 1.
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3.
Executive Summary
Alcohol is a drug which is consumed by the majority of the population in
England. Whilst many do so with few negative consequences, for an
increasing number of people alcohol consumption results in poor health,
social and family problems, and crime and anti-social behaviour.
Alcohol misuse is a complex issue. Alcohol use, within the Department of
Health’s recommended limits, is unlikely to cause harm. However when these
limits are exceeded significant problems can be caused, both to the drinker
themselves and to those around them.
This strategy focuses on carefully managing this complexity to ensure that
those who do drink do so without causing harm to themselves or others, and
that those who experience negative consequences receive appropriate
support.
Alcohol-related harm
Alcohol misuse can have a significant impact on communities, including crime,
ill health and social and financial costs. In most areas the levels of these
harms has increased as alcohol consumption has risen.
Between 1991 and 2005 the number of alcohol-related deaths in the UK more
than doubled from 4,144 to 8,386 (ONS 2006). The rate of alcohol related
hospital admissions had also increased by over 50% since the mid 1990s.
The rate of alcohol-related hospital admissions in Salford is now the 6th
highest in England and Wales. The contribution of alcohol to reduced life
expectancy is also above both the national and regional average, contributing
to 13.75 months of life lost for males and 5.95 months of life lost for females.
Alcohol misuse is a major contributor to crime, disorder and anti-social
behaviour. The contribution of alcohol is particularly significant in incidents of
violent crime, with approximately 1/5 of all violent incidents being committed in
or around pubs and clubs. In approximately half of all violent incidents, victims
believe offenders to be under the influence of alcohol at the time of the
offence. This includes incidents of domestic abuse (DH/HO 2007).
Alcohol consumption levels can be categorised as follows:
Low risk drinking: Drinking within the Government’s recommended limits.
The Government advises that:
 Adult women should not regularly drink more than 2-3 units of alcohol a day
 Adult men should not regularly drink more than 3-4 units of alcohol a day
 Pregnant women, or women trying to conceive, should avoid drinking
alcohol. If they do choose to drink, to protect the baby they should not drink
more than 1-2 units of alcohol once or twice a week and should not get
drunk.
6
Hazardous drinking: Drinking in excess of the Government’s recommended
limits, but not yet experiencing harm.
Harmful drinking: Drinking in excess of the Government’s recommended
limits and experiencing harm, or causing harm to others. Women who
regularly drink over 6 units a day (or over 35 units a week) and men who
regularly drink over 8 units a day (or 50 units a week) are at highest risk of
such alcohol-related harm.
Dependent drinking: Drinking in excess of the Government’s recommended
limits and experiencing harm and symptoms of dependence.
Binge drinking: Drinking a large amount of alcohol over a short period of
time. In surveys, women drinking over 6 units a day and men drinking over 8
units are usually defined as binge drinking. However, in practice, many binge
drinkers are drinking substantially more than this level.
As levels of hazardous and harmful alcohol consumption, and binge drinking,
are higher in the North West region than any other in England, developing and
sustaining a concerted local effort to tackle alcohol issues is a priority.
Aims and objectives
The aim of this strategy is to reduce the harm caused by alcohol, including
harm associated with crime, health, the economy and family and social
networks. The strategy focuses on four strategic objectives, for which a range
of actions and outcome measures have been identified.
STRATEGIC OBJECTIVE 1: Ensure that those who drink alcohol in Salford
are able to do so safely and responsibly
In order to achieve this objective we will develop and deliver a sustained
alcohol social marketing campaign for the City, which complements those
being delivered across Greater Manchester and through the national ‘Know
your limits campaign’. Alcohol screening and brief interventions have been
shown to be effective in reducing alcohol consumption therefore we aim to
ensure that these are provided in a range of agencies including Primary Care
and in the Emergency Department. We will work with alcohol retailers to
ensure that safe drinking environments are provided, by establishing
neighbourhood based licensing fora and continuing to develop a responsible
retailers scheme. In addition, we plan to lobby central government to improve
regulation of alcohol pricing in off-licenses and supermarkets and address the
way that alcohol is promoted and advertised, with particular regards to young
people.
STRATEGIC OBJECTIVE 2: Reduce the impact of alcohol on ill-health and
life expectancy
In order to achieve this objective we will expand and improve alcohol
treatment provision. This will include developing provision through general
7
healthcare services and increasing capacity in specialist services. We will
ensure that Service Users and Carers are involved in the development and
delivery of these services. Alcohol misuse can have a negative impact on an
individuals ability to sustain employment and maintain their housing. We will
therefore ensure that appropriate housing, housing-related support and
access to employment, education and training are available to those in, or
leaving, alcohol treatment.
STRATEGIC OBJECTIVE 3: Reduce alcohol-related crime and anti-social
behaviour
In order to achieve this objective we will further develop the criminal justice
alcohol treatment pathway, and increase the capacity and capability of
criminal justice agencies to provide alcohol interventions. Ensuring that
appropriate intelligence is gathered and shared is also an area of importance.
We plan to establish systems in the Emergency Department to collect data on
the locations of alcohol related assaults so that this information can be shared
with crime and disorder partners. We will also utilise new and existing powers
to take action against licensed premises which contribute to crime, disorder
and anti-social behaviour.
STRATEGIC OBJECTIVE 4: Reduce the harm caused to children and young
people by alcohol use
In order to achieve this objective we will reduce supply of alcohol to young
people by conducting regular test purchasing operations across the City, and
taking action against adults who supply alcohol to young people. We will
provide alcohol education to young people in schools and community settings
and ensure that teachers and parents have the skills and knowledge to
provide alcohol information to young people. We aim to provide attractive,
affordable alternatives to drinking for young people, however for young people
who do drink specialist support will be available. Harm can also be caused to
young people as a result of alcohol use by other members of the
family/carers. We will therefore ensure that those working with parents are
able to recognise and address the impact of parental alcohol use, and that
support is provided for families.
Performance monitoring
From April 2008 there will be 3 national indicators (NI) which specifically focus
on alcohol. These are:
NI 39 Alcohol-harm related hospital admission rates
NI 41 Perceptions of drunk and rowdy behaviour as a problem
NI 115 Substance misuse by young people
In addition we will monitor progress in achieving our objectives through a
range of performance measures including: the prevalence of hazardous,
harmful and binge drinking; the proportion of incapacity benefit claims which
8
are linked to alcohol dependence; the number of offenders referred for alcohol
treatment; and the rate of alcohol-specific hospital admissions for under 18s.
Partnership arrangements
Salford Drug and Alcohol Action Team is the partnership board responsible for
reducing alcohol-related harm in the City. This partnership reports to the Local
Strategic Partnership via the Crime and Disorder Reduction Partnership and
the Healthy City Executive. A lead officer for alcohol is jointly funded by the
PCT and the City Council.
An Alcohol Reference Group was established in 2004 to provide a strategic
lead on alcohol related issues in Salford. This group currently reports to the
Drug and Alcohol Action Team.
A review of the Crime and Disorder Reduction Partnership is currently
underway, and the Audit Commission are also undertaking a review of Crime
and Disorder Reduction Partnerships and alcohol. Proposals for the
partnership arrangements to take forward this strategy will therefore be
developed following the outcomes of these reviews.
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4.
Alcohol-related harm
Alcohol-related harm in England
Alcohol misuse can have a significant impact on communities, including crime,
ill health and social and financial costs. In most areas the levels of these
harms has increased as alcohol consumption has risen.
Alcohol consumption
Since the 1960s there have been large increases in the amount of alcohol
consumed in the UK. Whilst the amount of beer consumed has remained
relatively stable, there has been a significant increase in wine and spirit
consumption (Prime Minister’s Strategy Unit 2003). Consumption levels have
increased among men and women in all age groups, however the largest
increases in consumption have been among 16-24 year old women, whose
alcohol consumption has almost doubled from 7.3 units per week in 1992 to
12.1 units in 2002 (Office for National Statistics (ONS) 2004).
Whilst the proportion of young people who drink alcohol has declined slightly,
those who do drink are consuming more alcohol, more often. Between 1990
and 2000 the average weekly consumption of 11-15 year old drinkers doubled
from 5 units to 10 units (Department of Health (DH)/Home Office (HO) 2007).
Calculating Units
Many people presume that one glass of wine, half a pint of beer or one shot of
spirits equals one unit. However drink strengths have increased and the
measures that drinks are served in have become bigger, therefore one drink often
contains a lot more than one unit of alcohol. The exact number of units of alcohol
in a drink can be calculated as follows:
Number of units = Volume in millilitres X % Alcohol By Volume (ABV)
1000
This means that:
175ml glass of 13% wine = 2.3 units
250ml glass of 13% wine = 3.3 units
1 pint of 5% lager = 2.8 units
35ml shot of 40% spirits = 1.4 units
The Department of Health recommends that men should not drink more than 3-4
units a day, and no more than 21 units per week. Women should not drink more
than 2-3 units per day, and no more than 14 units per week.
After heavy drinking alcohol should be avoided for 48 hours to give the body
tissue time to recover.
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Health
Alcohol is linked to more than 60 types of disease, disability and injury, and is
the third leading contributor to the disease burden in developed countries
(Scottish Health Action on Alcohol Problems (SHAAP) 2007). Increases in
consumption over the past half a century have resulted in corresponding
increases in the health harms related to alcohol misuse. Between 1995/6 and
2005/6 the number of hospital admissions of over 16 year olds, with a primary
diagnosis related to alcohol, increased by just over 50%. For under 16 year
olds admissions increased by 29% over the same period (ONS 2007).
Alcohol-related illness and injury now accounts for approximately 180,000
admissions per year. In Emergency Departments approximately 70% of
admissions at peak times (Friday and Saturday evenings) are related to
alcohol (DH/HO 2007).
Between 1991 and 2005 the number of alcohol-related deaths in the UK more
than doubled from 4,144 to 8,386 (ONS 2006). The largest increase was
among 35 – 54 year old males. Trends in liver cirrhosis mortality demonstrate
the significant increase in alcohol-related deaths since 1990.
(Leon, D.A. and McCambridge, J. 2006)
The annual number of deaths as a result of chronic conditions linked to
alcohol is greater than the combined number of people who die from breast
cancer, cervical cancer and MRSA each year (Alcohol Concern 2006).
Crime, disorder and anti-social behaviour
Alcohol misuse is a major contributor to crime, disorder and anti-social
behaviour. The contribution of alcohol is particularly significant in incidents of
violent crime, with approximately 1/5 of all violent incidents being committed in
or around pubs and clubs. In approximately half of all violent incidents, victims
believe offenders to be under the influence of alcohol at the time of the
offence. This includes incidents of domestic abuse (DH/HO 2007).
National surveys indicate that alcohol-related anti-social behaviour is of
concern to the public with 25% believing that people being drunk or rowdy in
public places is a significant problem (DH/HO 2007).
11
The economy
Alcohol makes a significant positive contribution to the UK economy with over
1 million people being employed in hotels, pubs, bars, nightclubs and
restaurants. In some areas the growth of the night-time economy has
supported the redevelopment of town and city centres. However there are
also significant costs to the economy, for example, loss of work productivity
caused by alcohol-related harm costs approximately £20 billion per year in
England and Wales. In addition costs arising from unemployment as a result
of harmful and dependent drinking are estimated to be in the region of £1.9
billion per year (DH/HO 2007).
Families
The impact of alcohol use spreads far beyond the impact on the individual,
and can make a significant contribution to family problems including violence,
divorce and family break-up. Parental alcohol misuse affects up to 1.3 million
children living in England and can impact on family functioning and stability,
parent/child relationships, child development, health, safety, educational
achievement, reception into care and the likelihood of involvement in
substance use and offending (Prime Minister’s Strategy Unit 2003).
Alcohol-related harm in Salford
Measures of alcohol-related harms for each Local Authority in England were
first published in 2006, to assist local areas in understanding how alcohol is
affecting residents and services, which can be compared between authorities
and examined for trends from year to year. These measures have been
updated in 2007 (NWPHO 2007). The measures show that levels of alcoholrelated harm are higher in the North West than in other regions in England,
and that Salford has one of the highest levels of alcohol-related harm in the
North West. The measures indicate that alcohol has a particularly large impact
in the following areas:
 Hospital admissions for males and females
 Incapacity Benefit or Severe Disablement Allowance claims where the
main medical reason is alcohol dependence
 Prevalence of harmful drinking and binge drinking
Alcohol use by adults
In 2007 Salford PCT conducted a lifestyles survey with a sample of local
residents, which included questions about alcohol consumption. This survey
showed that 25% of respondents had drunk over 21 units in the week prior to
undertaking the survey.
Alcohol use by young people
In 2005 and 2007 Trading Standards commissioned a survey of 14-17 year
olds to investigate their alcohol consumption and purchasing patterns. This
survey showed that between 2005 and 2007 the proportion of young people
claiming to drink once a week or more reduced from 60% to 34% and the
number of young people saying that they buy their own alcohol also reduced,
from 41% to 21%. However, whilst the survey showed very significant
12
reductions in these two measures in Salford, responses also indicated that
young people in Salford are more likely to drink in public places than others in
the North West (51% in Salford compared to North West average 37%) and
are more likely to drink in large groups (29% drinking in groups of more than
20, compared to North West average 18%). Levels of regular binge drinking in
Salford are also among the highest in the North West (37% drinking 5 or more
drinks on one occasion at least once a week). The 2007 survey had a smaller
sample size for Salford, with 250 young people participating in 2007 and 550
in 2005, therefore this may have affected the results outlined above.
Alcohol-related crime
Data from the local alcohol profiles for England show that levels of alcoholrelated crime in Salford are higher than the national average, with the rate of
alcohol-related recorded crime being the 26th highest nationally.
The Greater Manchester Police crime recording system enables crimes and
incidents to be recorded as being alcohol-related. However, the alcohol
marker is not always used consistently as a result of the person recording the
incident/offence not mentioning alcohol as a factor in the crime, or there being
no witnesses to the offence.
For the period April – December 2007 there were 955 crimes recorded in
Salford, and 5,422 incidents, which had the alcohol-influence marker
attached.
Conclusions
As levels of alcohol consumption increased over the past half a century there
has been a corresponding increase in levels of alcohol-related harm. In
Salford levels of alcohol consumption are higher than the national average
and this also results in levels of alcohol-related harm being particularly high in
the City. The harms experienced have a significant impact on quality of life in
the City and contribute to performance against key targets such as life
expectancy, violent crime, anti-social behaviour and children’s health and
wellbeing. Concerted local action to reduce alcohol-related harm is therefore
needed.
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5.
Policy drivers
National
National Alcohol Strategy
The Government published its first national alcohol harm reduction strategy in
2004. This strategy included 4 key aims:
 To improve the information available to individuals to start the process
of change in the culture of drinking to get drunk
 To better identify and treat alcohol misuse
 To prevent and tackle alcohol-related crime and disorder and deliver
improved services to victims and witnesses
 To work with the industry in tackling the harms caused by alcohol
The national strategy was updated in June 2007, with the publication of “Safe.
Sensible. Social: the next steps in the National Alcohol Strategy”. This
updated strategy identifies 3 key groups who cause or experience the most
alcohol-related harm: young people under 18 who drink alcohol; 18-24 year
old binge drinkers; and harmful drinkers.
“Safe. Sensible. Social” also identifies the following next steps to tackle
alcohol misuse in England:
 Sharpened criminal justice for drunken behaviour
 A review of NHS alcohol spending
 More help for people who want to drink less
 Toughened enforcement of underage sales
 Trusted guidance for parents and young people
 Public information campaigns to promote a new sensible drinking
culture
 Public consultation on alcohol pricing and promotion
 Local alcohol strategies
Performance monitoring
From April 2008 there will be 3 national indicators (NI) which specifically focus
on alcohol, through which the Government will measure local progress in
reducing alcohol-related harm. These are:
NI 39 Alcohol-harm related hospital admission rates
NI 41 Perceptions of drunk and rowdy behaviour as a problem
NI 115 Substance misuse by young people
In addition reducing alcohol-related harm can make an important contribution
to other national indicators, for example those relating to life expectancy and
violent crime.
Policy and guidance
Since November 2005 the Department of Health and the National Treatment
Agency for Substance Misuse have published a number of key documents to
guide the commissioning of alcohol treatment services:
“Alcohol Needs Assessment Research Project (ANARP)”: measured the gap
between the demand for and provision of specialist alcohol treatment services
14
at a national and regional level. This identified that for every 12 people
requiring alcohol treatment in the North West of England only 1 person is able
to access it. This is regarded as a low level of access.
“Alcohol Misuse Interventions: Guidance on developing a local programme of
improvement”: provides guidance on developing and implementing local
programmes to improve the care of hazardous, harmful and dependent
drinkers and identified £15million of Government investment to improve the
commissioning and delivery of alcohol treatment services.
“Models of Care for Alcohol Misusers (MoCAM)”: provides a framework for
commissioning alcohol treatment services, and advises that a local treatment
system should comprise 4 tiers of intervention:
Tier 1: Alcohol-related information and advice, screening, simple brief
interventions and referral, provided by a range of generic services
Tier 2: Open access, non-care planned, alcohol-specific interventions
Tier 3: Community-based, structured, care-planned alcohol treatment
Tier 4: Alcohol specialist inpatient treatment and residential rehabilitation
“Review of the effectiveness of treatment for alcohol problems”: provides a
critical appraisal of the evidence base for the treatments available for people
with alcohol problems, which identified that every £1 spent on alcohol
treatment saves the public sector £5.
The Public Health White Paper “Choosing Health” outlined plans to pilot
alcohol screening and brief interventions in primary care, A&E and the
Criminal Justice System. Working with the alcohol industry to develop an
information campaign to reduce binge drinking and a voluntary social
responsibility scheme for alcohol producers and retailers was also proposed.
Every Child Matters: Change for Children is the Government’s vision for
ensuring that agencies work together to protect and promote the well-being of
children and young people. The Government’s aim is for every child, whatever
their background or circumstances, to have the support they need to:
 Be healthy
 Stay Safe
 Enjoy and achieve
 Make a positive contribution
 Achieve economic well-being
Alcohol use by young people, or their parents and carers, can have an impact
on all of these five areas.
The National Supporting People Strategy ‘Independence and Opportunity’
was launched in June 2007. This strategy acknowledges that having the right
housing and support available at the right time is an essential part of ensuring
that every citizen has the opportunity to live a fulfilled, active and independent
life. Importantly, the national strategy clearly acknowledges that problems and
uncertainties can affect anyone, but they are most likely to affect the more
disadvantaged and vulnerable members of our society, and that assistance at
the right time can often prevent a full-scale, long-term crisis.
15
The National Drugs Strategy “Drugs: protecting families and communities”,
was published in February 2008. The Strategy sets out how the Government
aims to restrict the supply of illegal drugs and reduce the demand for them
over the next ten years, with a focus on protecting families and strengthening
communities. However alcohol use by young people is also included within
the remit of the Strategy.
Legislation
The Licensing Act 2003 came into force on 24th November 2005. The Act
includes four licensing objectives which all licensed premises are now
required to meet:
 Prevention of crime and disorder
 Promotion of public safety
 Prevention of public nuisance
 Protection of children from harm
The Act devolved licensing responsibilities to Local Authorities, made
provision for flexible opening hours and set up a system of personal and
premises licenses under the scrutiny of 7 Responsible Authorities including
Police, Trading Standards, Fire and Rescue Service and Local Safeguarding
Children Boards.
The Violent Crime Reduction Act 2006 provides additional powers to tackle
alcohol-related violence in the Night-time Economy, including Drinking
Banning Orders, under which restrictions can be imposed on individuals who
commit alcohol-related offences, and Alcohol Disorder Zones, so that, in
areas affected by significant alcohol-related crime and disorder, licensed
premises can be required to contribute to the costs of managing the night time
economy.
Local
Needs assessment
An alcohol health needs assessment was completed in June 2007, examining
the needs of the adult population in Salford. The needs assessment identified
that whilst the burden of alcohol related disease and mortality has increased
across the country, these increases have been particularly pronounced in
Salford. The City experiences higher levels of alcohol related harms to health,
the rates of which appear to be increasing more rapidly than the rest of
England. Rates of alcohol related deaths have increased particularly sharply
among 35-54 year old males. This reflects the increase in weekly alcohol
consumption from the mid 1950s onwards. As there have been further
increases in alcohol consumption among 16 – 24 year old women, and
continued heavy drinking among 16 – 44 year old males, it is likely that this
will be reflected in higher rates of liver cirrhosis in the future unless alcohol
consumption can be reduced.
This needs assessment also identified that further investment is required at all
tiers (‘Models of care for alcohol misusers’ DH 2006) if the rise in alcohol
consumption and alcohol-related harm is to be halted.
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Local Area Agreement
Salford’s Local Area Agreement 2008-2011 includes a number of alcoholrelated indicators:
 The number of hospitalised admissions due to all conditions attributed
to alcohol
 The number of young people receiving an alcohol intervention from
young people’s substance misuse service
 The number of young people referred to a specialist service as a result
of admission to A&E for drugs or alcohol misuse
 Increase the number of offenders referred for alcohol treatment
There are a number of other local indicators to which alcohol makes a
significant contribution, particularly violent crime, anti-social behaviour and
domestic violence; health inequalities and life expectancy; educational
attainment and employment activity; child protection and family support.
Tackling alcohol-related harm in Salford can play an important role in
achieving performance targets in these areas.
Salford’s LAA will be revised during 2008, with 35 improvement targets (in
addition to 18 statutory education and early years targets) being selected for
the City. As the rate of alcohol related hospital admissions in Salford, is the 6 th
highest nationally, it is very likely that reducing alcohol-related hospital
admissions will be one of the 35 improvement targets in the Local Area
Agreement.
Alcohol Commission
In 2006, an Alcohol Scrutiny Commission was established to investigate “The
nature and extent of alcohol-related problems in the city and the measures in
place to deter and prevent anti-social behaviour resulting from them with
regards to young people (under 18 years)”. The Commission’s
recommendations included:
 Improved collaboration between partners when considering and
implementing initiatives, with the DAAT having a strategic overview of
all work undertaken
 Implementation of a proof of age scheme for all 16 year olds to be
issued when leaving secondary school education
 Greater emphasis on alcohol education in primary and secondary
schools
 Implementation of a city-wide by-law for a street drinking ban
Regional and sub-regional coordination
At regional level there is a North West Alcohol Strategy Group. Work
commissioned by this group has included the Regional Alcohol Indicators and
the North West Trading Standards survey which examined alcohol use and
purchasing by young people. This has recently been complemented by the
establishment of a Greater Manchester Alcohol Strategic Group, which will
lead on initiatives which are best carried out at this sub-regional level, for
example social marketing. This group will also provide a link between Local
Authority/PCT areas and the Regional Alcohol Strategy Group. The Greater
17
Manchester group can also devolve work to the Greater Manchester Alcohol
Leads group which comprises alcohol strategy coordinators and lead
commissioners from the 10 Greater Manchester districts.
Conclusions
Alcohol is an issue which cross cuts a number of policy areas. This means
that tackling alcohol related harm can contribute to the achievement of targets
in a number of areas, but also that coordinated partnership working is needed.
Since the publications of “Safe. Sensible. Social” in 2007 alcohol issues have
assumed an increasingly prominent position on national and regional policy
agenda. It is, therefore, important that local effort to reduce alcohol related
harm keeps pace with these changes, particularly as Salford experiences
relatively high levels of alcohol related harm.
18
6.
Partnership arrangements
Salford Drug and Alcohol Action Team is the partnership board responsible for
reducing alcohol-related harm in the City. This partnership reports to the Local
Strategic Partnership via the Crime and Disorder Reduction Partnership and
the Healthy City Executive. A lead officer for alcohol is jointly funded by the
PCT and the City Council.
An Alcohol Reference Group was established in 2004 to provide a strategic
lead on alcohol related issues in Salford. This group currently reports to the
Drug and Alcohol Action Team.
A review of the Crime and Disorder Reduction Partnership is currently
underway, and the Audit Commission are also undertaking a review of Crime
and Disorder Reduction Partnerships and alcohol. Proposals for the
partnership arrangements to take forward this strategy will therefore be
developed following the outcome of these reviews.
During the implementation of Salford’s Drug and Alcohol Strategy 2005-8 a
number of sub groups of the DAAT have been established to take forward
work on alcohol. To deliver this new strategy it is proposed that these sub
groups are reorganised in order to fit with the key areas of work in the new
strategy.

The existing Responsible Authorities meeting will continue to take
forward the aspects of the strategy which relate to alcohol retailing.

The existing Young People’s Substance Misuse Commissioning Group
will continue to commission drug and alcohol services for young people
and take forward the aspects of the strategy which relate to children
and young people.

The Criminal Justice Alcohol Steering Group will merge with the Drug
Interventions Programme Steering Group to form a Drug and Alcohol
Criminal Justice Group which will take forward the crime and disorder
elements of the strategy.

The Hospital Alcohol Steering Group will be expanded to be an Alcohol
Health and Treatment Group to take forward the aspects of the strategy
which relate specifically to healthcare and alcohol treatment.
A list of the organisations which are represented in each of these proposed
groups can be found in Appendix 2.
19
Related local strategies and action plans
Alcohol is a cross cutting issue and this strategy therefore has close links with
a number of other key strategies and action plans in the City including:
Community Safety Strategy
Road Safety Strategy
Children and Young People’s Plan
Joint Strategic Needs Assessment
Young People’s Substance Misuse Treatment Plan
Salford DAAT Service Users and Carers Strategy
Reducing Re-offending Action Plan
Homelessness Strategy
Supporting People Strategy & associated plans
Supported Employment Strategy
Corporate Employment and Skill Action Plan
Community Plans
Health Improvement Action Plans
Annual Teenage Pregnancy Action Plan
Sexual Health Strategy
Healthy weight Strategy
Health Inequalities Strategy
Safeguarding Children’s Plan
The Local Alcohol Strategy is designed to support the work of these linked
strategies and plans and ensure that national and local targets are achieved.
20
7.
STRATEGIC OBJECTIVE 1: Ensure that those who drink alcohol in
Salford are able to do so safely and responsibly
National Context
Levels of alcohol consumption
Most of the data that is available on alcohol consumption in the UK comes
from national surveys where people self-report their consumption level. In
2005 the average number of units consumed by adults per week was 10.8,
with 35% of men, and 20% women drinking over daily benchmarks on at least
one day. However customs and excise data on the amount of alcohol
purchased in the UK suggests that people are actually consuming alcohol at
twice the level reported in surveys (DH/HO 2007).
Alcohol consumption levels can be categorised as follows:
Low risk drinking: Drinking within the Government’s recommended limits.
The Government advises that:
 Adult women should not regularly drink more than 2-3 units of alcohol a day
 Adult men should not regularly drink more than 3-4 units of alcohol a day
 Pregnant women, or women trying to conceive, should avoid drinking
alcohol. If they do choose to drink, to protect the baby they should not drink
more than 1-2 units of alcohol once or twice a week and should not get
drunk.
Hazardous drinking: Drinking in excess of the Government’s recommended
limits, but not yet experiencing harm.
Harmful drinking: Drinking in excess of the Government’s recommended
limits and experiencing harm, or causing harm to others. Women who
regularly drink over 6 units a day (or over 35 units a week) and men who
regularly drink over 8 units a day (or 50 units a week) are at highest risk of
such alcohol-related harm.
Dependent drinking: Drinking in excess of the Government’s recommended
limits and experiencing harm and symptoms of dependence.
Binge drinking: Drinking a large amount of alcohol over a short period of
time. In surveys, women drinking over 6 units a day and men drinking over 8
units are usually defined as binge drinking. However, in practice, many binge
drinkers are drinking substantially more than this level.
Knowledge of units and risks of alcohol-related harm
Although most drinkers have heard of measuring alcohol consumption in units
(86%) and most people are aware of the daily benchmarks (69%), only 13%
keep a check on the number of units they drink.
In October 2006 the Government launched a national campaign targeting 1824 year old binge drinkers. The campaign aimed to increase knowledge and
understanding of sensible drinking guidelines, and raise awareness of the
21
consequences of binge drinking. The Government has made a commitment to
continue this campaign and it will be further developed to target other groups
of drinkers, for example those drinking at hazardous and harmful levels at
home. National campaigns will also aim to raise the public’s knowledge of
units of alcohol and ensure that people have the information to accurately
estimate how much they drink.
The Government has also launched “Screening and brief interventions
trailblazers”, in NHS and criminal justice settings, to investigate how harmful
drinkers can be identified and supported to reduce their drinking to sensible
levels. The results of these trials are due to be reported in May 2009
Alcohol retailing
The real price of alcohol has decreased steadily over the past 50 years. Over
the same period alcohol consumption has increased.
Consumption of alcohol in the UK (per person aged 15+) relative to its price:
1960 - 2002
SHAAP (2007)
As part of the new National Alcohol Strategy the Government has announced
its intention to commission an independent national review of evidence on the
relationship between alcohol price, promotion and harm.
The 2004 Alcohol Harm Reduction Strategy for England set clear objectives
for the industry to demonstrate its willingness to reduce alcohol-related harm
and establish a code of good practice. The industry has since set up and
funded the Drinkaware Trust to raise awareness, challenge attitudes and
change behaviour in relation to alcohol misuse and alcohol-related harm. In
November 2005 the alcohol industry launched the Social Responsibility
Standards for the Production and Sale of Alcoholic Drinks in the UK.
22
Local Context
Alcohol consumption in Salford
Levels of alcohol consumption in Salford, like many urban areas in the North
West, are significantly higher than the national average. Among the adult
population in Salford there are approximately:
 40,400 hazardous drinkers (23%)
 13,200 harmful drinkers (7.5%)
 4,200 dependent drinkers (4%)
These figures also include approximately 44,000 (26.5%) binge drinkers
(NWPHO 2007).
Levels of alcohol consumption within the different neighbourhoods and
communities of Salford is not yet fully understood and requires further
investigation.
Raising awareness of the risks of alcohol-related harm
Since the publication of the last local alcohol strategy (2005) a series of
relatively small alcohol campaigns have been delivered in Salford, aiming to
raise awareness of local support services and to encourage people to
consider the negative consequences of drinking over recommended limits.
These campaigns have primarily targeted people drinking outside the home. A
Greater Manchester wide marketing campaign is now being coordinated by
the Association of Greater Manchester PCTs and will be rolled out in Salford
during 2008/9.
In order to reduce the number of people drinking over recommended limits
training has been developed to enable staff from a variety of services and
backgrounds to deliver alcohol screening and brief advice to those they work
with. This training has been delivered to supported housing providers and
Health Trainers. Screening has also now been established in the Emergency
Department at Salford Royal Hospital.
Working with alcohol-retailers
Some on licensed premises in Salford engage in local pubwatch meetings and
work is underway to increase engagement in such forums, particularly in
areas which seem to experience high levels of alcohol-related crime. In
addition a city-wide Licensees Forum was established in early 2007, however
this has attracted little interest from local on and off license holders, therefore
a new approach to working with the licensed trade needs to be found.
Following consultation with licensees two training sessions were organised,
covering responsible alcohol retailing and conflict management. Both sessions
were accredited by the British Institute of Innkeeping Awarding body and were
well received by licensees who attended.
In order to promote good practice, off licensed premises are now being asked
to make a commitment to comply with a list of conditions, in additional to
those already included on their license, for example having electronic till
prompts to safeguard against under age sales, and having CCTV pictures
23
available to the police. It is intended that this voluntary conditions scheme will
be expanded to cover on licensed premises and will form the basis of a code
of good practice for alcohol retailers in the City.
Evidence & Gap Analysis
Alcohol consumption and price
The relationship between alcohol price, consumption levels and associated
harm has been the subject of much research attention. The vast majority of
these studies have found that an increase in the price of alcohol generally
leads to a decrease in consumption, and visa versa. A review undertaken in
Scotland in 2007 estimated that a 10% rise in alcohol price would save the
lives of 479 Scottish men and 265 women every year (SHAAP 2007).
Current legislation does not permit the regulation of prices at a local level.
Consequently if prices are to be reduced there is a need to lobby Government
for changes in national pricing policies or legislation to ensure that price can
be used as a mechanism to reduce consumption.
Responsible retailer schemes
The Home Office have highlighted a range of good practice schemes which
encourage partnership working with alcohol retailers in order to reduce alcohol
misuse. A range of code of practice and award schemes are in place across
the country in a variety of settings including city centres, small towns and rural
areas.
Salford’s responsible retailing scheme is in the very early stages of
development, however by further developing the scheme and encouraging
licensees to meet the standards set we can ensure that licensed premises are
managed responsibly.
Developing a balanced night time economy
Research by the Civic Trust found that:
 More people would use centres at night if they were safe, more
accessible and offered more choice
 A good mix of clientele can lessen intimidation and improve
perceptions
 A wider range of attractions and consumers leads to longer-term
economic viability.
The Civic Trust therefore recommends that local partnerships should have a
vision for their night time economy and should plan for a positive, balanced
mixture of businesses and activities that will attract all sections of the
community to the area at night (The Civic Trust 2006).
Salford’s Urban Regeneration Company have already commenced work with
the Civic Trust to support redevelopment work being undertaken in Central
Salford, and it is intended that this relationship with the Civic Trust will be
continued to ensure that this, and other new developments are in line with
Civic Trust recommendations.
24
Social marketing
The Public Health White Paper “Choosing Health” advocated the use of social
marketing techniques to raise public awareness and change behaviour. Social
marketing involves the use of marketing, alongside other concepts and
techniques, in order to achieve behavioural change. Systematic reviews have
shown that social marketing techniques have successfully been applied to
alcohol (Stead et al 2006).
By using social marketing techniques in Salford we can change drinking
behaviour among those groups most at risk of experiencing alcohol-related
harm.
Screening and brief advice
There is a large body of international research evidence to demonstrate the
effectiveness of screening, using alcohol screening tools (such as the Alcohol
Use Disorders Identification Test (AUDIT) and Fast Alcohol Screening Tool
(FAST)) and simple, brief advice, in reducing people’s drinking to more
sensible levels. The evidence indicates that for every eight people who
receive advice, one will reduce their drinking to within low-risk levels. This
compares favourably with smoking where only 1 in 20 will act on the advice
given (Raistrick et al 2006).
Screening and brief advice are not routinely provided in Salford. There is
considerable opportunity to screen the public and provide advice through
front-line services working with the public. If training is provided so that frontline services can provide alcohol screening and brief interventions, this has
great potential to reduce the prevalence of hazardous, harmful and binge
drinking in Salford, and reduce the harm associated with alcohol misuse.
Recommendations
Considering the evidence above and the gaps identified, over the next three
years our work to reduce the number of people drinking over recommended
limits should focus on the following areas:
 Delivering a sustained alcohol social marketing campaign to encourage
those drinking at hazardous and harmful levels to reduce their alcohol
consumption and the risk of harm.
 Providing alcohol screening and brief advice through a wide range of
front line services so that levels of alcohol consumption are assessed,
and appropriate prevention and harm reduction advice can be provided
to reduce levels of alcohol consumption and associated harm.
 Lobbying central government to ensure that pricing and promotions are
controlled in order to reduce levels of alcohol consumption across the
population.
 Creating safe drinking environments by working with alcohol retailers to
ensure that on and off licensed premises are managed responsibly.
25
Implementation
In order to reduce the number of people drinking over recommended limits we
will focus on the following objectives:
Delivering a sustained alcohol social marketing campaign
a) Understand the target audience for responsible drinking campaigns
and how to reach them
b) Develop local campaigns to complement those being delivered across
Greater Manchester and through the national alcohol harm reduction
campaign programme, in line with market analysis
c) Increase the availability of unit and responsible drinking information
across the City
d) Encourage local employers to provide responsible drinking information
e) Work with the University of Salford to reduce the risk of alcohol-related
harm to students
Provision of screening and brief advice
f) Provide alcohol screening, using World Health Organisation recognised
screening tools, and brief advice in all GP practices in the City (clinical
pathway described in Appendix 3)
g) Ensure that alcohol screening and brief advice is available in the
Emergency Department
h) Ensure that front-line staff in a variety of agencies have the knowledge
and skills to provide alcohol screening and brief advice
Lobbying on price, promotions and advertising
i) Lobby Central Government to:
- Improve regulation of alcohol pricing in off-licenses and
supermarkets
- Address the way that alcohol is promoted and advertised, with
particular regards to young people
Creating safe drinking environments
j) Establish neighbourhood based fora for the licensed trade to improve
communication between enforcement agencies and the trade, and
promote best practice
k) Continue to develop voluntary conditions/responsible retailing scheme
so that on and off licensed premises in all areas of the City are involved
l) Provide and promote training for bar staff and licensees
m) Ensure that the vision for the regeneration of the City encompasses the
Civic Trust standards for a balanced night-time economy
A more detailed action plan can be found at the end of this document.
Performance Measures:
We will measure our progress through the following outcome measures:
 Prevalence of hazardous drinking
 Prevalence of harmful drinking
 Prevalence of binge drinking
26
8.
STRATEGIC OBJECTIVE 2: Reduce the impact of alcohol on illhealth and life expectancy
National Context
Impact on physical health
Alcohol contributes to a wide range of health conditions and accounts for
almost 10% of the burden of disease in the UK, being surpassed only by
tobacco and high blood pressure (SHAAP 2007).
For conditions such as lip cancer, chronic pancreatitis, chronic hepatitis and
cirrhosis of the liver, over half of cases are thought to be attributable to alcohol
(Morleo et al 2006). In addition, regular heavy drinking significantly increases
the risks of developing conditions such as hypertension, stroke and coronary
heart disease. Such conditions make a significant contribution to life
expectancy.
Increased risk of ill-health to harmful drinkers:
Department of Health/Home Office (2007)
The health problems caused by alcohol place a significant burden on the
National Health Service, resulting in approximately 180,000 hospital
admissions per year, and up to 70% of emergency admissions at peak times.
Impact on mental health
As well as physical health alcohol also has a close link with mental health
problems, including depression, anxiety and suicide. Mental health problems
can be a cause of heavy drinking, and heavy drinking can be a cause of
mental health problems. 42% of men and 16% of women suffering from
depression drink over recommended limits. 65% of suicides are alcoholrelated (Alcohol Concern 2006).
Impact on sexual health
Alcohol use can lower inhibitions and increase risk taking, this can include
having unwanted or unprotected sex. Thus alcohol can contribute to
unwanted pregnancies and the spread of sexually transmitted diseases.
Sexual health services are therefore an important route through which to
deliver alcohol advice and information.
Health inequalities
27
Alcohol-related harms to health disproportionately affect the most deprived
areas of the country, thus making a significant contribution to health
inequalities. For women living in the most deprived areas alcohol-related
death rates are three times higher than for those living in the least deprived
areas. For men living in the most deprived areas alcohol-related death rates
are over five times higher than for those living in the least deprived areas
(DH/HO 2007).
Drinking during pregnancy
Guidance on drinking during pregnancy has recently been updated to
recommend that women who are pregnant or trying to conceive should not
drink alcohol. 54% of mothers currently report drinking during pregnancy, with
8% drinking more than 2 units per week on average (DH/HO 2007). Alcohol
can damage the baby’s developing organs and nervous system, resulting in
later mental and physical problems, and can cause miscarriage.
There were 128 cases of Foetal Alcohol Syndrome in England in 2002-3,
however there is no reliable data available on the incidence of other Foetal
Alcohol Spectrum Disorders. It has been estimated that 9 per every 1000 live
births in Western Countries involve children affected by Foetal Alcohol
Spectrum Disorder (British Medical Association 2007: 3). This would equate to
27 children born with a Foetal Alcohol Spectrum Disorder in Salford each
year.
Employment
Alcohol misuse and its associated health problems can have a negative
impact on maintaining employment. Approximately 17 million working days
are lost each year due to alcohol misuse. Alcohol is also involved in 20% of
industrial accidents. Whilst many who access alcohol treatment will be in
employment, re-engaging those who are not in education, employment or
training is an important goal of alcohol treatment and can help to achieve
successful treatment outcomes.
Housing
Alcohol misuse can have a negative effect on individual’s ability to maintain
their housing, either through not being able to meet rent/mortgage payments,
or neglect of living conditions. Indeed, house fires are frequently associated
with alcohol use, with 1 in 3 fire related deaths happening when people have
been drinking. Homelessness is also thought to be a cause of, and can
exacerbate, alcohol problems, for example Shelter have estimated that 50%
of rough sleepers are alcohol dependent. Ensuring that people with alcohol
problems find sustainable and secure housing is an important element of
alcohol treatment, as relapse is more likely when housing is not suitable or
stable. The Supporting People Programme aims to ensure that the most
vulnerable and disadvantaged people in our communities, such as those with
alcohol problems, are offered a choice and range of good quality supported
accommodation services to enable and empower them to develop the skills
and confidence to live, and remain living, independently .
Alcohol Treatment
28
The Government’s framework for alcohol treatment services recommends that
alcohol treatment systems should comprise four tiers (see page 8). Whilst
Tiers 1 and 2 can be provided by a range of non-specialist alcohol services,
for example in primary care and probation, Tiers 3 and 4 require specialist
alcohol workers and services.
The Department of Health has calculated Prevalence Service Utilisation
Ratios for each region of England to assess the availability of alcohol
treatment, relative to need. This varied from 1 in 12 alcohol dependent people
accessing treatment in the North West, to 1 in 102 in the North East (DH
2005). In North America an access level of 1 in 10 is regarded as a low level
of access, 1 in 7.5 medium and 1 in 5 high. These findings highlight the lack of
capacity in alcohol treatment services across the Country. Consequently,
“Safe. Sensible. Social.” identified the need for further provision of alcohol
treatment for harmful and dependent drinkers and outlined plans for the
development of a framework to support commissioners in planning local
investment. However, this has not yet been published. As part of the new
national alcohol strategy the Government will also be expanding the range of
support available to those who wish to reduce their drinking, this may include
helplines, internet-based guidance and questionnaires, and self-help and
mutual aid groups.
Drug use and alcohol
The National Treatment Outcome Research Study (NTORS) found that 33%
of drug misusers entering treatment were drinking above safe weekly limits
(NTA (2004) Promoting Safer Drinking: A Briefing Paper for Drugs Workers).
Models of Care for Alcohol Misusers (NTA 2006) therefore recommends that
drug users in treatment have their alcohol use and treatment needs routinely
and continually assessed, and it is good practice for drug users in treatment to
have their alcohol problems treated in the same setting.
Local Context
Life expectancy and health inequalities
Increasing life expectancy and reducing health inequalities are key targets for
the City. In Salford, alcohol results in 13.75 months of life lost for males and
5.95 months of life lost for females. The contribution of alcohol to reduced life
expectancy in Salford is above both the national and regional average
(NWPHO 2007).
Hospital admissions
From April 2008, the number of hospital admissions attributable to alcohol is a
national indicator, and Salford will therefore set targets to reduce the
incidence of such admissions. Ensuring that alcohol treatment services are fit
for purpose and have sufficient capacity to meet demand is essential if this
target is to be achieved.
Alcohol treatment provision in Salford
Greater Manchester West Mental Health NHS Foundation Trust provide Tier 2
and Tier 3 alcohol services in Salford. This service operates in all areas of the
29
city, with the majority of referrals coming to the service via GP practices. In
addition the service has link workers with mental health services, the criminal
justice system (see objective 3), and the hospital (see below). In 2006/7
almost 1,500 adults engaged in treatment with Salford Alcohol Service. This
represents approximately 11.5% of harmful and dependent drinkers in the City
(see page 18). From April 2008 Salford Alcohol Service will be integrated with
Salford Drug Service, providing an integrated substance misuse service from
three sites across the city. This development aims to ensure that the service is
equipped to meet the changing needs of the Salford population and ensure
that the service is accessible to residents of all parts of the City.
Greater Manchester West Mental Health NHS Foundation Trust and Salford
Royal NHS Foundation Trust jointly provide a Tier 2 and 3 alcohol service at
Salford Royal Hospital for harmful and dependent drinkers attending hospital.
This service helps to reduce length of stay for patients with alcohol-related
conditions and prevent readmission to hospital.
Since 2007 Salford Drug and Alcohol Services have employed an alcohol
worker to work with drug users who are drinking at harmful and dependent
levels. Of approximately 1,200 clients in contact with Salford Drug Service an
estimated 30% are drinking at dependent levels. This new post is also
responsible for providing training to drugs services staff in providing alcohol
screening and brief interventions.
Alcoholics Anonymous also provide a Tier 2 service, providing 6 groups
across the City.
In light of increases in alcohol consumption and rising levels of alcohol-related
harm an expansion of alcohol treatment services is needed to keep pace with
demand. There is potential to expand the range of agencies providing Tier 2
alcohol services so that the specialist alcohol service can focus on providing
more specialist Tier 3 services. This would increase the availability of
treatment for dependent and harmful drinkers and thus would assist in
reducing waiting times.
Tier 4 residential alcohol detoxification and rehabilitation services are
commissioned by Salford PCT and Salford City Council, from a range of
providers, primarily based in Greater Manchester. Ensuring that this provision
is sufficient to meet the increasing demand created by an increase in alcohol
consumption and associated problems is a challenge.
Employment
Employability is a key theme in Salford’s Local Area Agreement and tackling
alcohol-related harm has an important part to play in increasing employability.
Salford has the 4th highest proportion of its population claiming incapacity
benefit or severe disablement allowance as a result of alcohol dependence
(NWPHO 2007). Work is already underway in the city to reduce the impact of
alcohol on local businesses and increase the number of people entering
employment following alcohol treatment. Salford Drug and Alcohol Action
Team have developed a Drug & Alcohol in the Workplace Policy which has
30
been adopted by the City Council and is being promoted as an exemplar
policy to other local employers. Guidance has also been developed for
employers to assist them in supporting employees with alcohol problems.
Through services, such as ‘Aspire’ and ‘Progress 2 Work’, alcohol users who
are accessing alcohol treatment are being supported to enter training and
employment.
Housing
A strategic review of supported housing for substance misusers and offenders
was undertaken in early 2007. The purpose of the review was to identify and
map current provision for adult drug and alcohol users, offenders and those at
risk of offending. Workers within Salford Alcohol Service were asked to record
the housing status of all the service users seen over a one month period: 10%
were not in secure accommodation.
The Supporting People Programme in Salford acknowledges that vulnerable
people often have multiple complex needs and therefore the support offered
across individuals within these groups, for example those with drug and
alcohol problems, those at risk of offending, and those with a dual diagnosis
often overlap, therefore service provision is built around attaining to support
an individual to address needs on a sequential and multidimensional level.
The Salford Supporting People Programme commission accommodation
based services which offer support and accommodation on a 24 hour basis,
floating support services which offer housing related support in a persons own
home and resettlement support which offer services that support move on
from supported / temporary accommodation to accommodation that is
deemed independent i.e. own tenancy
The programme in Salford currently commission:


8 units of floating support and 16 units of accommodation based
support for people who’s primary issues are alcohol related.
50 units of floating support for people who’s primary issues are drug
related with secondary issues relating to alcohol.
In addition there are several short term accommodation based and hostel
services which support people with complex needs who may have a primary
issue around homelessness, however have secondary and tertiary issues
around drug and alcohol misuse and or a dual diagnosis and or offending
Evidence & Gap Analysis
Effective alcohol treatment
In 2007 the Department of Health and the National Treatment Agency for
substance misuse published a review of the effectiveness of treatment for
alcohol problems (Raistrick et al 2006). This review identified a range of
interventions which are effective for harmful and dependent drinkers. Brief
interventions can successfully be delivered in settings such as primary care,
but provision of support and training for practitioners is important in ensuring
31
effective implementation. Such less intensive treatments are likely to be
attractive for people with a moderate severity of problem. For those who are
dependent drinkers, or who find it difficult to cut down following brief
interventions, a range of psychological interventions are effective. These
include cognitive behavioural therapy, motivational enhancement therapy and
mutual aid groups. In addition pharmacological interventions can be effective
in supporting detoxification and relapse prevention.
The review also identified that planned and structured aftercare is effective in
improving outcomes among service users with more severe alcohol problems.
“Safe. Sensible. Social.” identified the significant savings to the NHS, at
national and local level, which could be made by investing in alcohol treatment
(DH/HO 2007):
Therefore by investing in expanding and improving in alcohol treatment in
Salford there is the potential for Salford PCT and local GP clusters to make
substantial savings.
Local alcohol service provision includes the provision of brief interventions,
psycho-social interventions and pharmacological interventions to support
detoxification and relapse prevention. Brief interventions can be provided by
any suitably trained individual, therefore by providing training to primary care
services we can expand alcohol treatment provision considerably. Such an
expansion is necessary if there is to be sufficient provision for the rising
numbers drinking at harmful and dependent levels. In addition there is the
potential to expand the range of psychological interventions provided by the
32
local alcohol service. Provision of aftercare is patchy and therefore needs to
be improved particularly in ensuring that relatively intensive support is
available post detoxification. Outcome monitoring of services needs to be
improved, and commissioning streamlined, to ensure that commissioned
services provide effective interventions.
Recommendations
Considering the evidence above and the gaps identified, over the next three
years our work to reduce the impact of alcohol on ill-health and life
expectancy should focus on the following areas:
 Expanding and improving alcohol treatment provision so that there is
sufficient capacity in the alcohol treatment system at all tiers, and that
interventions provided are in line with national guidance and reviews of
treatment effectiveness. We will also ensure that service users and
carers are involved at all stages in the development of services.
 Providing aftercare and wraparound services to ensure that support
services are in place to maximise the effectiveness of treatment
interventions, including access to employment education and training,
and housing support.
Implementation
In order to reduce the impact of alcohol on ill-health and life expectancy we
will focus on the following objectives:
Expanding and improving alcohol treatment provision
a) Provide Tier 2 alcohol interventions in healthcare settings (clinical
pathway described in Appendix 3)
b) Increase capacity in Tier 3 and Tier 4 alcohol services
c) Identify unmet needs and provide appropriate services
d) Improve coordination of alcohol treatment commissioning
e) Increase involvement of Service Users and Carers in the development
and delivery of services
Aftercare and wraparound services
f) Identify structured support programmes and activities in the City which
can be accessed by alcohol service users
g) Expand peer support programmes
h) Provide appropriate housing and housing related support for
dependent drinkers and those in or leaving alcohol treatment
i) Reduce risk of household fires among alcohol misusers
j) Prepare alcohol service users for entering employment through
education and training
k) Provide access to employment for those in and leaving alcohol
treatment
A more detailed action plan can be found at the end of this document.
33
We will measure our progress through the following outcome measures:
 Rate of alcohol-related hospital admissions
 Months of life lost attributable to alcohol
 Proportion of incapacity benefit claims which are caused by alcohol
dependence
 Number receiving brief interventions in primary care via Local
Enhanced Service for alcohol
 Number entering alcohol treatment
34
9.
STRATEGIC OBJECTIVE 3: Reduce alcohol-related crime and antisocial behaviour
National Context
Levels of alcohol-related crime
There is a strong association between alcohol and crime. Alcohol misuse is
associated with anti-social behaviour and public disorder, violence, injury and
victimisation, domestic violence, sexual assault, and deaths and casualties
through road traffic accidents involving alcohol.
Approximately half of all violent incidents take place at weekends, with the
majority of incidents between midnight and 6am. This is particularly the case
for stranger violence and wounding offences, 66% of which occur between
these hours at weekends (DH/HO 2007).
Whilst alcohol use does not cause domestic abuse, it is often a factor in
offences. In nearly half of all incidents of acquaintance violence and domestic
violence the offender is believed to be under the influence of alcohol at the
time of committing the offence. Heavy drinkers are at increased risk of
domestic violence victimisation, and alcohol problems can also develop
following victimisation (Home Office 2004).
Alcohol-related crime is a particular concern for members of the public, with
25% believing that people being drunk or rowdy in a public place is a fairly or
very big problem in their area (DH/HO 2007).
Working with offenders
In Autumn 2007 the Home Office established a small number of arrest referral
pilot projects to investigate how screening and brief advice can be delivered in
criminal justice settings. In addition, during 2007 the National Offender
Management Service funded 7 alcohol best practice pilots to improve the way
alcohol-related offenders are dealt with.
Legislation
The Licensing Act 2003, introduced some significant changes to the Country’s
licensing framework. In addition to the introduction of more flexible licensing
hours, the Act provided a range of powers to regulate sales of alcohol and
take action against irresponsible premises.
The Violent Crime Reduction Act 2006, has also introduced a new range of
powers to tackle irresponsible licensed premises and alcohol-related crime
and disorder including:
 Alcohol disorder zones – under which licensed premises can be
charged for the cost of additional enforcement activity
 Directions to leave and drinking banning orders – under which
individuals can be banned from a locality or premises
35


Powers for trading standards and the police to ban the sale of alcohol
for 48 hours in premises which persistently sell (on three or more
different occasions within three months) to under 18 year olds
Powers for the police to apply for fast track license reviews of premises
associated with serious crime and disorder.
The Home Office has also undertaken work in the areas with the highest
levels of more serious violent crime under the Tackling Violent Crime
Programme. This programme worked with 56 Crime and Disorder
Partnerships to support local efforts to reduce alcohol-related violent crime
and to develop good practice which could then be disseminated to other
areas. For example some areas have initiated voluntary award schemes for
the on-licensed trade to promote the responsible management of licensed
premises and reduce alcohol-related crime.
Local Context
Levels of alcohol-related crime and anti-social behaviour
Between April and December 2007 there were 955 crimes and 5,422 incidents
recorded in Salford which had the alcohol-influence marker attached. This
represents approximately 4.5% of recorded crimes. The majority of these
offences and incidents occurred at weekends. However the number of
offences and incidents which are recorded as being alcohol-related probably
does not accurately reflect the true number in which alcohol was a factor.
National data suggests that the majority of alcohol-related crime takes place
on weekend evenings. An analysis of crimes and incidents occurring between
8pm and 3am at weekends shows that between April and December 2007
there were 1,103 criminal damage offences, 946 less serious woundings and
39 serious woundings in Salford. It is likely that a large proportion of these
offences were alcohol-related. The top repeat streets for these offences were
Liverpool Road and Bolton Road where there are a large concentration of
licensed premises. Over the same period there were 1,663 incidents
recorded, of which 42% were anti-social behaviour (inconsiderate and rowdy
behaviour), 24% were domestic incidents and 8% were violent assaults. The
hotspots for such incidents were also Liverpool Road and Bolton Road.
A Designated Public Places Order is now in place across most of the City, to
prevent alcohol consumption on streets and in parks, where this is linked to
alcohol-related crime and anti-social behaviour. Further investigation is
needed to evaluate the impact that this ban has had on crime and anti-social
behaviour.
Tackling Violent Crime Programme
The Tackling Violent Crime Programme commenced in Salford in 2005,
focusing on tackling alcohol-related violent crime and domestic violence.
Work undertaken as part of this programme included intensive test purchasing
operations (described under objective 4) and a domestic violence
enforcement campaign.
36
Alcohol treatment interventions in the Criminal Justice System
In Salford an alcohol arrest referral scheme, similar to those now being
developed as Home Office pilots, has been in place since 2005. The Criminal
Justice Alcohol Team provide alcohol brief interventions and access to
treatment to those referred by the Police, Probation, Courts and prisons. The
police are able to make attending such appointments a condition of police bail.
Since July 2007 Salford Magistrates Court have been able to impose Alcohol
Treatment Requirements: a six month community order requiring offenders to
engage in alcohol treatment. Setting up the bail condition element of the
scheme and the introduction of Alcohol Treatment Requirements was one of
seven national alcohol best practice pilots funded by the National Offender
Management Service. This work has been very positively received by partners
working in the city and has been acknowledged as good practice by the Home
Office. Since April 2005 more than 750 people have been referred to alcohol
treatment via the criminal justice system. Only 26 people have referred on
more than one occasion as a result of reoffending.
Working with the alcohol retailers
Under the Licensing Act 2003, Responsible Authorities in Salford have
effectively shared information and taken action against several premises
where there have been under age sales or alcohol-related crime and antisocial behaviour. Licensed premises which have successfully been taken to
review have been asked to comply with a list of conditions which aim to
ensure that alcohol is retailed responsibly. These conditions are now forming
the basis of a licensed premises good practice scheme.
Multi-agency working to prevent domestic abuse
A great deal of innovative work has taken place in Salford to tackle domestic
abuse, including an alcohol worker attending the Specialist Domestic Violence
Court to undertake assessments and offer treatment, and the involvement of
the alcohol service in Multi-Agency Risk Assessment Conferences. Salford
Alcohol Service include domestic abuse screening in their assessments and
some Women’s Aid staff have received training in alcohol screening.
Alcohol, anti-social behaviour and housing
The links between alcohol and anti-social behaviour, and the impact that this
can have on an individual or family’s ability to maintain their accommodation,
has been acknowledged locally and there are strong links between local antisocial behaviour and housing services. In addition to the specific substance
misuse floating support and accommodation described under strategic
objective 2, Supporting People also commission specialist floating support for
families through the Assisted Families Project (ASSFAM).
Drink driving
Salford has a well developed Road Safety Strategy which includes the use of
bail conditions for drink driving offences. National drink driving awareness
campaign materials are distributed across the City including to local licensed
premises.
37
Evidence & Gap Analysis
Alcohol arrest referral schemes
There are a number of areas of the country, like Salford, which have
implemented alcohol arrest referrals schemes in advance of the national
pilots. The evaluations of these schemes have been very positive, for
example, in Dudley offenders who accessed the scheme committed 50%
fewer offences than those who had not accessed the scheme.
The impact of the interventions introduced in Salford is not yet fully
understood therefore an evaluation of Salford’s criminal justice alcohol work
will be carried out during 2008. Subject to a successful evaluation there is the
potential to expand and improve the range of alcohol interventions offered
through the criminal justice system, particularly ensuring that interventions are
available for low level offences, as this may present an opportunity for earlier
intervention.
Data collection and information sharing
In several areas of the country including the Wirral, Cardiff and the South
East, systems have been put in place to collect data in hospital emergency
departments about assault related injuries and share this with local Crime and
Disorder Reduction Partnerships. As only approximately 25% of violent
offences resulting in NHS treatment are recorded by the police, collecting
information about the location of such incidents can provide valuable
information to partnerships about the locations and incidence of alcoholrelated violent crime. This allows resources for prevention and enforcement
activity to be targeted accordingly. In Cardiff the implementation of such a
scheme resulted in a 40% reduction in violent assaults.
Introducing such data collection systems in the City could have a significant
impact on reducing violent crime.
Tackling Violent Crime Programme
The Home Office has produced guidance on “Tactical Options for Dealing with
Alcohol-Related Violence”, based on examples of best practice identified
through the Tackling Violent Crime Programme. This guide includes examples
of work undertaken in other areas including ensuring alcohol-related flags are
used on crime reports, promotion of polycarbonate drinking vessels to reduce
glass related injuries and systems to enable licensed premises to alert CCTV
control rooms to emerging problems.
By improving the collection of information about hotspots for alcohol related
crime and anti-social behaviour and the connection to on and off licensed
premises the need for such interventions can be better understood, and such
examples of good practice be implemented.
38
Recommendations
Considering the evidence above and the gaps identified, over the next three
years our work to reduce alcohol-related crime and disorder should focus on
the following areas:
 Working with victims and offenders to ensure that alcohol screening,
advice and treatment can be accessed at all stages of the criminal
justice system.
 Improving data collection to ensure that a detailed picture of the extent
and nature of alcohol-related crime in the City is available, so that
enforcement and prevention activity can be planned accordingly.
 Utilising existing legislation to ensure that appropriate action is taken
on and off licensed premises which contribute to alcohol related crime
and anti-social behaviour, and good practice is promoted.
Implementation
In order to reduce alcohol-related crime and anti-social behaviour we will
focus on the following objectives:
Working with victims and offenders
a) Further develop the criminal justice alcohol pathway
b) Increase capacity and capability of criminal justice agencies to provide
alcohol interventions
Intelligence gathering & information sharing
c) Establish data collection and sharing systems between the Emergency
Department and Crime and Disorder Reduction Partnership
d) Improve use of alcohol marker in Police data
e) Conduct further local analysis to improve understanding of the
relationship between alcohol sales and crime and anti-social behaviour
Working with licensed premises
f) Work with licensees to reduce crime and anti-social behaviour
g) Utilise new and existing powers to take action against premises which
contribute to crime, disorder and anti-social behaviour
A more detailed action plan can be found at the end of this document.
We will measure our progress through the following outcome measures:
 Number of offenders referred for alcohol treatment
 Percentage of the public who perceive drunk and rowdy behaviour to
be a problem in their area
 Serious violent crime rate
 Assault with injury crime rate
 Repeat incidents of domestic violence
39
10.
STRATEGIC OBJECTIVE 4: Reduce the harm caused to children
and young people by alcohol use
National Context
Alcohol use by young people
The percentage of young people who consume alcohol has remained
relatively stable over the past 30 years, however young people who do drink
are consuming significantly more. The average weekly consumption of 11 –
15 year olds doubled between 1990 and 2000, from 5 units to 10 units. More
recently alcohol consumption for older adolescents has remained stable,
whilst consumption among younger adolescents has increased. Alcohol
consumption among 11-13 year old boys increased from 5.5 units per week
in 2001 to 11.9 units in 2006, and consumption among girls increased from
5.7 units to 8.4 units. Among 15 year olds 24% claim to have been drunk
more than 10 times in the past year (DH/HO 2007).
Policy and guidance
The National Drugs Strategy “Drugs: protecting families and communities”,
includes alcohol use by young people within its remit, with the following key
actions identified in relation to children and young people:



Supporting families affected by substance misuse
Extending use of FRANK to provide access to support and
interventions, to support local campaigns and school-based education,
and to target key audiences
Improving support and information for parents
The Government is also due to publish a Young People & Alcohol Action Plan
during 2008.
Every Child Matters: Change for Children is the Government’s vision for
ensuring that agencies work together to protect and promote the well-being of
children and young people. In order to ensure that the drug strategy is an
integral part of implementing this vision, the Government selected a number of
High Focus Areas across the country to take this forward and develop an
effective practice model. Salford was selected as a high focus area and work
has focused on tackling the Hidden Harm agenda (see page 44) and targeting
truants as a vulnerable group.
Guidance for schools in developing drug and alcohol education was published
in 2004. Implementing drug and alcohol policies and education programmes is
also part of the Health Schools Standard. The Continuing Professional
Development programme in PSHE for teachers and school nurses includes
alcohol education and therefore aims to improve the quality of teaching in this
subject. Ofsted reports suggest that the quality of alcohol education is
improving however not all schools provide enough time for effective learning
and some teachers lack up to date specialist knowledge.
40
The National Service Framework for Children set standards which will help the
NHS, Local Authorities and their partner agencies achieve high quality service
provision. The standards incorporate the recommendation that information
and services are offered to prevent risk taking and promote health lifestyles in
children and young people, including preventing and reducing use of alcohol.
In addition parents with specific needs such as addiction to alcohol should
have their needs identified early and provided with effective multi-agency
support.
The impact on children of parental/carer alcohol misuse
In 2003 the Advisory Council on the Misuse of Drugs published a report on
protecting the Children of Drug and Alcohol Misusers from harm entitled
‘Hidden Harm’, the Government has since published a response and identified
3 areas where changes are required:
 Policy change (nationally, regionally and locally) to ensure that children
do not come to harm
 Procedural shifts by drugs and alcohol services to assess and meet the
needs of their clients as parents and their children
 Training is required to skill all practitioners to work with a new
framework of care that will identify the needs of children affected by
parental substance misuse.
Under-age sales of alcohol
The Home Office programme of campaigns to tackle under-age sales of
alcohol commenced in summer 2004, with the aim of assessing the progress
made by the licensed trade in their goal of reducing underage sales, and to
send a clear message to all licensed premises and those using them that
irresponsible management and behaviour will not be tolerated. As a result of
these operations work has been undertaken across the country to reduce
under age sales, including Challenge 21 campaigns and test purchasing
operations. Sales to under 18 year olds, made during test purchasing
operations, have resulted in retailers being prosecuted and licenses being
reviewed or revoked.
Alcohol and Teenage Pregnancy
The National Teenage Pregnancy Strategy was launched in 1999, and aims to
halve the teenage pregnancy rate by 2010. Young people report having more
risky sex when they are under the influence of alcohol. Among 15-16 year
olds one in 14 say they have had unprotected sex after drinking, and one in
seven 16-24 years olds say they have done so (Alcohol Concern 2002). Early
alcohol use is also associated with risky sex and sex at a younger age.
Reducing alcohol consumption among young people has an important role to
play in reducing the teenage pregnancy rate.
41
Local Context
Young people and alcohol consumption in Salford
The North West Trading Standards Survey has highlighted the extent of
alcohol misuse among young people in Salford. In particular the issues of
drinking on the streets in large groups, and regular binge drinking have been
shown to be of particular concern.
In 2006 young people’s substance misuse in Salford was the subject of
research conducted by Parker and Egginton, who identified that the dominant
substance misuse profile among young people in Salford is Alcohol,
Cannabis, Cocaine and Ecstasy (ACCE). This research also highlighted the
prevalence of street drinking in large gatherings and the need to ensure that
young people drinking in these situations are protected from harm.
Alcohol Commission
In 2006 an Alcohol Commission was also established in Salford to investigate
“The nature and extent of alcohol-related problems in the city and the
measures in place to deter and prevent anti-social behaviour resulting from
them with regards to young people (under 18 years)”. The Commission
identified several recommendations for the City, many of which have now
been carried out, for example consideration of a city wide street drinking bilaw, which was introduced in early 2007. Some of the Commission’s
recommendations still require ongoing work, for example promoting proof of
age cards and training teachers to provide alcohol education in schools.
Education and prevention
A wide range of alcohol education is now taking place in Salford schools
including a peer education programme, theatre in education and specialist
alcohol education resources such as DVDs. This work is supported by a
specialist education consultant and a substance misuse education worker,
who also provide training for teachers and support for schools in developing
drug and alcohol policies. To date 37 Salford teachers have gained the
national accreditation certificate for teaching PSHE. However, the difficulty of
incorporating alcohol education, as a non-statutory subject, into the busy
school curriculum remains, and further work is required to ensure that
teachers have the skills and confidence to deliver alcohol education and to
ensure that high quality alcohol education is provided in all primary and
secondary schools in the City.
Workshops are also provided for young people in community settings,
including joint alcohol and sexual health harm reduction workshops. As part of
these workshops consultation is also carried out with young people on the
harm reduction materials and initiatives that they would like to see in place in
the City. Consultation has also been undertaken through outreach work with
Salford Youth Service.
42
Reducing under-age sales
Test purchasing operations conducted by Trading Standards and Greater
Manchester Police, to identify premises selling alcohol to under-age drinkers
have been very successful, with the number of premises selling to trading
standards volunteers reducing from 53% in August 2005 to 11.6% in January
2007. Where premises have sold repeatedly action has been taken, with the
licensing panel imposing new conditions with the aim of preventing further
under-age sales. Whilst test purchasing operations have been successful
there is now concern that young people are obtaining alcohol from parents
and other adults. Therefore alongside the provision of education for young
people there is also a need to educate parents about the harmful effects of
alcohol on young people, and the impact on communities of young people
drinking on the street.
Although not directly linked to local work to reduce under-age sales it has
been noted that several premises are now only allowing entry to over 21, or in
some cases over 25 year olds. Whilst in many cases such policies have been
introduced as a result of anti-social or disorderly behaviour by younger age
groups in the premises in the past, it does nevertheless mean that older
young people are then drinking on the streets. This potentially poses a risk to
vulnerable younger people, and in some cases older young people are a route
of alcohol supply to under 18 year olds drinking in public places. Therefore it
is important to ensure that young people are provided with safe places to go
and things to do.
Alcohol treatment for young people
Salford’s first substance misuse treatment plan has recently been developed,
for 2008/9. This includes plans for the provision and development of alcohol
services for young people. The key objectives of this plan include:
 Re-launch SMART (Young People’s Drug & Alcohol Service) to include
a “Transitions service” for young people aged 18 – 21
 Identify and reach out to new communities in Salford to prevent and
reduce harm caused by substance misuse
 Work in partnership to address the needs of families affected by
substance misuse
 Access aftercare and wraparound provision for young people leaving
treatment
Specialist alcohol treatment for young people is provided by SMART
(Substance Misuse Advice and Referral Team). Problematic alcohol use is the
most common reason for young women to be referred to the service, and the
second for young men, behind cannabis use. Since 2005 two new posts have
been introduced to the service which have a specific focus on alcohol. The
A&E Young People’s Harm Reduction Nurse provides alcohol interventions to
young people admitted to A&E as a result of substance misuse.
Approximately 90% of referrals from A&E are for young people whose
admission is alcohol-related. In 2007 SMART were successful in obtaining 3
years funding from Comic Relief for a specialist young people’s alcohol
worker. This post has increased the level of alcohol expertise within the team
43
and has provided additional capacity to increase work with partners to ensure
that vulnerable young people receive alcohol education and support.
Training has been provided to professionals across the City in providing
substance misuse screening and interventions. As a result of requests from
those who have received training a specific training session on young people
and alcohol has been developed and is being rolled out across the City.
Providing training to the Youth Service, voluntary and community groups
working with young people, particularly those providing outreach, is a key area
of importance in ensuring that young people receive harm reduction
information and are signposted to local services as appropriate. As alcohol
use is widespread among young people it is important that responding to
alcohol use is embedded in the core competencies for the children and young
people’s workforce.
Hidden Harm
There are approximately 4,000 young people in the City who live with a parent
who is a dependent drinker. Drug and alcohol services have agreed protocols
and procedures with local safeguarding children’s board to protect young
people who may be at risk as a result of parental alcohol use. Alcohol service
staff have been trained in addressing the impact of parental substance misuse
and parents accessing drug and alcohol services have access to Webster
Stratton parenting courses. A part-time post is funded within the Young Carers
project to provide support to young people who care for a parent who uses
drugs or alcohol. However capacity is limited and it is therefore important that
other services are available for young people which can build protective
factors and support young people, as the children of substance misusing
parents are at greater risk of developing substance misuse problems
themselves. In addition a post has been funded to work with looked after
children and to link with ASSFAM to provide support to families where
parental alcohol misuse is identified as a cause of anti-social behaviour.
Evidence & Gap Analysis
Educating and supporting young people
The National Institute for Clinical Excellence has published guidance on
delivering school based interventions on alcohol. This guidance recommends
that alcohol education should be an integral part of the national science and
PSHE education curricula and should increase knowledge and explore
attitudes and perceptions of alcohol use. A whole school approach to alcohol
should be taken involving staff, parents and pupils. Where young people are
believed to be drinking harmful amounts of alcohol, brief one to one advice on
reducing the risks of alcohol use should be offered, and where appropriate
referral to external agencies offered.
A Drug Education Consultant and a Substance Misuse Education Worker are
employed in the City to ensure that schools alcohol education programmes
and policies are in line with national guidance and evidence of good practice.
Ensuring that all schools meet these standards is a priority, to ensure that all
young people have the necessary knowledge and skills to make decisions
44
about alcohol use. Through the Healthy Schools scheme schools are
encouraged to take a whole school approach to alcohol education, however
there is potential to further engage parents in alcohol education both through
schools and in the community.
One to one advice is available to young people through a specialist substance
misuse service, and through a range of other young people’s services which
have received training to deliver advice and information, for example
Connexions and the Youth Offending Service. However there is potential to
increase the number and range of young people’s workers who are able to
provide such interventions, particularly for voluntary sector providers, and to
increase awareness of the availability of specialist substance misuse services
for young people.
Test purchasing
Locally there has been a large reduction in the proportion of test purchase
operations resulting in sales. This figure has particularly decreased since
several premises were successfully taken to license reviews.
It is therefore important that such activity continues and that the outcomes of
reviews are well publicised.
Recommendations
Considering the evidence above and the gaps identified, over the next three
years our work to reduce the harm caused to children and young people by
alcohol misuse should focus on the following areas:




Reducing under age sales by continuing to conduct test purchasing
operations to identify premises selling to young people and publicising
the results of these.
Providing high quality alcohol education in line with evidence of
effectiveness, in schools and in the wider community.
Providing harm reduction advice and specialist support to young people
to ensure that the risks to those who choose to drink are minimised.
Providing support for families who are affected by substance misuse to
minimise the potential negative impact of parental alcohol use on
young people.
Implementation
Reducing under-age sales
a) Continue to conduct regular, intelligence led operations across the City
b) Take action against adults who supply alcohol to young people
Provide high quality alcohol education
c) Ensure schools have alcohol policies and education programmes in
line with local and national guidance
d) Ensure teachers have the skills and knowledge to deliver alcohol
education
45
e) Ensure parents have the skills and knowledge to address alcohol
issues with their children
f) Provide alcohol education in a range of settings outside of the school
classroom
Reduce harm among young people who drink alcohol
g) Reduce harm to young people drinking in public places
h) Provide accessible specialist support to young drinkers
i) Provide attractive, affordable alternatives to drinking for young people
j) Collect and improve use of intelligence on where and why young
people drink
Supporting families affected by alcohol misuse
k) Ensure professionals working with parents are able to recognise and
address the impact of parental substance misuse on children and
young people
l) Provide support to families affected by parental/carer substance
misuse
A more detailed action plan can be found at the end of this document.
We will measure our progress through the following outcome measures:
 Rate of frequent substance use by young people
 Percentage of schools achieving the National Healthy Schools Status
 Number of teachers completing the PSHE Continuing Professional
Development Programme
 Percentage of premises selling alcohol to young people during test
purchase operations
 Rate of alcohol-specific hospital admissions for under 18s
 Under 18 conception rate
46
11.
ACTION PLAN
STRATEGIC OBJECTIVE 1: Ensure that those who drink alcohol in Salford are able to do so safely and responsibly
TARGET
Reduce the gap in the prevalence of hazardous, drinking
between Salford and the national average
Reduce the gap in the prevalence of harmful drinking between
Salford and the national average
Reduce the gap in the prevalence of binge drinking between
Salford and the national average
Objective
Action required
1a) Understand the target
audience for responsible
drinking campaigns and
how to reach them
1b) Develop local
campaigns to
complement those being
delivered by Greater
Manchester and through
the national alcohol harm
reduction campaign
programme, in line with
market analysis
Commission market analysis
of hazardous and harmful
drinking in Salford
Ensure that Salford is
included in Greater
Manchester campaigns
Deliver local campaigns
based on outcomes of market
analysis
SALFORD
22.94%
BASELINE
NATIONAL AVERAGE
20.1%
GAP
2.84
7.55%
5.0%
2.55
26.45%
18.0%
8.45
Outputs/
Outcomes
Market analysis
report completed
Resources
Date
Lead
£5,000
Q1/2008-9
IDENTIFIED: DAAT
Salford City
Council - DAAT
Greater
Manchester
campaign
delivered in
Salford
Minimum of 1
campaign
delivered per year
Within existing
resources
Q1/2008-9
Salford City
Council - DAAT
£50,000 per year
REQUIRED
Q4/2010-11
Salford City
Council - DAAT
47
1c) Increase the
availability of unit and
responsible drinking
information across the
city
Promote availability of free
materials from The
Drinkaware Trust and
Department of Health to local
organisations who can
distribute to the public
Increase the
number of Salford
addresses
receiving
Drinkaware and
Know your limits
information from
2007/8 baseline.
1d) Encourage local
employers to provide
responsible drinking
information to staff
PCT and City Council to take
the lead in publicising
responsible drinking message
to staff
Responsible
£500 REQUIRED
drinking
information
communicated to
staff at least twice
per year
Drugs and alcohol Within existing
workplace packs
resources
distributed to 100
largest employers
in Salford
Q3/2008-9
Drinkaware and
Know Your Limits
information
available through
these services
1 campaign per
year delivered
Within existing
resources
Q4/2010-11
Within existing
resources
Q4/2010-11
Provide advice and guidance
to local employers about
promoting responsible
drinking
1e) Reduce the risk of
alcohol-related harm to
students
Provide harm reduction
information via the Student
Union and Student
Assistance Service
Deliver alcohol harm
reductions campaigns
Within existing
resources
Q4/2008-9
Q4/2010-11
Salford City
Council –
DAAT
PCT
Salford City
Council –
Community
Health & Social
Care (CHSC)
PCT
Salford City
Council – Chief
Executive’s
Salford City
Council –
DAAT
Economic
Development
Partnership
University of
Salford
University of
Salford
48
1f) Provide alcohol
screening, using World
Health Organisation
recognised screening
tools, and brief advice in
all GP practices in the
City
1g) Ensure that alcohol
screening and brief
advice is available in the
Emergency Department
Include alcohol screening and
brief advice in the
specification for a lifestyles
Local Enhanced Service
Provide alcohol screening
and brief advice training to
primary care staff
Establish systems to monitor
the numbers screened and
provided with brief advice in
primary care
Embed routine use of
screening tool in the
Emergency Department
Establish systems to monitor
provision of screening and
brief advice in the Emergency
Department
Lifestyle LES
commissioned
£40,000 per year
BID PENDING
Q2/2008-9
PCT
Training provided
to staff in all GP
practices
Number of people
screened and
offered advice or
referral can be
reported quarterly
Screening
regularly used in
Emergency
Department
Number of people
screened and
offered advice or
referral can be
reported quarterly
£10,000 BID
PENDING
Q3/2008-9
PCT
GP Practices
Within other
resources identified
for this sub-objective
Q3/2008-9
PCT
GP Practices
Within existing
resources
Q1/2008-9
Salford Royal
Foundation
Trust (SRFT)
Resources required
can be calculated
when systems to
collect data has
been identified
Q4/2009-10
SRFT
49
1h) Ensure that front-line
staff in a variety of
agencies have the
knowledge and skills to
provide alcohol screening
and brief advice
1i) Lobby Central
Government to:
 Improve regulation
of alcohol pricing
in off licenses and
supermarkets
 Address the way
that alcohol is
promoted and
advertised, with
particular regard to
the impact on
young people
Fully utilise screening and
brief advice training funded by
Association of Greater
Manchester PCTs for frontline staff working in Salford
Provide training to front-line
staff in:
Health Improvement Teams
Midwifery
Dentistry
Sexual health services
Mental health services
Adult social care services
Conduct a local photographic
survey to provide evidence of
promotions in local off
licenses and supermarkets
and encourage involvement
from other areas in the
Region
Respond to opportunities
provided by Government to
provide feedback on the
impact of national policies at
local level
At least 90% of
training places
available for
Salford are
utilised
At least 1 training
session provided
to staff in each
agency
Within existing
resources
Survey completed
Within existing
resources
Response
provided for all
available
consultations
Within existing
resources
Q1/2008-9
Within existing
resources
2008/9
2010/11
2010/11
2009/10
2009/10
2008/9
Q4/2008-9
2010-11
Salford City
Council - DAAT
Salford City
Council –
DAAT
PCT
Salford City
Council - CHSC
Salford City
Council –
Environment
Salford City
Council –
DAAT
Salford City
Council – all
directorates
PCT
50
1j) Establish
neighbourhood based
forums for licensed trade
to improve
communication between
enforcement agencies
and the trade to promote
best practice
Map existing forums and
pubwatch meetings across
the City
Consult with Licensees and
Neighbourhood Managers to
identify appropriate
membership and terms of
reference for licensing fora
Engage on and off licensed
premises in new
pubwatch/licensees forum
meetings
1k) Continue to develop
voluntary
conditions/responsible
retailing scheme so that
on and off licensed
premises in all areas of
the City are involved
Encourage off-licenses to
sign up to conditions
voluntarily or as a condition
of license
Develop suitable conditions
for on-licensed premises
and promote sign up
Document
produced
describing existing
groups
Consultation carried
out via Community
Committees,
Pubwatch meetings
and through visits to
licensed premises
Meetings
established in 8
neighbourhood
areas and attended
by on and off
licenses
100% off licensed
premises sign up to
scheme
Within existing
resources
Q2/2008-9
Salford City
Council – Chief
Executive’s
Within existing
resources
Q3/2008-9
Salford City
Council – Chief
Executive’s
Salford City
Council - CHSC
Within existing
resources
2009-10
Salford City
Council – Chief
Executive’s
Salford City
Council - CHSC
£4000 for publicity
materials for
premises
IDENTIFIED:
PCT/CDRP
Q4/2010-11
Greater
Manchester
Police
100% of Top Threat
premises as
identified by Police
£4000 for publicity
materials for
premises
REQUIRED
Q4/2010-11
Greater
Manchester
Police
51
Set up multi-agency
systems to monitor
compliance with conditions
1l) Provide and promote
training for bar staff and
licensees
1m) Ensure that the
vision for the
regeneration of the City
encompasses the Civic
Trust standards for a
balanced night time
economy
Systems agreed
and monitored
through
Responsible
Authorities Group
DVD produced and
distributed to
licensees
Within existing
resources
Q4/2008-9
£2,000 REQUIRED
Q1/2009-10
Promote accredited training
courses to licensees and
their staff
BIIAB training
courses held in
Salford for
licensees to attend
£1,500 per year to
subsidise course
fees
REQUIRED
Q4/2009-10
Provide training and
information through
neighbourhood based
licensing fora
1 training or
information item is
included on every
agenda
Within existing
resources
2009-10
Consider the Civic Trust
standards in the
development of Media City
and Central Salford
New developments
meet Civic Trust
standards
Within existing
resources
Q4/2010-11
Develop local training DVD
for licensees to use with
staff
Greater
Manchester
Police
Responsible
Authorities
Salford City
Council –
Environment
Responsible
Authorities
Salford City
Council –
Environment
Responsible
Authorities
Salford City
Council –
Environment
Responsible
Authorities
Salford City
Council – Chief
Executive’s
Economic
Development
Partnership
52
STRATEGIC OBJECTIVE 2: Reduce the impact of alcohol on ill-health and life expectancy
TARGET
SALFORD
Reduce the gap between Salford and the national average in
the months of life lost attributable to alcohol
Reduce the gap between Salford and the national average in
the rate of incapacity benefit claims as a result of alcohol
dependence
Reduce the rate of increase in alcohol-related hospital
admissions by 1% year on year
Number receiving brief interventions in primary care, as part
of Local Enhanced Service for alcohol
Increase the number entering alcohol treatment in line with
targets set by National Treatment Agency
MALES: 13.75
FEMALES: 5.95
353.09
BASELINE 2006/7
NATIONAL
AVERAGE
MALES: 9.38
FEMALES: 4.36
122.72
BASELINE
2005/6 -2006/7 10%
0
To be established in 2008/9
GAP
MALES: 4.37
FEMALES: 1.59
230.37
TARGET
9% 2007/8
8% 2008/9
7%2009/10
6% 2010/11
80% of GP patients over
aged 18 will have an
alcohol assessment in
their notes and will be
offered brief interventions
as appropriate (March
2011)
To be set by NTA for
2009/10 onwards
53
Objective
Action required
2a) Provide Tier 2 alcohol
interventions in
healthcare settings
Establish a local enhanced
service for alcohol
Establish a specialist
midwife role
2b) Increase capacity in
Tier 3 and Tier 4 alcohol
services
Provide training to
healthcare professionals in
delivering alcohol brief
interventions
Establish systems to
monitor the number of brief
interventions delivered in
primary care
Identify funding for
additional specialist alcohol
workers
Ensure interventions
delivered in tier 3 and 4
alcohol services are in line
with the review of
effectiveness of alcohol
treatment
Outputs/Outcome
s
Local Enhanced
Service for alcohol
established in every
GP cluster
Alcohol specialist
midwife role
established
Training provided in
all GP clusters
Resources
Date
£250,000 BID
PENDING
Q2/2008-9
Partners (lead
in bold)
PCT
£20,000 per year
BID PENDING
Q4/2008-9
PCT
Covered within
resources identified
in 1e
Q2/2008-9
PCT
Number of brief
interventions
delivered can be
reported quarterly
Funding identified
for at least 2
additional alcohol
workers
Service
specifications and
contracts define
appropriate
interventions in line
with MoCAM and
DH Review of
alcohol treatment
effectiveness
Within other
resources identified
for this subobjective
£70,000 per year
BID PENDING
Q2/2008-9
PCT
GP Practices
Q2/2008-9
PCT
Within existing
resources
Q4/2008-9
Salford City
Council DAAT
PCT
54
Improve alcohol treatment
monitoring in line with the
National Drug Treatment
Monitoring System and the
Treatment Outcomes Profile
2c) Identify unmet needs
and provide appropriate
services
2d) Improve coordination
of alcohol treatment
commissioning
Alcohol services
able to provide
quarterly reports to
NDTMS from 20089, including the
Treatment
Outcomes Profile
from 2009-10
Care pathway
agreed
Within existing
resources
Q1/20089
Salford City
Council - DAAT
PCT
Need for additional
resources to be
identified
2009-10
Develop a care pathway for
dependent drinkers who do
not want to access alcohol
treatment
Care pathway
agreed
Need for additional
resources to be
identified
2009-10
Consult with local groups
and communities to identify
unmet needs and establish
appropriate provision
Information
gathered from
community
committees and
health improvement
teams as part of
needs assessment
process
Alcohol
commissioning is
coordinated
through 1 strategic
group
Within existing
resources
Q3/20089
Salford City
Council – DAAT
PCT
Salford City
Council – CHSC
Salford City
Council – DAAT
PCT
Salford City
Council – CHSC
Salford City
Council – DAAT
PCT
Salford City
Council – CHSC
Within existing
resources
Q4/20089
Develop a care pathway for
people suffering from
alcohol-related brain
damage
Establish joint
commissioning
arrangements to support
delivery of the alcohol
strategy
Salford City
Council - DAAT
PCT
55
2e) Increase involvement
of Service Users and
Carers in the
development and delivery
of services
2f) Identify structured
support programmes and
activities in the City which
can be accessed by
alcohol service users
2g) Expand peer support
programmes
Continue development of
Service Users Forum
Establish a Carer’s
Reference Group to provide
a central point of
communication between
carers, Salford DAAT and
service providers
Map existing provision
Work with providers to
ensure that they understand
the needs of alcohol users
and are able to
accommodate them
Work with Alcoholics
Anonymous to identify
areas where joint work can
be carried out with other
strategy partners and
service providers
Expand support group
provision to cover all Drug
and Alcohol Service locality
bases
300 members by
2011
Annual elections of
board members
4 newsletters
published per year
Group established
Within existing
resources
Q4/201011
Salford City
Council - DAAT
Within existing
resources
Q4/20089
Salford City
Council - DAAT
Directory of
activities available
Providers willing to
support alcohol
service users to
undertake activities
Within existing
resources
Within existing
resources
Q1/20089
Q4/20089
Salford City
Council - DAAT
Salford City
Council - DAAT
Areas of
development
agreed with
Alcoholics
Anonymous
Within existing
resources
Q2/20089
Salford City
Council – DAAT
Alcoholics
Anonymous
Support groups
established in Little
Hulton and Eccles
Within existing
resources
Q4/20089
Salford City
Council - DAAT
56
2h) Provide appropriate
housing and housing
related support for
dependent drinkers and
those leaving alcohol
treatment
2i) Reduce risk of
household fires among
alcohol misusers
Expand Substance Misuse
Tenancy Support Service
Capacity in floating
support team
increased
£80,000 per year
BID PENDING
Q1/2008
-9
Ensure housing support
providers have the skills
and knowledge to support
tenants with alcohol
problems
Provide at least 1
training session to
supported housing
providers
Within existing
resources
Q2/2008
-9
Ensure Fire & Rescue
Service (FRS) have
appropriate harm reduction
materials to distribute
Drinkaware and
Know your limits
leaflets distributed by
Fire and Rescue
Service
Information sessions
provided once per
year at all service
bases
Referral for FRS is
offered as part of
alcohol service
assessment process
Annual inspections
undertaken of all
premises identified
by Supporting People
Within existing
resources
Q2/2008
-9
Within existing
resources
Q4/2008
-9
Within existing
resources
Q2/2008
-9
Within existing
resources
Q4/2008
-9
Provide regular fire
prevention information
sessions for alcohol service
users
Establish a ‘priority’ referral
process from alcohol
services to FRS for Home
Fire Risk Assessment
Regularly review fire
protection measures in all
hostels/accommodation
units providing supported
accommodation to people
with alcohol problems
Salford City
Council –
Housing &
Planning
Salford City
Council - DAAT
Salford City
Council - DAAT
Salford City
Council –
Housing &
Planning
Salford City
Council - DAAT
Greater
Manchester
Fire & Rescue
Service
Greater
Manchester
Fire & Rescue
Service
Greater
Manchester
Fire & Rescue
Service
57
2j) Prepare alcohol
service users for entering
employment through
education and training
2k) Provide access to
employment for those in
and leaving alcohol
treatment
Provide motivational
training, personal finance
management training and
life coaching
Provide training courses up
to level 3
50 clients to
Within existing
complete courses per resources
year
Enable services users to
enter employment by
working with employers and
Job Centre Plus to match
service users with suitable
job opportunities
Continue to provide support
in workplace for 13 weeks
after commencing
employment
Within existing
resources
Q4/2010- Salford City
11
Council - DAAT
12 clients to achieve
qualifications to level
2
Increase year on
year numbers of
clients entering full
time employment
£6000
Q4/2010- Salford City
IDENTIFIED: DAAT 11
Council - DAAT
Increased number of
employees
sustaining
employment beyond
13 weeks from
2007/8 baseline
Within existing
resources
Q3/2008- Salford City
9
Council – DAAT
Job Centre Plus
Economic
Development
Partnership
Q4/2010- Progress to
11
Work
Salford City
Council - DAAT
58
STRATEGIC OBJECTIVE 3: Reduce alcohol-related crime and anti-social behaviour
TARGET DESCRIPTION
Increase the number of offenders referred to alcohol treatment
Reduce public perceptions of drunk and rowdy behaviour as a
problem
Reduce the rate of serious violent crime
Reduce the rate of assault with injury
Reduce repeat incidents of domestic violence
BASELINE
280 (2006/7)
TARGET
400
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
To be agreed as part of LAA
negotiation process
Objective
Action required
Outputs/ Outcomes
Resources
Date
3a) Further develop the
criminal justice alcohol
pathway
Evaluate the effectiveness
of criminal justice alcohol
interventions
Sustain funding for Criminal
Justice Alcohol Workers
Evaluation completed £10,000
IDENTIFIED:
NOMS/CDRP
Funding for 2008-9
£75,000 per year
onwards agreed
BID PENDING
Q4/20089
Identify mechanisms
through which alcohol
interventions can be
provided to those not
required to attend court
Establish
education/referral
scheme for those not
attending court
Within existing
resources
depending on
model established
Q4/20089
Ensure prisons are aware of
local treatment pathways
and make appropriate
referrals
Increase the number
of referrals from
prisons from 2007/8
baseline
Within existing
resources
Q2/20089
Q1/20089
Partners (lead
in bold)
Salford City
Council DAAT
Crime &
Disorder
Reduction
Partnership
Salford City
Council DAAT
Greater
Manchester
Police
Salford City
Council DAAT
59
Develop alcohol worker
input with Specialist
Domestic Violence Court
cases
3b) Increase capacity and
capability of criminal
justice agencies to
provide alcohol
interventions
Train Probation staff to
provide screening, brief
interventions and initial
assessment for Alcohol
Treatment Requirements
Extend the range of alcohol
programmes offered
through Probation for
offenders drinking at
hazardous and harmful
levels
Ensure that services
working with victims and
offenders are able to make
appropriate referrals into
alcohol treatment
Increase in number
of referrals from
specialist domestic
violence court to
alcohol services from
2007/8 baseline
Training provided to
all Offender
Management Units
Within resources
identified above
At least 1 new
alcohol programme
established
Resource
implications to be
identified when
Low Intensity
Alcohol
Programme has
been accredited by
NOMS
Within existing
resources
Training provided to:
Court Clerks
Custody Staff
Together Women
Project
Within existing
resources
Q4/2008- Salford City
9
Council –
DAAT
Salford
Magistrates
Court
Q4/2008- Salford City
9
Council DAAT
Probation
Q4/2009- Probation
10
Q4/2008- Salford City
9
Council –
DAAT
Salford
Magistrates
Court
Greater
Manchester
Police
Together
Women Project
60
3c) Establish data
collection and sharing
systems between the
Emergency Department
and CDRP
3d) Improve use of
alcohol marker in Police
data
Establish assault data
collection systems in the
Emergency Department
Agree protocols for sharing
information with CDRP
Data collection systems Up to £10,000
established
REQUIRED
Q4/2008-9
Protocols agreed
Within existing
resources
Q4/2008-9
Ensure information is
utilised to plan prevention
and enforcement activity
CDRP provide
information to the
Emergency
Department about how
the information has
been used
Good practice identified
and reported to Drugs
and Alcohol Criminal
Justice Group
Issue discussed at
Greater Manchester
Strategy Group and
Alcohol Leads Group
and actions agreed
Include locations of
licensed premises in
strategic threat
assessment alongside
alcohol related crimes
Within existing
resources
Q2/200910
Within existing
resources
Q2/2008-9
Greater
Manchester
Police
Within existing
resources
Q4/2008-9
Within existing
resources
Q2/2008-9
Salford City
Council – DAAT
Greater
Manchester
Police
Salford City
Council – Chief
Executive’s
Identify good practice in
other areas of the Country
Work with colleagues in
Greater Manchester to
identify how this can be
implemented force wide
3e) Conduct further local
analysis to improve
understanding of the
relationship between
alcohol sales and crime
and anti-social
behaviour
Map the locations of
alcohol-related crimes and
incidents, and those likely
to be associated with
alcohol to the locations of
licensed premises
Salford Royal
Foundation
Trust
Salford Royal
Foundation
Trust
Crime &
Disorder
Reduction
Partnership
Crime &
Disorder
Reduction
Partnership
61
Conduct a further trial of
marking of products in offlicenses so the retailer can
be identified
Use data on locations of
anti-social behaviour and
reported crimes to analyse
the impact of enforcement
campaigns and work with
alcohol retailers
3f) Work with licensees
Provide crime prevention
to reduce crime and anti- advice to licensed
social behaviour
premises
Establish system to notify
licensed premises when
there are particular risks to
their security
Establish Radio-Net
systems for licensed
premises in hotspots for
alcohol-related crime and
disorder
3g) Utilise new and
existing powers to take
action against premises
which contribute to
crime, disorder and antisocial behaviour
Trial conducted in 1
neighbourhood area
To be calculated
when products to
be used have
been identified
Within existing
resources
Q4/2008-9
Greater
Manchester
Police
Q2/2008-9
Advice provided to all
licensees fora
Within existing
resources
Q2/2008-9
Systems established
Within existing
resources
Q4/2008-9
Salford City
Council – Chief
Executive’s
Greater
Manchester
Police
Greater
Manchester
Police
Greater
Manchester
Police
Up to £1,200
required per area
Q4/200910
Greater
Manchester
Police
£1,000 per month
IDENTIFIED:
POLICE
Q4/2008-9
Greater
Manchester
Police
Within existing
resources
Q1/2008-9
Greater
Manchester
Police
Test purchasing and
alcohol-related crimes
and incidents data
included in strategic
threat assessment
Systems established in
areas identified in
Strategic Threat
Assessments as having
the highest levels of
alcohol-related crime
Establish systems to
1 operation per month
monitor sales to drunks by conducted to monitor
licensed premises and take sales to drunks
action where appropriate
Utilise Police powers under Powers utilised in
the Violent Crime
conjunction with data
Reduction Act to fast track obtained from the
action against premises
Emergency
associated with high levels Department (objective
of violent crime
3c)
62
STRATEGIC OBJECTIVE 4: Reduce the harm caused to children and young people by alcohol use
TARGET DESCRIPTION
Reduce the proportion of young people frequently
misusing substances
Increase the percentage of schools achieving the
National Healthy Schools Status
Increase the number of teachers completing the PSHE
Continuing Professional Development Programme
Reduce the percentage of premises selling alcohol to
young people during test purchase operations
Reduce the under 18 conception rate
Reduce the gap between Salford and the national
average in the rate of hospital admissions for under 18s
BASELINE
TARGET
Data not yet available
Data not yet available
66%
80% (April 2009)
38 teachers from Phases 1-4. A
further 14 teachers on the
current Phase 5
53% (2006/7)
82 teachers by 2011
20% (March 2010)
58.8 per 1000 (2006)
30.7 per 1,000
SALFORD
NATIONAL AVERAGE
GAP
109.64
60.61
49.03
Objective
Action required
Outputs/ Outcomes
Resources
4a) Continue to conduct
regular intelligence-led
operations across the
City
Conduct regular test
purchasing operations
20 per month test
£40,000 per year
purchasing
IDENTIFIED:
operations conducted CDRP
per year
Q4/201011
Publicise action taken
against licensed premises
Information on
successful action
provided to local
media
Q4/20089
Within existing
resources
Date
Partners (lead
in bold)
Salford City
Council –
Environment
Greater
Manchester
Police
Salford City
Council Environment
63
4b) Take action against
adults who supply alcohol
to young people
4c) Ensure schools have
alcohol policies and
education programmes in
line with local and
national guidance
Improve use of data to
identify premises which may
be selling to under 18s and
to identify the impact of
action taken against
licensed premises on levels
of anti-social behaviour
Utilise existing legislation to
take action against adults
who buy alcohol on behalf
of young people and
premises who sell to them
Test purchasing and
alcohol-related crime
and incident data
included in strategic
threat assessment
Within existing
resources
Q2/20089
Greater
Manchester
Police
Action taken against
adults buying alcohol
on behalf of young
people
Within existing
resources
Q4/20089
Educate parents about the
risks associated with
unsupervised consumption
of alcohol by young people
Information provided
to parents via
schools & anti-social
behaviour team
Within existing
resources
Q4/20089
Provide support to schools
to develop policies and
education programmes
School policies are in
line with national
guidance
Within existing
resources
Q4/201011
Provide support to schools
to manage alcohol-related
incidents appropriately
Increase in number
of schools providing
reports (or nil
returns) to school
from 2007/8 baseline
Within existing
resources
Q4/201011
Greater
Manchester
Police
Salford City
Council Environment
Salford City
Council –
DAAT
Salford City
Council – Chief
Executive’s &
Children’s
Services
Salford City
Council Children’s
Services
Salford City
Council Children’s
Services
64
4d) Ensure teachers have
the skills and knowledge
to deliver alcohol
education
4e) Ensure parents have
the skills and knowledge
to address alcohol issues
with their children
4f) Provide alcohol
education in a range of
settings outside of the
school classroom
Embed in Safer Schools
Scheme
Drugs and alcohol
included in Safer
Schools scheme
Within existing
resources
Q2/20089
Continue to engage
teachers in Continuing
Professional Development
programme for PSHE
Provide alcohol training to
primary and secondary
school teachers
Engage a minimum
of 10 teachers per
year
Within existing
resources
Q4/20089
1 session provided
for primary, and 1 for
secondary each year
Within existing
resources
Q4/201011
Provide alcohol training to
parents through schools
and in community settings
All schools offered
parents information
sessions annually
Within existing
resources
Q4/201011
Provide information to
parents by ensuring wide
distribution of new parenting
and alcohol leaflets to be
developed by Department of
Children, Schools and
Families
Extend peer education
project to all areas of the
City
Distribute new
leaflets through all
schools
Within existing
resources
Q2/20089
Provide peer
education project in
all localities
£3,000 per year
IDENTIFIED:
DAAT
Q4/20089
Salford City
Council Children’s
Services
Salford City
Council Children’s
Services
Salford City
Council Children’s
Services
Salford City
Council Children’s
Services
Salford City
Council –
DAAT
Salford City
Council –
Children’s
Services
Salford City
Council Children’s
Services
65
4g)Reduce harm to
young people drinking in
public places
Provide workshops in
community settings
including joint workshops
focusing on sexual health
Provide workshops in Within existing
4 geographical areas resources
Q4/20089
Provide training to youth
service and voluntary and
community groups working
with young people
Consult with young people
to identify the reasons for
drinking in public places and
other risk taking behaviours
10 training sessions
provided
Within existing
resources
Q4/20089
Young people
consulted through
workshops and other
youth fora
Within existing
resources
Q4/20089
Develop harm reduction
resources for young people
Harm reduction
information cards
developed
Outreach workers
included in training
sessions for youth,
community and
voluntary workers
identified in 4f
£2,500
IDENTIFIED:
DAAT
Within existing
resources
Q1/20089
Train outreach workers in
delivering alcohol advice,
information and referral
Q4/20089
Salford City
Council –
DAAT
Salford City
Council –
Children’s
Services
Salford City
Council - DAAT
Salford City
Council –
DAAT
Salford City
Council –
Children’s
Services
Salford City
Council - DAAT
Salford City
Council –
DAAT
Salford City
Council –
Children’s
Services
66
4h) Provide specialist
support to young drinkers
4i) Provide support and
alcohol education to
Looked After Children
Consider the safety of
young people in any activity
undertaken to reduce antisocial behaviour caused by
young people drinking in
public places
Secure funding for A&E
Young People’s Harm
Reduction Nurse
Secure funding/ensure
sustainability of specialist
young people’s alcohol
worker post
Extend availability of
services to ensure that
support is available outside
of school hours
Secure sustainable funding
for Leaving Care/Looked
After Children substance
misuse worker
Work with the Headteacher
for Looked After Children to
improve alcohol education in
schools
Guidance and
training developed to
ensure ‘duty of care’
is addressed and
there is consistency
across agencies
Funding secured for
2008-9 onwards
Within existing
resources
Q4/20089
Salford City
Council – Chief
Executive’s
£37,000 per year
BID PENDING
Q1/20089
Funding secured for
2010 onwards or
agree
£36,000 per year
REQUIRED from
2010
Q4/20089
Salford City
Council - DAAT
PCT
Salford City
Council - DAAT
Extend service
opening hours to
include Saturdays
Within existing
resources
Q4/201011
Salford City
Council - DAAT
Funding secured
£38,000
REQUIRED from
2009/10
Q4/2008- Salford City
9
Council - DAAT
Joint work
Within existing
undertaken by Drug
resources
Education Consultant
and Headteacher for
Looked After
Children
Q4/2008- Salford City
9
Council Children’s
Services
67
4j) Provide attractive,
affordable alternatives to
drinking for young people
4k) Collect and improve
use of intelligence on
where and why young
people drink
4l) Ensure professionals
working with parents are
able to recognise and
address the impact of
parental substance
misuse on children and
young people
Provide alcohol education to
foster parents
1 education session
provided
Within existing
resources
Utilise Youth Opportunities
Fund and Youth Capital
Fund to provide places to go
and things to do for young
people
Provide a range of places
for young people to meet
and affordable activities to
take part in every
neighbourhood
Ensure appropriate data is
collected and shared to
identify the impact that
alcohol is having on young
people
Commission Schools Health
Education Unit Survey for
schools in Salford
Funds accessed
Resources from
Youth
Opportunities
Fund and Youth
Capital Fund
Resources from
Youth
Opportunities
Fund and Youth
Capital Fund
Within existing
resources
SHEU survey
commissioned
£15,000
REQUIRED
Develop policy and
protocols for services who
may work with substance
using parents
Policy and protocols
developed
Within existing
resources
Youth offer delivered
Young people and
alcohol data is part of
data collected by
Salford Observatory
Q4/2008- Salford City
9
Council Children’s
Services
Salford City
Council - DAAT
Q4/2008- Salford City
9
Council Children’s
Services
Q4/2009- Salford City
10
Council Children’s
Services
Q4/2009- Salford City
10
Council - DAAT
Q4/2008- Salford City
9
Council –
DAAT
PCT
Q2/2008- Salford City
9
Council - DAAT
Salford City
Council –
Children’s
Services
68
4m) Provide support to
families affected by
parental/carer substance
misuse
Provide training to staff in
services who may work with
substance using parents
Include substance using
parents as a defined group
within the City’s Parenting
Strategy
2 training courses
provided
Within existing
resources
Q4/2008- Salford City
9
Council - DAAT
Substance using
parents included in
parenting strategy
Within existing
resources
Continue pilot project in
New Deal for Communities
area working with children of
substance misusing parents
24 young people with
substance using
parents accessing
support programme
per year
Family leads
established in all
locality teams
Within existing
resources
Q1/2008- Salford City
9
Council –
DAAT
Salford City
Council –
Children’s
Services
Q4/2009- New Deal for
10
Communities
Within existing
resources
Q1/2008- Salford City
9
Council - DAAT
Within existing
resources
Q1/2008- Salford City
9
Council Children’s
Services
Establish a family lead in
each Drug and Alcohol
Service locality team, who is
trained in the Common
Assessment Framework and
participates in the Family
Action Model
Roll out new literacy hour
Resource evaluated
resource, exploring issues
by participating
of parental substance
schools
misuse, in primary schools
69
References
Advisory Council on the Misuse of Drugs (2003) Hidden Harm: Responding to
the needs of children of problem drug users. London: Home Office
Alcohol Concern (2002) Alcohol and Teenage Pregnancy. London: Alcohol
Concern
Alcohol Concern (2006) Wasted: Lives lost to alcohol. London: Alcohol
Concern
The Civic Trust (2006) Nightvision: Town Centres for All. London: Civic Trust
Department for Education and Skills (2003) Every Child Matters. Norwich: The
Stationary Office
Department for Education and Skills/Department of Health (2004) National
Service Framework for Children, Young People and Maternity Services.
London: DfES/DH
Department of Health (2004) Choosing Health: Making Health Choices Easier.
London: Department of Health
Department of Health (2005) Alcohol Needs Assessment Research Project.
London: Department of Health
Department of Health (2005a) Alcohol Misuse Interventions: Guidance on
developing a local programme of improvement. London: Department of
Health.
Department of Health (2006) Models of Care for Alcohol Misusers. London:
Department of Health
Department of Health/Home Office (2007) Safe, Sensible, Social: The next
steps in the National Alcohol Strategy. London: Department of Health
Home Office (2004) Alcohol and intimate partner violence: key findings from
the research. London: Home Office
Home Office (2007) Tactical Options for Dealing with Alcohol-Related
Violence. London: Home Office
Leon, D.A. and McCambridge, J. (2006) ‘Liver Cirrhosis Mortality Rates in
Britain from 1950 to 2002: an analysis of routine data’. The Lancet Vol 367,
52-56.
Morleo, M., Dedman, D., Hughes, K., Hooper, J., Tocque, K., Bellis, M.A.
(2006) Regional Alcohol Indicators for the North West of England 2006.
Liverpool: Centre for Public Health
70
National Institute for Clinical Excellence (2007) School based interventions on
alcohol. London: NICE
National Treatment Agency (2004) Promoting Safer Drinking: A briefing paper
for drugs workers. London: NTA
North West Public Health Observatory (2007) Local Alcohol Profiles for
England, Via: http://www.nwph.net/alcohol/lape (Checked 21st January 2008)
Office for National Statistics (2004) Living in Britain: General Household
Survey 2002. Norwich: HMSO
Office for National Statistics (2006a) Alcohol-related deaths. Via:
http://www.statistics.gov.uk/cci/nugget.asp?id=1091 (Checked 4th June 2007)
Office for National Statistics (2007) Statistics on Alcohol: England 2006. The
Information Centre
Prime Minister’s Strategy Unit (2003) Alcohol Harm Reduction Project: Interim
Analytical Report.
Raistrick, D., Heather, N. and Godfrey, C. (2006) Review of the Effectiveness
of Treatment for Alcohol Problems. London: Department of Health
SHAAP (2007) Alcohol: Price, Policy and Public Health. Edinburgh: Scottish
Health Action on Alcohol Problems
The Stationary Office (1998) Tackling Drugs to Build A Better Britain London:
The Stationary Office
Stead et al. (2006) A review of the effectiveness of social marketing alcohol,
tobacco and substance misuse interventions. London: National Social
Marketing Centre
71
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Introductory sections
Suggested change
The advice that alcohol should be avoided for 2-3 days per week
should be added in addition to the daily limits
Highlight the risks of children of drinkers becoming heavy alcohol
users themselves
An executive summary is needed
The current Crime and Disorder Reduction Partnership and Audit
Commission Reviews need to be mentioned
Consideration should be given to included Greater Manchester
Fire and Rescue Service (GMFRS) in the make up of the Alcohol
Strategy Board
The impact of alcohol misuse on the economy is mentioned but
not followed through as an objective.
The Teenage Pregnancy Action Plan should be referenced as a
related local strategy/action plan. The safeguarding children’s
plan, healthy weight strategy and health inequalities strategy
should also be mentioned.
There is no mention of the influence of the City of Manchester
Alcohol Strategy and a collaborative approach
It would be helpful to have a brief description of the roles and
responsibilities and terms of reference for each group
Conclusions should be included at the end of each section
Action taken
This has been added to the alcohol-related harm section
This is included in the alcohol-related harm section
This has been included
Information has been included in the ‘Partnership arrangements’
section
This section has now been removed pending the
recommendations of the CDRP review, however we agree that
GMFRS should be included in any alcohol strategy group
established
Achieving the other strategy objectives should result in a reduction
in the impact that alcohol has on the economy. For example
ensuring that those who do drink, do so within recommended
limits should reduce alcohol-related absences from work.
These have been included
Information about joint working through the Greater Manchester
Alcohol Strategy Group is included in ‘Policy drivers’ section
A brief description and membership list for each group has now
been included
These have been added
72
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Specific data should be added:
- from the Trading Standards survey
- How the lifestyles survey information compared to England
Definitions of hazardous, harmful and dependent drinkers need to
be given earlier in the document
An explanation needs to be included of how Every Child Matters
relates to alcohol
More detail about the needs assessment needs to be included
-
This has been added
-
Comparable information is not currently available
These are now included in the executive summary
This information has been included
This section has been expanded
73
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Objective 1
Suggested change
Stress the need for formal screening procedures as a means of
identifying problem drinkers rather than units drunk
There need to be clearer and easier to understand guidelines
available on safe levels of alcohol consumption. Holding
awareness raising sessions in the community, workplaces etc
would be useful. More emphasis is needed on prevention and
education across the whole population.
Pubs seem to provide a place for people to go and meet people
and prevent them feeling isolated. Perhaps we need to look at
alternatives – pub activities to reduce drinking; encourage drinking
of other drinks to create a new social norm.
Reducing the levels of alcohol consumed in Salford across all
populations may be a better Strategic Objective to use here
Brief interventions do not fit into this section and are better placed
in the treatment section
Action taken
Reference to the AUDIT screening tool has now been included in
this section
We aim to provide this through Objective 1
We would hope to incorporate these ideas into our social
marketing campaigns, depending of the results of the market
analysis.
This was discussed with Lead Members when the original draft
was produced however it was felt that this broader objective was
preferable.
We have tried to draw a distinction between the provision of:
 brief advice (structured advice taking no more than a few
minutes) to hazardous drinkers as a preventative measure
to prevent alcohol-related harm and therefore included in
this objective
 brief interventions (structured therapies taking 20 – 30
minutes and often involving one or more repeat sessions)
for harmful drinkers who will already be experiencing harm,
included in objective 2
74
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Objective 2
Suggested change
Why not include A&E attendances as an outcome measure rather
than admissions
Stress the value of the Alcohol Needs Assessment Research
Project (ANARP) findings
Clarify who is to deliver training on brief interventions and include
numbers receiving brief interventions as an outcome measure
Add more economic information: costs and potential savings to be
made
More information should be included about Foetal Alcohol
Syndrome and Foetal Alcohol Spectrum Disorders
Actions should be incorporated to establish a priority referrals
system for clients of Salford Alcohol Service to receive fire risk
assessments and to ensure that hostel/secure accommodation
units are reviewed annually to ensure adequate fire protection
measures are in place
It would be helpful to show how the number of people in treatment
relates to the number of harmful/dependent drinkers in the
population
It would be helpful to get an idea of the numbers supported by
Alcoholics Anonymous
More information is needed on the national Supporting People
strategy and housing related support services for people with
alcohol problems in Salford.
Action taken
Hospital admissions is a national indicator therefore this has been
included rather than A&E attendances
The lack of capacity in the treatment system which ANARP
identified has been further emphasised
This has been included in the action plan
This has been included
This has been included
These actions have been added
This has been added
This information is not available
More information has been added.
75
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Objective 3
Suggested change
Please clarify the definition of persistent offenders
More police checks of drink drivers are needed. Young drinkers
should be the target group as there is evidence of an increase
among this group
Stronger enforcement on under age sales and selling to drunks is
needed
Reference should be made to alcohol being used as a coping
strategy by Domestic Abuse victims/survivors
Specific domestic abuse objectives/actions should be included
The Court and Police should use saturation policies to prevent
opening of off licenses in areas affected by anti-social behaviour.
This objective should be given higher priority
Housing issues should be included under this objective as a result
of the links between alcohol, housing and anti-social behaviour
The figure of 25% of people believing being drunk or rowdy in a
public place is a big or fairly big problem. The figure quoted in the
LAA is 41%, therefore this information needs to be checked.
Action taken
This has been included
It would not be legal to specifically target young people for testing.
We aim to provide this through Objective 3
This has been included
A specific action has been included under objective 3a
The Licensing Act does not provide a legal basis for such policies.
Each application is looked at on its own merits. Where there are
fears that anti-social behaviour may be caused applications are
opposed.
All strategic objectives have equal priority
A section has been added under this objective
25% is the national figure, whereas 41% is the local figure. Where
the 25% figure is mentioned this is referenced to the national
alcohol strategy.
76
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Objective 4
Suggested change
More information should be included about the links between
alcohol and teenage pregnancy
Include information about joint work being carried out in and out of
school settings on risk taking behaviours/safe nights out, with
training for professionals and young people on these issues
Funding for the young people’s A&E liaison nurse is uncertain and
should therefore be included as an area for development, rather
than in the description of work that is currently being undertaken
An additional theme should be included about supporting families
and children of those who are experiencing problems relating to
alcohol
Proposed LAA targets relating to young people seem to be only
partially translated into the strategy
Alcohol and drugs workers need to be around when needed – not
in school hours
Should the action on under age sales be just continued or
increased?
Action taken
This has been added
This has been included in the action plan
The uncertainty of funding has been highlighted. This is a critical
area of work therefore it is important that it is clearly referenced in
the strategy.
This is included within objective 4
The National Teenage Pregnancy Target has now been included
as this is likely to be part of the new LAA
Extending opening hours has now been included as an action
Salford has one of the highest levels of test purchasing activity in
the Country therefore we aim to continue working at this level.
77
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
Performance Measures / Action plan
Suggested change
The strategy needs a clear set of outcomes and measures (with
timescales) set against each objective/delivery plan for achieving
them
More specific outcome measures are needed
Where Salford City Council is the lead agency for an action the
name of the responsible directorate should be included
Targets need to be included
Baselines should be included for performance measures
A finance column should be included as there is not indication of
what funding/budget is available. Whether work can be done
within existing resources or whether additional funding is required
should also be indicated
Actions and aims have been included but there is no information
about implementation
There is a mixture of language between objectives and actions
Action taken
An output/outcome has now been included for each action.
Timescales are also provided.
This has been added
Targets have now been included
Baselines have now been included
This has been added
The action plan has been expanded to include an
outcomes/outputs column
This has been checked and corrected
78
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
General comments
Suggested change
The baseline and evidence upon which the strategy is predicated
is not clearly demonstrated in the document:
- Improved referencing is needed
- Where alcohol-related data is provided it would be helpful
to also include percentages to ascertain the scale of the
situation
- Where there is reference to activities baselines are not
provided. A 3 year average would be best practice
There should be part of the strategy that aims to encourage
publicans to allow people aged 18+ into their premises, rather than
having over 25s policies. This could encourage sensible drinking
among young people and prevent street drinking.
Action taken
-
References have been checked throughout the document
and some additions included
- Percentages have been added where such information is
available
- Baselines have been provided where such information
available. In most cases 3 years data is not available
A small number of pubs have door policies which restrict entry by
age. These have been introduced where there have been
problems with disorder. There is no specific policy in the City
restricting entry by age. The Police work with premises, to ensure
that they are managed in a way that promotes responsible
management and retailing.
There needs to be greater focus on students
Reducing the risk of alcohol-related harm to students has now
been included under strategic objective 1.
There should be an acknowledgement that issues such as 24 hour Very few premises have 24 hour licenses, and where these do
drinking, availability of outlets etc contribute towards the problem – exist they are very rarely used. Locally extending opening hours
particularly in the message that this sends out
does not appear to have had an impact of levels of crime and
disorder. The impact of consumption levels is not yet known,
however through objective 1 we aim to give clear messages about
safe and responsible drinking.
Recommendations should be included at the end of each Strategic This has been added
Objective section
79
APPENDIX 1:
Changes suggested in responses to the consultation on Salford’s Draft Alcohol Strategy –
February 2008
The gaps and what actions are needed need to be more clearly
identified
Patient and public involvement that has taken place needs to be
described in the document
The evidence section has been expanded for each strategic
objective
A section describing the consultation process has been added.
80
APPENDIX 2: Membership of partnership groups responsible for
delivering Salford’s Alcohol Strategy
Responsible Authorities Group (Monthly)
Greater Manchester Police
Licensing
Trading Standards
Pollution Control
Commercial Services
Greater Manchester Fire & Rescue Service
Local Safeguarding Children’s Board
DAAT
Young People’s Commissioning Group (Quarterly)
DAAT (Chair)
Primary Care Trust
Youth Offending Service
Children’s Services – Commissioning
Children’s Services – School Improvement
Connexions
Fairbridge
SMART/Lifeline
Youth Service
Drug and Alcohol Criminal Justice Group (Quarterly)
Greater Manchester Police (Chair)
DAAT
Salford Drug and Alcohol Service
Probation
Government Office North West
Manchester Prison
Forest Bank Prison
National Treatment Agency
Community Safety Unit
Salford Magistrates Court
Crown Prosecution Service
Alcohol Health & Treatment Group (Quarterly)
Primary Care Trust (proposed Chair) – Commissioning, Public Health and GP
representatives
Salford Royal NHS Foundation Trust – Emergency Department & Ward representatives
Salford Drug and Alcohol Services
DAAT
81
APPENDIX 3: Alcohol Clinical Pathway
Tier 1
Patient screened in Primary Care using Fast Alcohol Screening Test (FAST)
All people within the population supported by the practice should be screened
opportunistically. However the following groups should be actively
screened as they represent particularly higher risk groups:
 during pregnancy,
 seeking advice about family planning,
 people with mental health problems (e.g. anxiety, depression, etc),
 people with gastrointestinal symptoms (e.g. gastritis, dyspepsia),
 people with hypertension, asthma and diabetes
 people experiencing repeated accidents,
 people who repeatedly attend A&E
 people with past or current substance misuse dependence
FAST score =
3+
FAST score =
0-2
No further
action
6 additional screening questions
(Alcohol Use Disorders
Identification Test (AUDIT))
AUDIT score =
3 – 15
AUDIT score =
16 - 19
AUDIT score =
20+
Refer to Tier 3
Provide brief
advice & refer to
Tier 2
Provide brief advice:
- Structured and personalised feedback on risk and
harm
- Emphasis on the patient’s personal responsibility
for change
- Clear advice to the patient to make a change in
drinking
- Alternative strategies for making a change in
drinking
- Delivered in an empathic and non-judgmental
fashion
- Attempt to increase the patient’s confidence in
being able to change behaviour
82
APPENDIX 3: Alcohol Clinical Pathway
Tier 2
Patient has AUDIT
score of 16 - 19
30 minute brief intervention provided in Primary
Care:
- Monitoring of alcohol consumption
- Identification of high-risk situations for excessive
drinking
- Development of plans to deal with high-risk
situations without excessive drinking
- Formulation of simple rules to limit consumption
during drinking sessions
- Discussion of alternatives to drinking as part of a
healthier lifestyle
Follow up at 2-3
months in Primary
Care
83
APPENDIX 3: Alcohol Clinical Pathway
Tier 3
Patient has AUDIT score of 20+
Referral to Salford Drug &
Alcohol Service for full
assessment including:
- drinking levels and patterns
- treatment history
- mental health
- family circumstances/children
- other services involved
- risk assessment
- housing
- employment
Care plan developed by key
worker and client. May include:
- psychosocial
interventions
- home detoxification with
community prescribing
- housing support
- referral to inpatient
detoxification (tier 4)
- referral to residential
rehabilitation (tier 4)
Regular review of care plan
(minimum every 3 months) by
key worker and client
Discharge plan developed by
key worker and client
84