Appendix 1
Lewisham alcohol strategy: action plan 2009
Lewisham’s Alcohol Harm Reduction Strategy &
Action Plan
2009-2012
1
Lewisham alcohol strategy: action plan 2009
Executive Summary
Alcohol misuse and treatment for alcohol misuse have not received the same level of attention and focus that has been given to drug misuse. However, in
response to increasing levels of harm associated with misuse of alcohol and increased incidences of alcohol related anti-social behaviour, the government
developed a National Alcohol Harm Reduction Strategy for England in 2004.
This began the process of addressing the issues but did set Partnerships clear targets in relation to reducing alcohol related harm. In 2007, the Home Office
issued “Safe.Social.Sensible.” which detailed the next steps to be taken and placed a responsibility on Local Strategic Partnerships to tackle alcohol misuse,
emphasising the need to address the health and anti-social behaviour problems associated with such misuse.
NOTE- Throughout this document the term Partnership refers to service users and carers, treatment providers including dual diagnosis services, the
Metropolitan Police Service (MPS), London Probation, London Fire Brigade, Primary & Secondary care, Lewisham Primary Care Trust, Supporting People &
Homelessness services, Domestic violence services and Young People’s services
A new Public Service Agreement (PSA) was also introduced. This put a responsibility on Partnerships to:
• Reduce the alcohol related hospital admission rate
• Reduce the assault with injury rate
• Reduce the public’s perception that alcohol misuse is a big problem
• Reduce alcohol misuse amongst young people.
Local authorities and partners are now monitored through the National Indicator (NI) set of 198 indicators. Three of these directly relate to alcohol including NI
39 -Alcohol-related hospital admission rates and in the context of alcohol-related crime and disorder, NI 40-Access to Treatment and NI 41 – Perceptions of
drunk and rowdy behaviour as a problem. As many of a third of the NIs can either directly or indirectly be linked to the impact of alcohol misuse.
On the face of it, Lewisham does not appear to have the same types of problems associated with alcohol misuse as some neighbouring areas. There is not
for example a town centre night-time economy focused on alcohol with the attendant problems that that brings. However, given the anticipated level of
demand there is clearly a need for alcohol intervention services
Recent developments have seen good multi-agency working taking place to tackle the problem of alcohol misuse. There are also instances of good practice,
with established Screening & Brief Intervention initiatives working effectively across Primary and Secondary care. However, more joint working is needed to
ensure that pockets of good work do not continue in an isolated manner but rather that agencies work together to maximise gains and to ensure that a high
standard of provision is available across the borough.
2
Lewisham alcohol strategy: action plan 2009
The Partnership will also need to ensure that data recording is improved across all agencies in relation to problems of alcohol misuse. This will ensure that
more accurate baseline information is available and will further ensure that the success or failure of interventions can be measured and resources directed
appropriately. The associated Needs Assessment highlights this as a priority for the Partnership.
The Partnership will also need to conduct a detailed review of local spending in relation to alcohol based on the data gathered. This will provide a full picture
of the direct and indirect expenditure related to alcohol services . In turn, this will enable the partnership to evaluate more accurately where resources are
being spent and where there may be a need for further investment.
Key Findings
The North West Public Health Observatory’s Local Alcohol Profile of Lewisham’s adult population of 182,667 (18- 64 yr olds) indicates that in Lewisham there
are approximately:
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
3
23,500 Binge Drinkers (Lewisham ranks 12th out of the 33 London Boroughs)
29,000 Hazardous Drinkers (Lewisham ranks 27th out of the 33 London Boroughs)
9,500499 Harmful Drinkers (Lewisham ranks 17th out of the 33 London Boroughs)
These groups are mutually exclusive
Binge Drinking: is classified as drinking more than 8 units for men and six units for one (double their recommended amount) in one day
Hazardous drinking: people drinking above recognised ‘sensible’ levels but not yet experiencing harm. Defined as consumption of between 22 and
50 units of alcohol per week for males, and between 15 and 35 units of alcohol per week for females.
Harmful drinking: people drinking above ‘sensible’ levels and experiencing harm, defined as consumption of more than 50 units of alcohol per week
for males, and more than 35 units of alcohol per week for females.
Dependent Drinker: people drinking above ‘sensible’ levels and experiencing harm and symptoms of dependence. More severe drinkers can be
classified into mild, moderate and severe dependence, depending if they are physically or psychologically dependent.
This strategy is committed to delivering healthy drinking messages, harm minimisation advice or signposting to services where required, whilst the
needs of all of these groups of drinkers are important, the strategy specifically focuses on meeting the needs of harmful drinkers.

The National Alcohol Needs Assessment Project (ANARP) (DoH, 2005) that 5% of adults in London are alcohol dependent. Using recent local
population data this would indicate that there are over 9000 alcohol dependent adults (18 - 64 yrs old) in Lewisham. There is an overlap of this group
with harmful drinkers and the strategy is most focused on this group.

The demand for services continues to rise year on year. If this trend continues then there is an anticipated increase from the current 513 clients to
just under 1000 client in 2010/11. This would be a growth in demand of over 85%. The current services have waiting lists of 5-8 weeks, and
Lewisham alcohol strategy: action plan 2009
community detox is unavailable. There is significant attrition from the waiting list. Foundation 66 and SlaM deliver services for alcohol users and both
services can treat no more than 500 clients at a time in totality.

The RUSH model (a measure of capacity) indicates that approximately 15% of the dependent population will present to specialist alcohol services for
help each year. Therefore in Lewisham, this would indicate a predicted demand for specialist treatment for over 1300 people.

Analysis of local data shows an over representation of the white ethnic group and an under representation for all other groups.

Further investigation is required in relation to the needs of Lesbian, Gay, Bisexual and Transgender (LGBT) and Learning & Physically disabled
populations.

In Lewisham 7 of the past 8 fire fatalities have been alcohol related since 2005.

19 (15%) suicides in Lewisham between 2002-7 were recorded as having alcohol as a significant factor (based on analysis of GP notes during this
period)

From May 2008 –May 2009 54 residents were successfully diverted from hospital admission into appropriate treatment services and an alcohol
related hospital admission was avoided.

In Lewisham between April 2008 -March 2009, 1690 clients accessed Supporting People services, 4% of all clients (65) stated Alcohol as their
Primary Support Need.

It is difficult to accurately identify the level of crime related to alcohol misuse in Lewisham. This is largely because across all crime types there is no
mandatory flag for alcohol on the data system. In 2007-08 2.9% of all crime types were flagged as alcohol related and this increased to 3.1% in 200809

Research shows that alcohol is generally used as part of general polydrug use by young people although it may not be recognised as the primary
substance of choice.
The Strategy aims to reduce alcohol related harm in Lewisham so that residents do not suffer the consequences of their own or others’ alcohol misuse. We
will achieve this by:
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Lewisham alcohol strategy: action plan 2009
1. Improving targeted education and communication.
2. Increasing the rapid identification and treatment of alcohol problems wherever people present within the system
3. Improving the co-ordination and enforcement of existing powers against alcohol-related crime and disorder.
4. Encouraging licensed premises to promote responsible drinking and to take a role in reducing alcohol related harm.
5. Improving the recording, collating, analysing and monitoring alcohol related data, including an annual alcohol needs assessment
This action plan details the actions required to achieve the objectives above and includes action to:
1. Clarify Alcohol Funding & Disaggregate budgets from broader substance misuse budgets.
2. Improve data streams across partnership agencies, to include police flagging of alcohol related crimes (especially domestic violence), housing, GP’s and
other identified data gaps.
3. Redesign the treatment system to expand capacity in view of local need and best practice.
4. Take forward the recommendations flowing from the Drinking Control Zone Review (March 2009) via including the feasibility of wet or designated area for
street drinkers.
5. Extend provision in University Hospital Lewisham A&E department to cover weekends and unsocial hours (currently 1 worker)
6. Increase the focus of work with young people in and out of school settings.
7. Extend Screening & Brief interventions to Community Mental Health Teams (CMHT’s)
8. Increase targeted community awareness campaigns such as National Tackling Drugs Week and People’s Day.
9. Continue to tackle under-age sales of alcohol via test purchase operations and the continued roll out and enforcement of Challenge 21/25.
5
Lewisham alcohol strategy: action plan 2009
10. Promote health education and safety in relation to promoting safe drinking limits and target at risk groups e.g. young women who binge drink
6
Lewisham alcohol strategy: action plan 2009
Lewisham Alcohol Strategy Action Plan 2009-2012: To be monitored via the SLP, DAAT Board and DAAT
JCG.
A. Improved targeted education and communication.
Objective
Target
Improve targeted
education for adults
Produce and widely distribute key alcohol messages &
signposting to support services in all main community
languages via leaflets and website (LBL & PCT). Access faith
and BME communities through links established with
churches. Substance Misuse services for parents and children
and young people to be listed on the Family Information
Service (FIS)
Run campaign on alcohol-related fire with the intention of
reducing alcohol related fire deaths
Year 1
9/10
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Year 2
10/11

Year 3
11/12

Lead
Alcohol Strategy
Co-ordinator (ASC)
& PCT & Bench
Fire brigade

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Amend induction procedure for new council tenants so that
alcohol information is included in the new tenant handbook,
and a fire safety visit is automatically booked
Fire brigade

Run a drink drive campaign twice a year aimed at council staff
and general public (December and May) providing education
and awareness of the number of units in drinks, the time it
takes for your body to clear alcohol and the issues of morning
after drink drive casualties and offences with the intention of
reducing drink driving offences/alcohol related road accidents.
Community Health trainers scheme to include alcohol
understanding.
7
Road Safety

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PCT Public Health

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Resource
implications
DAAT & PCT core
business
Fire Service core
business; additional
funding to be
sought
Fire Service core
business. Funding
of production of
amended
handbooks to be
sought from LBL
Road Safety core
business
PCT core business
Lewisham alcohol strategy: action plan 2009
Ensure parents/carers receive appropriate information on local
alcohol support by making current literature and training and
support services available at points of contact. Substance
Misuse services for parents and children and young people to
be listed on the Family Information Service (FIS)
Service/users carers
co-ordinator
DAAT core
business
ASC via HR in LBL
and PCT
DAAT core
business
Ensure that the principles of the CAF (Common Assessment
Framework) underpin the young people’s strand of the
Strategy and aim to ensure appropriate support is made
available to children and young people affected by their own or
others alcohol misuse.
YP commissioner
and DAAT
DAAT core
business
Roll out a series of targeted outreach sessions focussing on
engaging marginalised young people who use alcohol.
YP Commissioner
This is subject to a
successful £20K
summer bid
YP Commissioner
DAAT core
business
YOS
YOS core business
Review and redevelop council and PCT workplace alcohol
policies
All young people
identified as being
vulnerable will receive
appropriate education,
advice, information and
support on alcohol
misuse both in and out
of school setting
DUST screening tool and/or E-CAF to be used in the
identification of alcohol misuse
YOS Asset Tool to be used in the identification of alcohol
misuse.
8
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Lewisham alcohol strategy: action plan 2009
Improve targeted
education for general
public (YP and adult)
9
Include action on alcohol in teenage pregnancy strategy with
the aim of reducing the amount of unplanned conceptions
(where alcohol was a feature).
Carry out a 3 month pilot with the 4 Sexual health clinics and
the Young Women’s Midwifery Team collecting data on
teenage pregnancy alcohol related conceptions to establish
baseline and possible link.
If the link proves significant pilot alcohol Screening and Brief
Interventions in clinic and/or midwife team. If this leads to a
decline in alcohol related teenage pregnancy conceptions over
6 months roll out to all clinics and YP midwives.
All Teachers, Mental health practitioners, Parent Support
Advisors (PSA)’s, school nurses, Connexions advisors, YOS
and youth service to have access to training in basic alcohol
awareness
Work with Schools, Pupil Referral Units, Youth Service
establishments to develop alcohol education and incidents
policies
Monitor use of PSHCE (Personal, Social, Health, & Citizenship
Education) to identify Substance misuse and referrals to
treatment via YPSMSG (Young Persons Substance Misuse
Steering Group)
Run seasonal alcohol awareness campaigns (Summer &
Christmas) and ensure presence at community fairs (People’s
Day). Organise events for National Tackling Drugs Week’s
(schools, non school setting and community) & White Ribbon
Day (DV awareness), World Mental Health Day (Dual
Diagnosis awareness)
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ASC, YP
Commissioner &
Teenage Pregnancy
Co-ordinator
PCT/DAAT core
business
YP Commissioner
DAAT core
business
YP Commissioner
DAAT core
business
YPSMG
DAAT & CYP Core
Business
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

DAAT core
business

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
DAAT Education
Team.
Lewisham alcohol strategy: action plan 2009
B. More rapid, identification and treatment of alcohol problems wherever people present within the
system
Objective
Target
Increase professional
and public awareness of
available alcohol
services, referral routes
and care pathways (to
include services for
young people and
families) – to reduce
inappropriate referral
and unrealistic
expectations
Increase professional
awareness of alcohol
issues, including
identification of problems
and appropriate referral
Produce and disseminate an alcohol services directory for
Lewisham (to include referral procedures and care pathways)
in main community languages to all Tier 1 agencies (with an
opportunity to attend basic & advanced alcohol awareness
training) (provided by The DAAT). Substance Misuse services
for parents and children and young people to be listed on the
Family Information Service (FIS)
Establish six monthly learning sets when all alcohol service
providers meet with commissioners to share learning and
good practice around treatment interventions.
Implement a programme of Alcohol awareness training for all
for Tier 1 agencies
Clarify Expenditure on
Alcohol
Review, Reconfigure &
10
Get alcohol awareness included in induction training for all
new housing and social services staff (Generic training and
bespoke training relevant to their specialist field)
Fully disaggregate the expenditure on alcohol
Year 1
9/10
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Year 2
10/11
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Year 3
11/12
Lead
Resource
implications
ASC
DAAT core
business
ASC & Treatment
Partnership
DAAT core business
ASC & DAAT
Manager
DAAT core business
ASC, Supporting
People & Brian
Scouler
DAAT core business
DAAT (JCM &
Accountant)
DAAT core
business
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Lewisham alcohol strategy: action plan 2009
develop the capacity of
the alcohol treatment
system for Lewisham
Expand local enhanced services for alcohol via GP practices

Expand satellite and outreach provision from alcohol services
into partnership agencies, the community and the street.
Expand the provision of brief interventions offered at the
earliest treatment opportunity (currently offered in GP
surgeries and UHL A&E department)
Expand operational hours to include evenings and weekend
services
Expand provision of Hospital liaison across general wards with
alcohol related problems to facilitate entry to alcohol treatment
pathways.
Expand Home detoxification interventions
Increase engagement
with under-served/underrepresented groups
including young people
especially those at risk,
over 65’s LGBT & BME
communities and
women.
11
DAAT core business
Establish baseline figures of the amount of young people
drinking at hazardous, harmful and dependent levels in the
borough
Establish need for outreach/floating support for vulnerable
adults e.g. through snapshot studies of social work, housing
etc caseloads
Take forward any recommendations and findings relating to
alcohol misuse within the 2009 DAAT Equalities Impact
Assessment (EIA) regarding these under-represented
communities
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DAAT
Commissioning
Capacity
DAAT core business
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DAAT/JCG
DAAT core business
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DAAT/JCG
DAAT core business

DAAT
PCT


DAAT/ASC/PCT


DAAT/JCG
Subject to funding
availability
DAAT/PCT
YP JCM
DAAT core business
ASC &Vulnerable
Adults Co-ordinator
DAAT core business
ASC
DAAT core business
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
Lewisham alcohol strategy: action plan 2009
Improve treatment of
alcohol problems within
drug services for poly
users
Continue Provision of
alcohol screening and
brief interventions (SBIs)
within Primary and
Secondary Care
Assess training needs within drug treatment partnership

Continue the Alcohol Local Enhanced Service (ALES) &
Directed Enhanced Service (DES)
Seek funding to expand University Hospital Lewisham A&E
provision (invest to save).
Improve the outcomes of children of dependent drinkers by
increasing alcohol screening at antenatal to 100% in primary
care thus helping to prevent foetal alcohol syndrome (FAS),
risks of child protection and child mental health problems, low
birth weight and infant mortality.
Improve treatment
responses for victim and
perpetrators of domestic
violence
Improve psychological
and mental health
treatment responses for
alcohol users
12
DAAT core business
Treatment agencies to remain signed up to DV MARAC to
ensure links into DV support agencies and appropriate
channels to highlight escalating risk cases

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Pilot alcohol screening and brief intervention in one of the
CMHT’s
Carry out pilot between dual diagnosis and mental health
home treatment team to explore feasibility of settling up
conducting community alcohol detoxes for people with comorbid mental health and alcohol dependence.
Review current data and establish robust system for collating
future data on the number of alcohol detoxifications carried out
by The Ladywell unit per annum as a mechanism to identify
unmet need.
DAAT Education
Team.
PCT funded
ASC & UHL
£48,000 bid to be
submitted to PCT
Shared Care
Commissioner, ALES
Post & GP with
Special Interest
DAAT core business
Treatment
Partnership via ASC
& DV Co-ordinator
DAAT core business
Dual Diagnosis Nurse
Consultant
DAAT core business
Dual Diagnosis Nurse
Consultant/DD team
leader
Dual Diagnosis
Service core
business
Dual Diagnosis Nurse
Consultant/DD team
leader
DAAT core business
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


DAAT
Commissioning
Capacity


Lewisham alcohol strategy: action plan 2009
All young people
identified as having
problems with alcohol
misuse will receive an
appropriate intervention
of care package, with
support for both
parents/carers
Review how alcohol treatment agencies assess risk within
mental health assessment specifically around violence and
suicidal ideation. Explore eligibility criteria for SLaM 1 day
Clinical Risk assessment Training or Dual Diagnosis to
develop bespoke Risk Assessment Training (capacity
dependent)
Provide a range of Tier 3 interventions for young people with
substance misuse problems. Including:
 Harm reduction
 1-2-1, group work & Care planning
 Family Support Services
 Criminal Justice interventions
Provide family support facilities both for parents of alcohol
using children and children of alcohol using parents.
Substance Misuse services for parents and children and
young people to be listed on the Family Information Service
(FIS)
13
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Dual Diagnosis Nurse
Consultant/DD team
leader
DAAT core business
YP Commissioner,
Treatment Providers
and YOS
DAAT core business
YP Commissioner
DAAT core business


Lewisham alcohol strategy: action plan 2009
C. Better co-ordination and enforcement of existing powers against alcohol-related crime, disorder and
anti-social behaviour
Objective
Target
Year 1
9/10
Reduce alcohol-related violence
including domestic violence
Use results from MPS alcohol-flagging data trawl
to make case for alcohol arrest referral workers

Improve police and CSU flagging of alcohol related
incidents and repeat alcohol-flagging data trawl
every 6 months
Ensure representation from DAAT on Domestic
Violence MARAC
Ensure all agencies within substance misuse
treatment partnership attends Stella Project
DV/substance misuse training and is aware of local
support agencies and referral pathways into them

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Multi-agency response to street drinking
that reduces public perception of antisocial behaviour
Roll out Recommendations of Drinking Control
Zone Review via Steering Group including the
working up of feasibility of designated space for
street drinkers
Continue bespoke problem solving approach in 5
street drinking hot-spots
Combat environmental issues affected
by alcohol consumption
14
Implement training & awareness programme for
Street Wardens & Safer Neighbourhood Teams
(SNT’s) in dealing with street drinking through
motivational interviewing, signposting and harm
reduction techniques

Year 2
10/11

Year 3
11/12
Lead
Resource
implications
MPS
MPS core
business

MPS & ASC
MPS/ DAAT core
business

ASC
DAAT core
business
DAAT/Treatment
agencies core
business

ASC &
Substance
Misuse
Treatment
Partnership
ASC

MPS & DAAT
Council/MPS
core business
ASC & CDEP
DAAT core
business

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DAAT core
business
Lewisham alcohol strategy: action plan 2009
Increase outreach provision for street
drinkers/street communities
Address urination, defecation and vomiting in
public places
Probation to review their work practice
with alcohol misusers
Audit offenders with alcohol related offences once
a year to ensure appropriate support has been
offered
Review the use Alcohol Treatment Requirements
in Lewisham.
To reduce crime and disorder associated
with underage drinking
15
Reduce the level of alcohol related youth
offending, ASB & nuisance by reviewing
effectiveness of summer initiative (2009) and make
business case for invest-to-save to mainstream
successful strands of initiative

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
DAAT & JCG
DAAT/PCT core
business
ASC &
Environment
DAAT core
business
Probation & ASC
DAAT core
business
Probation & ASC
DAAT core
business
YP
Commissioner
DAAT core
business

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

Lewisham alcohol strategy: action plan 2009
D Encouraging licensed premises to promote responsible drinking and to take a role in reducing alcohol
related harm.
Objective
Target
Rolling programme for test
purchasing operations by
Trading Standards
Establish new links with YP partners to widen
pool of volunteers available for test purchase
operations, including older looking volunteers
to test application of ‘Challenge 21’
Achieve bi-monthly test Purchase Operation10 premises per session
PubWatch schemes to
include off licenses and
restaurants
Evaluate effectiveness of PubWatch and
continue roll out if proven to have met agreed
outcomes.
Initiatives to reduce sales
of Super Strength
lager/cider such as Super
tenants and White
Lightening
High profile, co-ordinated campaign, in
partnership with MPS licensing Unit,
Licensing, Trading Standards and Licensees,
to ask Licensees to sign up to agreement to
cease sales of single cans of super strength
lager or cider. Ensure Risk assessment is
carried out as to potential knock-on effects of
this for street drinkers and off license staff.
Campaign to encourage off licenses to mark
their cans of super strength lager/cider to
enable detection in the event of confiscation
and or under-age sales
Review size of MPS Licensing Unit with view
to expansion (currently 3 staff)
16
Year 1
9/10
Year 2
10/11
Year 3
11/12
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Lead
Resource implications
Trading
Standards
Trading Standards core
business
Trading
Standards
Trading Standards core
business
Licensing
Licensing core business
MPS licensing
Unit, Licensing,
Trading
Standards and
Licensees
MPS licensing Unit,
Licensing, Trading Standards
core business
MPS licensing
Unit, Licensing,
Trading
Standards and
Licensees
MPS licensing
Unit & ASC
MPS licensing Unit,
Licensing, Trading Standards
core business
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MPS funding implication
Lewisham alcohol strategy: action plan 2009
To Reduce Alcohol related
crime in licensed premises
Record violence against front line staff,
including those in licensed premises, late
night food outlets and A&E to improve
treatment and enforcement responses
Establish baseline information of disorder and
violence emanating from licensed premises
with view to creating Top 10 of Licensed
Premises that cause concern for targeted
work.
17
DAAT core business
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MPS licensing
Unit, Licensing,
Trading
Standards and
Licensees
Licensing core business
Lewisham alcohol strategy: action plan 2009
E. Better recording, collating, analysing and monitoring alcohol related data, including an annual
alcohol needs assessment
Objective
Target
Year
1
9/10
Establish baseline of
alcohol related harm data
set indicators
Develop partnership
approach to collecting and
monitoring alcohol related
data
Develop data sharing
protocols between partners
Agree with partners a core data set for
measuring alcohol related harm in Lewisham

Develop system for
collecting and monitoring
alcohol-related data
18
Arrange core data sets with partners, and
arrangements for collecting, collating and
monitoring the information
Review data sharing protocols between adult
services and children’s services
Review the data licensees may be able to
share – e.g. refusals data and disorder calls –
and its merit in monitoring alcohol-related
harm; agree protocols
Produce action plan to improve flagging of
police data
Year 2
10/11
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Year 3
11/12
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

Lead
Resource implications
Alcohol Strategy
Stakeholders
DAAT core business
DAAT core business
Alcohol Strategy
Stakeholders
ASC and CYP social
care services
Social Services core
business
Licensing & MPS
Licensing Unit
Licensing core business
ASC & MPS
DAAT core business

Agree reporting guidelines and mechanisms
for data sharing with A&E department



ASC & PCT
DAAT & PCT core
business
Agree reporting guidelines and mechanisms
for data sharing with Supporting People &
SHIP
Produce Scoping Exercise to assess cost and
feasibility of changing or amending system so
that young people partnership agencies such
YOS/Connexions/Youth Service can collect
data on alcohol misuse



ASC, SP & SHIP
DAAT, SP core business
DAAT & YOS
DAAT & YOS core
business
